Respiratory Emergencies Acknowledge Erum Kabani & Kiran Ali & Azmat Jehan
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 ▫ Hypoxaemic Respiratory Failure (Insufficient O 2 transferred to the blood): PaO 2 50-60 mm Hg when breathing room air ▫ Hypercapnic respiratory failure (Inadequate CO 2 removal): PaCO 2 45-50 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
Physiological Condition of Respiratory Alterations Hypoxemic (oxygenation failure): Ventilation Perfusion mismatch (V/Q mismatch) Shunting Diffusion abnormality Alveolar Hypoventilation
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
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
F I O 2 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
Hyper inflated Lungs : COPD
Hypercapnic Disorders • Imbalance between ventilatory supply and ventilatory demand. Obstructive Disorders resulting in CO2 retention
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 • Tachypnoea RR > 35 Breath /min • Accessory muscles, Recession, Nasal flaring Respiratory Compensation • HR • BP, sweating Sympathetic Stimulation • Altered mental state • HR and BP (late) • ⇓ PaO2 + ⇑ PaCO2 ⇨ acidosis ⇨ ⇑ ICP • Disorientation, Headache, Asterixis, • Coma Tissue Hypoxia • Cyanosis Haemoglobin Desaturation
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- Fall '19
- Respiratory distress, Pulmonary contusion