Ipapburke Pulm Test 2- Acute Respiratory Failure

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DEFINITION OF ACUTE RESPIRATORY FAILURE

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RESPIRATORY DYSFUNCTION RESULTING IN ABNORMALITIES OF OXYGENATION OR CO2 ELIMINATION SEVERE ENOUGH TO IMPAIR OR THREATEN THE FUNCTION OF VITAL ORGANS

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ROUGH DEFINITION OF ACUTE RESP. FAILURE BY ABG

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P O2 LESS THAN 60, P CO2 GREATER THAN 50

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CAN BE FROM FAILURE OF OXYGENATION, FAILURE OF VENTILATION, OR BOTH

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ACUTE RESPIRATORY FAILURE

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SYMPTOMS AND SIGNS OF ACUTE RESP. FAILURE

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THOSE OF THE UNDERLYING DISEASE ALONG WITH HYPOXEMIA AND HYPERCAPNIA

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HYPERCAPNIA

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EXCESSIVE CARBON DIOXIDE IN THE BLOOD

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CHIEF SIGNS OF HYPOXEMIA

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CYANOSIS, RESTLESSNESS, CONFUSION, ANXIETY, DELIRIUM, TACHYPNEA, TACHYCARDIA, HYPERTENSION, CARDIAC ARRHYTHMIAS, AND TREMOR

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CARDINAL SIGNS OF HYPERCAPNIA

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DYSPNEA AND HEADACHE

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BESIDES THE CARDINAL SIGNS...THE OTHER SIGNS OF HYPERCAPNIA

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PERIPHERAL AND CONJUNCTIVAL HYPEREMIA, HYPERTENSION, TACHYCARDIA, TACHYPNEA, IMPAIRED CONSCIOUSNESS, PAPILLEDEMA, ASTERIXIS

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ASTEREXIS

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TREMOR OF THE WRIST WHEN IT IS DORSIFLEXED

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HYPEREMIA

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INCREASED BLOOD FLOW TO CERTAIN TISSUES OF THE BODY

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HOW DO YOU CONFIRM SUSPICION OF ACUTE RESP. FAILURE?

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ABG

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TX FOR ACUTE RESP. FAILURE

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CORRECT UNDERLYING CAUSE, RESPIRATORY SUPPORT, AND GENERAL SUPPORTIVE CARE

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WHAT IS THE GOAL IN ACUTE HYPOXEMIC RESPIRATORY FAILURE AS FAR AS RESPIRATORY SUPPORT?

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TO PROVIDE ADEQUATE OXYGENATION OF THE VITAL ORGANS

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MONITOR PATIENTS WITH CHRONIC HYPERCAPNIA CLOSELY FOR WHAT?

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HYPOVENTILATION, BUT DO NOT WITHHOLD OXYGEN---MAY JUST NEED LOW FLOW NASAL CANNULA

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IN WHAT CONDITIONS MIGHT HIGHER CONCENTRATION OF O2 BE NEEDED?

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PNEUMONIAS AND ARDS

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WHEN IS A TRACHEAL INTUBATION INDICATED

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FOR HYPOXEMIA NOT QUICKLY REVERSIBLE, FOR UPPER AIRWAY OBSTRUCTION, IMPAIRED AIRWAY PROTECTION, POOR HANDLING OF SECRETIONS, AND FACILITATION OF MECHANICAL VENTILATION

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FORMULA FOR DURATION OF FLOW

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DF= CF TIMES PSIG/ L DIVIDED BY M

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MORE COMFORTABLE TUBE FOR LONG TERM INTUBATION

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NASOTRACHEAL TUBE

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WHAT IS THE BEST USE FOR OROTRACHEAL INTUBATION

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URGENT AIRWAY MANAGEMENT

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WHAT SHOULD BE DONE AS SOON AS ANY PATIENT IS INTUBATED?

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AUSCULTATION TO VERIFY BOTH LUNGS ARE BEING INFLATED AND SHOULD HAVE CXR TO VERIFY THAT THE TIP OF THE TUBE IS AT THE AORTIC ARCH

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INDICATIONS FOR MECHANICAL VENTILATION

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APNEA, ACUTE HYPERCAPNIA NOT QUICKLY REVERSIBLE, SEVERE HYPOXEMIA, PROGRESSIVE PATIENT FATIGUE DESPITE APPROPRIATE CARE

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WHAT TYPE OF VENTILATION ARE MOST MACHINES MADE TO GIVE?

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POSITIVE-PRESSURE, VOLUME CYCLED VENTILATION

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WHAT CAN MIGRATION OF THE ENDOTRACHEAL TUBE FROM PROPER PLACEMENT LEAD TO?

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HYPOXIA AND/OR ASPIRATION IF IT DISLODGES UPWARD OR ATELECTASIS OF THE LEFT LUNG AND OVER DISTENTION OF THE RIGHT IF THE TUBE GOES DOWNWARD INTO THE RIGHT MAIN BRONCHUS

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WHAT IS BAROTRAUMA?

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TRAUMA CAUSED BY PRESSURE- OCCURS IN PATIENTS WHOSE LUNGS ARE OVER DISTENDED BY TOO GREAT OF A VOLUME

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SIGNS OF BAROTRAUMA

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SUBCUTANEOUS EMPHYSEMA, AIR IN THE MEDIASTINUM (PNEUMOMEDIASTINUM), AND SUBPLEURAL AIR CYSTS

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3 MAIN COMPLICATIONS OF VENTILATION

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ACUTE RESPIRATORY ALKALOSIS FROM OVERVENTILATION; ACUTE RESPIRATORY ACIDOSIS SECONDARY TO UNDERVENTILATION OR PATIENT DEMAND; HYPOTENSION FROM ELEVATED INTRATHORACIC PRESSURE DECREASING VENOUS RETURN

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WHAT PATIENTS ARE VENTILATOR COMPLICATIONS MOST LIKELY TO OCCUR IN?

