Respiratory Physiology Case Study

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TERMINOLOGY
CLINICAL CLARIFICATION 1
• Life-threatening condition characterized by the inability of the pulmonary system to meet the metabolic demands of the body with respect to oxygenation of the blood and systemic organs and/or CO2 elimination
• May be accompanied by ventilatory failure 7
• Develops within minutes or hours as opposed to chronic respiratory failure that develops over several days, weeks or years
CLASSIFICATION 2, 1
• Classification is mainly based on arterial blood gas (ABG) measurements
• Regardless of the type, the final outcome is the same: functional failure of respiratory muscle leading to respiratory arrest
• Distinction between different types is not always concrete
○ Type 1 (Hypoxemic)
– Lung failure
– PaO₂ < 60 mmHg and pCO₂ > 50 mmHg on room air (fraction of inspired oxygen [FiO₂] = 0.21) at sea level
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○ Type 2 (Hypercapnic / Ventilatory)
– Respiratory muscle pump failure
– pCO₂ > 50 mmHg
○ Type 3 (Peri-operative)
– Results from impaired abdominal wall mechanics
– May result in type 1 or type 2 respiratory failure
– Common in the post-operative period
○ Type 4 (Shock)
– Occurs during resuscitation for septic, hypovolemic and cardiogenic shock
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DIAGNOSIS
CLINICAL PRESENTATION 3
• History
○ Anxiety, agitation, and irritability may result from acute hypoxemia 3
○ Palpitations or dizziness, light-headedness may be noted from cardiac arrhythmia 3
○ Difficulty in breathing, shortness of breath are typical complaints 3
○ Cough may indicate the etiology of respiratory distress
– Cough with productive sputum, discolored sputum, may be present in bacterial pneumonia 3
– Cough with small white pearls of mucous (mucous plugs) is typical of asthma 3
– Cough with blood may indicate pulmonary embolus 3
○ Recent episodes of cold, viral infection, or other pulmonary illness may be

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