Type I and Type II resp failure

Question 1

What part of respiration is there a problme with in Type I resp failure? What structures?

Answer 1

Exchange
Alveolar membrane
Pulmonary vasculature
Cellular level
Eg fluid on lungs

Question 2

How do yuo treat Type I resp faillure?

Answer 2

Increase pO2 with high flow oxygen (see NICE guidelines for more guidance)

Question 3

What is the problem based on in Type II resp failure?

Answer 3

Ventilation
CO2 no longer being exchanged
Builds up

Question 4

Treatment Type II resp failure

Answer 4

Controlled O2
88-92%
NIV-CPAP

Question 5

Causes Type I resp failure

Answer 5

pneumonia
Fibrosis
COVID
Aspiration
Pulmonary emboli
HF
Other infections
Asthma

Question 6

Type II resp failure causes

Answer 6

COPD
Obesity
Neurological disorders
Scoliosis
Sedatives - opiates, benzodiazapines
Severe pneumonia/pulm oedema/asthma -> tiring

Question 7

What is the FiO2 of healthy people?

Answer 7

11 Kpa

Question 8

How do you wokr out FiO2 for % O2 patient is on?

Answer 8

-10
eg if on 40% O2, 30% FiO2

Question 9

What is the difference Type 1 and Tyoe 2 resp failure?

Answer 9

Type 1 = hypoxia
Type 2 = hypoxia and hypercapnia

Question 10

What is an example of a thiazide like diuretic?

Answer 10

Endapamide

Question 11

Parameters for hypoxia

Answer 11

PaO2 <8.0kPa

Question 12

Parameters for hypercapnia

Answer 12

PaC02 >6.0kPa

Question 13

If patient receiving supplemental oxygen, how much less should pO2 be than Fi02?

Answer 13

10kPa

Question 14

Examples of causes of type I resp failure

Answer 14

Pneumonia
Fibrosis
COVID
Aspiration
Pulmonary emboli
HF
Other infections
Asthma

Question 15

Type II

Answer 15

COPD
obesity
Neurological disorders
Scolisosi
Sedatives
Severe pneumonia/pulmonary oedema/asthma - tiring

Question 16

What is the difference between management of type i and II resp failure

Answer 16

Type I = O2 ‘Type II = controlled O2 + may need NIV

Question 17

pH and paCO2 levels for resp and metabolic acidosis, alkalosis

Answer 17

• Respiratory acidosis
  
  • Low pH with high PaCO2
• Metabolic acidosis
  
  • Low pH, low PaCO2
• Respiratory alkalosis
  
  • High pH + normal or high PaCO2
• Metabolic alkalosis
  
  • High pH, low PaCO2

Question 18

What does an ABG vs VBG tell you

Answer 18

Both = acid base status
Only ABGs tell you oxygenation and ventilation of a patient

Question 19

When do you perform an ABG?

Answer 19

• New hypoxia
• Monitoring acid base status eg in DKA
• Overdose
• Assessment repsonse to NIV
• Assessment for need for Home O2

Question 20

Conditions with metabolic acid base disturbance

Answer 20

• DKA
• Overdose
• Sepsis
• Renal failure

Question 21

Conditions causing disturbed oxygenation/gas exchange?

Answer 21

• Asthma
• COPD
• Pneumonia
• Ventilated patients

Question 22

Parameters for PaO2

Answer 22

> 10.6

Question 23

Parameters for PaCO2

Answer 23

4.7-6.0

Question 24

Parameters HCO3-

Answer 24

22-28

Question 25

Causes of metabolic acidosis

Answer 25

- Increased production/ingestion of acid - Decreased loss of acid - Loss of HCO3 -Decreased pH + HCO3

Question 26

Metabolic alkalosis

Answer 26

- Increased loss of acid - Increase pH + HC03

Question 27

Respiratory compensation mechanisms

Answer 27

- Increasing ventilation = hyperventilating to blow off C02 - decrease pCO2 - Decreasing ventilation - hypoventialting + increasing pCO2 - Can occur quickly

Question 28

Kidney metabolic compensation

Answer 28

- Excreting acid - increase HCO3 - Retain acid - decrease HC03 - Metabolic compensation usually indicates a chronic problem - Takes time

Question 29

Common causes of metabolic alkalosis

Answer 29

Vomitting, burns , hypokalemia

Question 30

Common causes of metabolic acidosis

Answer 30

Shock (lactic acidosis) DKA (ketoacidosis) Renal/liver failure Drug overdose Diarrhoea

Question 31

Respiratory acidosis casues

Answer 31

Severe COPD/asthma Severe pneumonia Severe pulmonary oedema Myasthenia gravis Sedative drugs - reduced RR Scoliosis - ineffective ventialtion Obesity - hypoventialtion

Question 32

Common causes of resp alkalosis

Answer 32

Hyperventialtion/anxiety Hypoxaemia eg acute asthma Cranial lesions