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8 Cards in this Set
- Front
- Back
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Approach to hypoxemia
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Treat underlying disorder
Assure tissue oxygen delivery Assess severity and “pace” of process Treat Hypoxemia -(Oxygen +/- positive pressure) Reassess patient -(Must remeasure Pa02) |
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Hypoxemia due to impaired diffusion
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Altitude
-Change in driving pressure across membrane Exercise (occasional) -Blood isn't in lung long enough Pulmonary edema -ARDS-terminal stages (treat with PEEP) Usually responds to oxygen |
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Hypoxemia due to mild V/Q mismatch
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Asthma
COPD (bronchitis, emphysema) Interstitial lung disease (can also be partly impaired diffusion, but V/Q overrides) Early alveolar filling Usually talking about mild problems that get better with oxygen |
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Hypoxemia due to physiologic shunt
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Shunt is when there is severe V/Q mismatch that doesn't respond to O2
Atelectasis Airspace-filling processes - (e.g., cardiogenic edema, pneumonia, ARDS, alveolar hemorrhage) Pulmonary embolism |
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Severe hypoxemia
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Caused by shunt
Usually acute, catastrophic High FI02 necessary, but (by definition) doesn’t resolve the problem Positive airway pressure helpful by increasing lung volume (recruiting alveoli) - CPAP (by mask) - PEEP (by ventilator) |
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P/F ratio
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Used to evaluate severity of hypoxemia
Divide the patient’s measured PaO2 by the inspired oxygen concentration (FIO2) P/F < 300=Acute Lung Injury P/F < 200=Acute Respiratory Distress Syndrome (ARDS) |
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Approach to hypoventilation
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DETERMINE PHYSIOLOGIC CAUSE(S)
- (Decreased frequency and/or decreased tidal volume and/or increased dead space) RECOGNIZE ETIOLOGIC CLINICAL FACTORS - (LOOK AT THE PATIENT) TREAT POTENTIALLY REVERSIBLE FACTORS - Increase frequency and/or increase tidal volume (CPAP, mechanical ventilation) and/or decrease dead space (bronchodilator) |
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When to use PEEP
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Any time there is an airspace filling disease
Allows us to recruit more airways and use less O2 (less toxicity) |