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PATIENTS WITH SEVERE AIRFLOW OBSTRUCTION (I.E. SEVERE COPD), STATUS ASTHMATICUS, AND HYPOVOLEMIC PATIENTS

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HIGH MORTALITY RATE IS FOUND IN WHAT TYPE OF PNEUMONIA?

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VENTILATOR-ASSOCIATED PNEUMONIA (HOSPITAL ACQUIRED)

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LAB WORK TO DO WHILE PATIENT IS BEING VENTILATED

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HEMATOCRIT, ELECTROLYTES, AND KIDNEY FUNCTIONS

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THESE TWO INTERVENTIONS MAY GO ALONG WITH VENTILATION WHEN PSYCHOLOGICAL PROBLEMS ARISE

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SHORT TERM SEDATION OR TEMPORARY PARALYSIS

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PREVENTIVE MEASURES THAT SHOULD BE UNDERTAKEN WHEN PATIENT IS ON VENTILATION

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WATCH CLOSELY FOR STRESS ULCERS AND DVT; ALSO PREVENT NOSOCOMIAL INFECTIONS

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SPECIAL TYPE OF ACUTE RESPIRATORY FAILURE THAT OCCURS AFTER A SYSTEMIC OR PULMONARY INSULT

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ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)

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ARDS IS CHARACTERIZED BY....

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RESPIRATORY DISTRESS, BILATERAL INFILTRATES, HYPOXEMIA, NONCOMPLIANT LUNGS, AND NORMAL PULMONARY CAPILLARY WEDGE PRESSURE

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COMMON RISK FACTORS FOR ARDS

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SEPSIS, ASPIRATION OF GASTRIC CONTENTS, SHOCK, INFECTION, LUNG CONTUSION, NONTHORACIC TRAUMA, TOXIC INHALATION, NEAR DROWNING, AND MULTIPLE BLOOD TRANSFUSIONS

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WHAT HAPPENS AT THE TISSUE LEVEL IN THE LUNGS WITH ARDS?

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INCREASED VASCULAR PERMEABILITY AND INACTIVATION OF SURFACTANT LEAD TO INTERSTITIAL AND ALVEOLAR PULMONARY EDEMA AND ALVEOLAR COLLAPSE

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CLINICAL FINDINGS IN ARDS

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RAPID ONSET OF PROFOUND DYSPNEA THAT OCCURS 12-48 HRS AFTER THE EVENT; LABORED BREATHING; TACHYPNEA; INTERCOSTAL RETRACTIONS; AND CRACKLES NOTED ON PHYSICAL EXAM; MARKED HYPOXEMIA REFRACTORY TO SUPPLEMENTAL O2, AND MULTIPLE ORGAN FAILURE

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CXR IN ARDS

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DIFFUSE OR PATCHY BILATERAL INFILTRATES

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ARDS CAN PRESENT SIMILARLY TO WHAT?

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PULMONARY EDEMA FROM A CARDIAC ORIGIN (IMPORTANT TO DETERMINE WHICH ONE IT IS)

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TX FOR ARDS

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IDENTIFY AND TREAT THE UNDERLYING ILLNESS/INJURY--PROB. A BROAD SPECTRUM ABX FOR SEPSIS AND OR INFECTION; GENERAL SUPPORTIVE CARE; MONITORING CARDIAC AND OTHER ORGAN FUNCTION; CLOSE OBSERVATION OF FLUID INTAKE

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PROGNOSIS IN ARDS

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MORTALITY RATE EXCEEDS 50%; IF ARDS AND SEPSIS- MORTALITY RATE IS 90%; MAJOR CAUSE OF DEATH IS ORGAN FAILURE

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MAJOR CAUSE OF DEATH WITH ARDS

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ORGAN FAILURE

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CLINICAL FINDINGS IN ARDS

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RAPID ONSET OF PROFOUND DYSPNEA THAT OCCURS 12-48 HRS AFTER THE EVENT; LABORED BREATHING; TACHYPNEA; INTERCOSTAL RETRACTIONS; AND CRACKLES NOTED ON PHYSICAL EXAM; MARKED HYPOXEMIA REFRACTORY TO SUPPLEMENTAL O2, AND MULTIPLE ORGAN FAILURE

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CXR IN ARDS

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DIFFUSE OR PATCHY BILATERAL INFILTRATES

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ARDS CAN PRESENT SIMILARLY TO WHAT?

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PULMONARY EDEMA FROM A CARDIAC ORIGIN (IMPORTANT TO DETERMINE WHICH ONE IT IS)

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TX FOR ARDS

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IDENTIFY AND TREAT THE UNDERLYING ILLNESS/INJURY--PROB. A BROAD SPECTRUM ABX FOR SEPSIS AND OR INFECTION; GENERAL SUPPORTIVE CARE; MONITORING CARDIAC AND OTHER ORGAN FUNCTION; CLOSE OBSERVATION OF FLUID INTAKE

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PROGNOSIS IN ARDS

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MORTALITY RATE EXCEEDS 50%; IF ARDS AND SEPSIS- MORTALITY RATE IS 90%; MAJOR CAUSE OF DEATH IS ORGAN FAILURE

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MAJOR CAUSE OF DEATH WITH ARDS

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ORGAN FAILURE