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Cardiorespiratory > Theory; Respiratory Failure > Flashcards

Theory; Respiratory Failure Flashcards

1
Q

Why is surfactant important in gaseous exchange?

A

The oxygen dissolved into the surfactant in the alveoli in order to travel through alveolar wall to capillaries

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2
Q

How do co2 and o2 move between the alveoli and capillaries at the same rate?

A

O2 I has a bigger gradient but is less soluble
Co2 is more soluble but has a smaller gradient

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3
Q

When is gaseous exchange occurring by “diffusion” and when by “bulk flow”?

A

alveoli to capillary = diffusion
Capillary to tissue = bulk flow

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4
Q

How does o2 get from alveoli to capillary? (The pathway)

A

Alveoli -> Diffuses into surfactant -> alveolar wall -> capillary wall -> plasma -> rbc and haemoglobin

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5
Q

How does o2 get from capillary to tissue? (The pathway)

A

O2 diffuses through rbc wall -> plasma -> capillary wall -> tissue membrane -> mitochondria

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6
Q

Why is the oxygen disassociation curve normally an S?

A

The first oxygen molecule binds slower to haemoglobin. The next two can bind more easily but the fourth is again hard to bind

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7
Q

What 3 things is essential for respiratory function

A

Brain - control
Lungs - exchange organ
Chest wall, diaphragm, neuromuscular - R PUMP

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8
Q

What is respiratory failure

A

Inadequate gaseous exchange by respiratory system:

Co2 and o2 cannot be kept within normal parameters so arterial blood isn’t adequately oxygenated causing hypoxia and hypoxaemia and ventilation is too poor to eliminate co2 resulting in hypercapnia

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9
Q

What is hypoxaemia

A

Resp system fails to oxygenate arterial blood adequately

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10
Q

What is hypoxia

A

Failure to provide the body with enough oxygen or to ventilate well enough to eliminate co2

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11
Q

How do you diagnose respiratory failure

A

Arterial blood sample and partial pressure of o2 and co2

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12
Q

What is hypercapnea

A

Too much co2 in the blood stream

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13
Q

Normal co2 partial pressures in arterial blood

A

PaCO2 = 4.7 - 6kpan (35-45 mmHg)

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14
Q

Normal o2 partial pressure in arterial blood

A

PaCO2 = 10.7-13.3kpa (80-100mmHg)

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15
Q

What is acute vs. Chronic respiratory failure? And one example of both

A

Acute: mins to hours
Pneumonia

Chronic: days
COPD

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16
Q

What is type 1 respiratory failure?

A

Fail to maintain o2 levels in arterial blood

Failure to oxygenate

Hypoxaemia

ABG: Pa02 <8kpa
PaCO2 normal or low

Co2 can be low as peripheral chemoreceptors stimulate more breathing as response to hypoxaemia to try provide more oxygen but they’re just blowing out more co2

17
Q

What is type 2 respiratory failure

A

Resp pump fails to ventilate

Failure to eliminate co2

Hypoxaemia and hypercapnia

ABGs: Pa02 <8kpa
PaCO2 higher >6.6kpa

18
Q

How does hypoxaemia manifest

A

O2 sats (saO2) <90%
PaO2 <8kpa

19
Q

What are 4 causes/ types of hypoxaemia

A

Hypoxic hypoxaemia: V/Q mismatch
Ischaemic hypoxaemia: V/Q mismatch
Anaemia hypoxaemia
Toxic hypoxaemia

20
Q

Describe hypoxic hypoxaemias 4 causes

A

Diffusion problem!!

