Respiratory Emergencies Azmat J. Khan RN, BScN, MScN
OBJECTIVES Definition Assessment Management Acute Respiratory Failure Pulmonary Embolism Pulmonary Contusion.
Respiratory Emergencies (RE) Respiratory emergencies may present as a minor problem, such as upper respiratory infection, or impeding respiratory arrest caused by epiglottitis. Rapid assessment and interventions are essential to prevent escalation of respiratory compromise. Because respiratory distress is caused by impaired oxygenation or ventilation, it is an emergent condition, regardless of etiology.
Acute Respiratory Failure •Emergency condition •All age •Major cause of death Definitions: Acute Respiratory Failure occurs when pulmonary system is no longer able to meet the metabolic demands of the body ▫Hypoxemic Respiratory Failure (Insufficient O2transferred to the blood): PaO250 mm Hg when breathing room air ▫Hypercapnic respiratory failure (Inadequate CO2removal): PaCO2 50 mm Hg.
Classification of Respiratory Failure
Brainstem Spinal cord Nerve root Airway Nerve Neuromuscular junction Respiratory muscle Lung Pleura Chest wall Sites at which disease may cause ventilatory disturbance
FIO2 Ventilation without Perfusion (dead space ventilation) Diffusion Abnormality Perfusion without Ventilation (shunting) Hypoventilation Normal
V/Q Mismatch: Dead Space Ventilation •Alveoli that are normally ventilated but poorly perfused DSV increase: •Alveolar-capillary interface destroyed e.g emphysema •Blood flow is reduced e.g CHF, PE •Over distended alveoli e.g positive- pressure ventilation
FIO2 Ventilation without Perfusion (dead space ventilation) Diffusion Abnormality Perfusion without Ventilation (shunting) Hypoventilation Normal
Diffusion Abnormality •Less common •Abnormality of the alveolar membrane or a reduction in the number of capillaries resulting in a reduction in alveolar surface area Causes include: ▫Acute Respiratory Distress Syndrome (ARDS) ▫Fibrotic lung disease
FIO2 Ventilation without perfusion (deadspace ventilation) Diffusion abnormality Perfusion without ventilation (shunting) Hypoventilation Normal the air that reaches the alveoli the blood that reaches the alveoli
Perfusion without Ventilation (Shunting) •Intra-cardiac ▫Any cause of right to left shunt E.g. Tetralogy of Fallot(TOF), Eisenmenger •Intra-pulmonary ▫Pulmonary haemorrhage or contusion ▫Small airways occluded ( e.g asthma, chronic bronchitis, COPD) ▫Alveoli are filled with fluid ( e.g pulmonary edema, pneumonia) ▫Alveolar collapse (e.g Atelectasis)
Hyper inflated Lungs : COPD
Respiratory Failure Symptoms CNS: •Headache •Visual Disturbances •Anxiety •Confusion •Memory Loss •Weakness •Decreased Functional Performance Pulmonary: •Cough •Chest pains •Sputum production •Stridor •Dyspnea Cardiac: •Orthopnea •Peripheral edema •Chest pain
Clinical Signs •
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- Fall '19
