Resp 5.docx - Resp 5: OSA ARDS Vents PE Chest Tube TN ...

Resp 5: OSA, ARDS, Vents, PE, Chest Tube, TN, Rib Fx, Lung Ca
OSA
Obstructive: more common, occlusion of oropharyngeal airway
Central: rare neurologic disorder that involves transient impairment of the neurologic drive to
the resp muscles
CM: loud cyclic snoring, periods of apnea lasting 15-120s during sleep, gasping or chocking
during sleep, restlessness, thrashing during sleep, daytime fatigue, morning HA, personality
changes, depression, intellectual impairment, impotence, HTN
CF: male, >age, obesity, large neck circumference (>17in men and >16in in women), alcohol and
other CNS depressants
DX:
Polysomnography: overnight sleep study
EEG: measures ocular activity and muscle tone
Vent-airflow recording
Continuous arterial oxygenation sat
HR
Transcutaneous arterial PCO2
Interventions:
Reduce wt
Alcohol cessation
Improve nasal patency
Don’t sleep supine
Oral appliances
CPAP, BiPAP
Sx: tonsillectomy, adenoidectomy
ARDS
Respiratory failure characterized by NON-CARDIAC PE, REFRACTORY HYPOXEMIA and a severe
from of an ACUTE RESP DISEASE
Abrupt onset. Alveoli collapse, and lungs become difficult to inflate. Fibrotic changes occur;
intra-alveolar septa thicken; gas exchange is reduced. Alveolar collapse → ATELECTASIS
Associated conditions: shock, inhalation injury, infection, OD, trauma
CM: DEVELOP in 24-48HRS
HALLMARK: Refractory hypoxemia DOES NOT IMPROVE WITH O2

Dyspnea
Restless/anxiety/AMS
Tachypnea
Intercostal retractions
Use of accessory muscles
Cyanosis
Adventitious breath sounds
*Refractory hypoxemia:
ABGs
CXR shows bilateral infiltrates that worsen and a WHITE-OUT pattern from poor perf
PFTs
Chest CT
Pulmonary artery pressure monitoring
Interventions:
Identify and treat the cause. Goal is to maintain PO2 >60 and spO2 >90%. Caution to prevent O2
toxicity
During CMV (continuous mandatory ventilation)
LOC, orientation, awareness
Condition of mucosa
Lung auscultation, sputum, C&S
v/s, skin color, cap refill, peripheral pulses
BS, u/o, daily wt
Aggressive resp support:
Provide O2, nebulizer, CPT, positioning, suction, ABGs
Rest assist with ADLs
Keep airway open:
Intubate and CMV
PEEP – positive end expiratory pressure
CPAP – continuous positive air pressure
ARDS interventions:
Low down glucocorticosteroids
T&P, prone positioning
Daily wt
Eternal/parenteral feedings
Swan ganz
Fluid replacement, strict i+o
Abx
Low molecular weight heparin

Mechanical Ventilation
Provides positive pressure ventilation and used when alveolar are inaccurate,