  1. Blood flow through unventilated lungs [SHUNTING] so vq mismatch
    - COPD
    - PF
    - CF
    - PNEUMONIA
    - SPUTUM RETENTION
  2. Acute bronchoconstriction
    - ASTHMA
  3. Problem transferring o2 across membrane; gas exchange across thickened membrane
    - PF
    - CARDIAC DISEASE ( HF, CongestiveCF, PO as diffusion is limited across resp membrane)
  4. Insufficient o2
    - altitude
21
Q

What is the law relating to alveolar o2 exchange

A

Ficks law

Surface area X difference in concentration
————————————
Diffusion distance

(Lung SA, partial gas pressures, resp membrane thickness)

22
Q

What would cause ischaemic hypoxaemia

A

Inadequate blood flow through lung

  • PE
  • pulmonary trauma
  • destruction of pulmonary vascukature in COPD
23
Q

What causes anaemia hypoxaemia

A

Reduction in carrying capacity if blood

  • blood loss
  • sickle cell crisis
  • anaemia
24
Q

What causes toxic hypoxaemia

A

Difficulty utilising oxygen

  • inhalation burns and smoke
  • CM poisoning
  • cyanide poisoning
25
Q

Clinical signs of hypoxaemia

A

Central cyanosis (lips and tongue)

Peripheral shut down (cold and clammy)

Tachycardia (HR>100)

Tachypnoea (RR>20BPM)

Low o2 sats (<90%)

Confusion or agitation

26
Q

Hypoxaemia causes tissue hypoxia.

How much time does it take for tissue hypoxaemia to occur in the
1. Brain?
2. Kidney and liver?
3. Skeletal muscle?
4 Vascular smooth muscle?
5. Hair and nails?

A
  1. 3-5mins
  2. 15-20 mins
  3. 60-90 mins
  4. 24hrs
  5. Days
27
Q

Causes of type 2 respiratory failure? (7)

A
  1. CNS depression or abnormal respiratory drive centres
    - opiates, alcohol, head injury, MS
  2. SC disorder
  3. Peripheral nerve abnormality
    - phrenic nerve damage
    - guillian barre
  4. Resp disease
    - fatigued resp muscles (COPD, prolonged type 1 resp failure)
  5. Neuromuscular disease
    - peripheral neuropathy
  6. Muscle weakness
    - myasthenia gravis
  7. Chest wall integrity lost or poor ventilators mechanics
28
Q

Respiratory failure causes … ST -> LT

A

ST
- resp muscle fatigue
- hypoventilation
- sputum retention
- hypoxaemia

LT
- cardiac arrhythmias
- cerebral hypoxaemia
- respiratory acidosis
-co2 narcosis
- coma
- CA

29
Q

(Using the strength vs load seesaw) how can COPD patients end up with respiratory failure?

A

Capacity or strength of Resp Muscles:
- shortened muscles due to hyperinflation
- fatigued muscles
- less oxygenation
- poor nutrition (struggle to eat due to breathlessness)
- general fatigue
- acc muscle overuse

SO INCREASED STRENGTH

load on respiratory muscles:
- increased AW resistance (aw collapse, bronchospasm, sputum)
- static and dynamic hyperinflation (dynamic is when demand of o2 is increased)
- increased resistance and elastic load

INCREASED LOAD

30
Q

What is cor-pulmonale

A

Long term high blood pressure in arteries of the lung and right ventricle of heart cause right sided heart to fail

31
Q

What is hypoxic drive

A

Associated with small number of COPD patients

Instead of co2 regulating rate and depth of breathing, low levels of o2 sensed by peripheral chemoreceptors drive breathing and resp

(Breathing is controlled by 1.

32
Q

Chronic resp failure physio interventions:

A

Reduce wob and manage breathlessness (reduce load)

NIPPV and improve ventilation (gets rid of co2)

33
Q

What is a CPAP

A

Delivers same gas flow during insp and exp

Increased FRC to improve GE in type 1

Splints open alveoli

34
Q

What does a NIPPV or BiPAP do

A

NIV: blows air into lungs by mask. Stops under-breathing

  • recognises when person starts breathing in and assists

Individually controlled insp and exp pressures

Unloads inspiratory muscles

Used for ventilators failure

35
Q

Acute effects of NIPPV

A

Reduce PaCO2
Increase alveolar ventilation
Rest resp muscles
Decreases load on muscles

36
Q

NIPPV contraindications

A

Haemodynamic instability
Confused
Gastrointestinal surgery or bowel obstruction
Barotrauma
Vomiting
Excessive secretions
Haemoptosis

Cardiorespiratory (4 decks)

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