U3 O2 - Respiratory Emergencies Flashcards
What is respiratory distress?
Difficulty in breathing - seen in patients with respiratory
compromise
Difficulty breathing N.B. this is subjective (e.g. what an individual is feeling) so in veterinary patients the term respiratory distress is generally used instead
What is fractional inspired oxygen concentration (FiO2)?
Fractional inspired oxygen concentration is a measurement of the amount of oxygen being breathed in or delivered to the patient. Room oxygen is assumed to have an FiO2 of 0.21 i.e. 21% because the composition of room air is ~ 78% nitrogen, ~ 21% oxygen, ~ 0.96% argon and 0.04% carbon dioxide
For moderately dyspnoeic patients it is necessary to increase FiO2 above 0.5-0.6 and for severely dyspnoeic patients it is necessary to raise it above 0.9.
N.B. In a normal patient, the measured PaO2 should equal 5 x FiO2.
What are blood gases?
Oxygen and carbon dioxide levels are reflected by the PaO2 and PaCO2
What is Hypercapnia/hypercarbia?
Increased levels of arterial carbon dioxide
Hypocapnia/ hyporcarbia?
Decreased levels of arterial carbon dioxide
Wat is hypoxaemia?
Often used synonymously with hypoxia. However, the specific definition of hypoxaemia is decreased arterial oxygen level
What is hypoxia?
Decreased oxygen supply to all or part of the body. This can be due to hypoxaemia, reduced oxygen delivery (e.g. cardiac disease) or decreased tissue oxygen uptake (e.g. respiratory obstruction).
What is PaO2? What is the normal PaO2?
Partial pressure of oxygen in arteries - meaning the amount of oxygen present in arterial blood. Normal lung function should result in a PaO2 greater than 85mmHg when breathing room air (range ~ 90-100 mmHg). This indicates how well the blood is being oxygenated.
What is PaCO2? What is the normal PaCO2?
Partial pressure of carbon dioxide in arteries - meaning the amount of carbon dioxide present in arterial blood (range ~ 35-45 mmHg). This indicates the effectiveness of ventilation (breathing).
PaCO2 levels above 50mmHg are significantly elevated and require treatment; those above 70mmHg are imminently lifethreatening and often require mechanical ventilation to manage and reverse the respiratory acidosis. The level of CO2 in the blood stream regulates cerebral blood flow with hypercapnia increasing cerebral blood flow and hypocapnia decreasing cerebral blood flow. PaCO2 levels below 20mmHg, because of hyperventilation, can result in excessive cerebral vasoconstriction and therefore decreased cerebral blood flowthis can be life-threatening. As CO2 is acidic in solution,
increased levels in the bloodstream (arteries) will cause the pH of blood to decrease = respiratory acidosis. Decreased levels in the bloodstream (arteries) will cause the pH of blood to increase = respiratory alkalosis It is important to remember the role of blood CO2 in respiration. Increased levels of blood CO2 stimulate increased rate and depth of breathing. So, if PaCO2 levels drop dramatically, apnoea and respiratory arrest can occur.
What is SaO2?
This is a measurement of the % of haemoglobin that is saturated with oxygen.
What is SpO2?
This is a measure of SaO2 measurement determined by pulse oximetry. Because of where the pulse oximeter is applied this is a measure of the peripheral capillary saturation with oxygen.
What is ventilation?
The exchange of air between the lungs and the atmosphere i.e. breathing
What is hypoventilation?
Under-ventilation e.g. breathing is inadequate to eliminate CO2 and take in enough O2. Will result in increased PaCO2 and decreased PaO2
What is hyperventilation?
Over-ventilation e.g. breathing is excessive. Excessive
elimination of CO2. Will result in decreased PaCO2
What is Eupneoa?
Normal breathing
What is hyperpnoea?
Increased depth and rate of breathing usually to meet
physiological demands e.g. exercise. Blood gasses are normal
What is bradypnoea
Abnormally decreased respiratory rate
What is tachypnoea?
Abnormally increased respiratory rate
What is orthopnoea?
Adopting an upright/ standing or sitting position due to difficulty breathing often with the elbows abducted and neck extended
What is apnoea?
Abscence of breathing
What is paradoxical respiration?
This description can be applied to two situations.
1. A lack of synchronous movement of the chest and
abdominal muscles due to marked dyspnoea. Increased
intercostal muscle action, during inspiration, draws the
diaphragm cranially so the abdominal muscles appear to
be sucked inwards. This link demonstrates a cat showing
paradoxical respiration.
https://www.youtube.com/watch?v=fx2V0bZlIjg
2. A patient may have a flail chest following thoracic trauma.
As a result of having multiple, adjacent, segmental rib
fractures, the flail segment will move in an opposite
direction to the rest of the thorax during respiration.
See 3.2.6.4 Flail chest
What is Cheyne stokes respiration?
Pattern of crescendo-decrescendo respirations followed by a period of apnoea – may be present in a patient in a coma or if damage to medulla in the brain
What is agonal respiration?
Slow, shallow irregular respirations caused by brain
anoxia. Apnoea is imminent.
What is air hunger?
An animal in severe respiratory distress often adopts a posture to maximise intake of air- orthopnoea, elbows abducted, and head and neck extended