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Pulmonology > Acute Respiratory Failure > Flashcards

Acute Respiratory Failure Flashcards

1
Q

If the A-a gradient is greater than what mmHg difference; it is indicative of pulmonary dysfunction.

A

> 20mmHg

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2
Q

What are the three different kinds of Acute Respiratory Failure and what are their causes?

A
  1. Hypoxic Respiratory Failure
    (Inadequate oxygenation of arterial blood)
  2. Hypercarbic Ventilatory Failure (Insufficient removal of CO2)
  3. Both
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3
Q

What potential causes could lead to neurologic failure and consequent poor ventilation?

A 
Spinal cord injury *C3, C4, C5*
Chest trauma to Phrenic Nerve
Neuromuscular blockers
Myasthenia gravis
Opioids or anesthetics
TBI
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4
Q

Diffusion abnormalities occurring at the alveolar level (reduced DLCO) could be caused by what clinical conditions?

A

Pulmonary Edema
Cardiogenic/Non-Cardiogenic Pulmonary Fibrosis
Interstitial Lung Disease

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5
Q

What is tissue perfusion without ventilation occurring commonly known as?

A

Shunting

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6
Q

What are some potential causes of shunting?

A 
Alveolar Disease 
(ARDS
Atelectasis
Pulmonary Edema
Pneumonia)
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7
Q

What is hypercapnia?

What are some potential causes?

A

Elevated PaCO2 (>45mmHg)

Too much CO2 in blood stream
Result of Obstructive Dz (I.e. COPD, Asthma, CF, or pulm fibrosis)

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8
Q

What is the clinical presentation of Acute Hypercapnia?

A 
Dyspnea
Increased HR and BP
HA, reduced hearing, hypersomnolence
Delirium and dimmed sight
Paranoia and/or confusion
Myoclonus
Asterixis
Seizures

(Altered level of consciousness does not appear until >75-80)

ABG: RESPIRATORY ACIDOSIS!
Increased CO2, decreased or normal pH (depending on bicarb compensation)

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9
Q

What is the treatment for a patient suspected of suffering from Acute Hypercapnia?

A

Increase FiO2 (3-4%/L) of O2
Venturi mask
Non-invasive Pos Pressure Ventilation

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10
Q

What are some of the indications for Pos Pressure Ventilation in a PT?

A

pH <7.3
Mod-severe respiratory distress
RR > 25
Increased Work of breathing

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11
Q

If a PT is suspected of having Acute Hypercapnia; what Labs and Imaging studies would you consider?

A 
Chem-15
ABG
CBC
Thyroid panel
Tox
CXR (Dx lung Dz or Thoracic cage abnormalities)
Helical CT or MRI may be indicated
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12
Q

Describe the process of pulmonary edema where the edema begins and where it ends.

A

Edema begins in the interstitium around the airway –>

  • -> then in interstitium around alveoli –>
  • -> then in the alveoli
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13
Q

What causes cardiogenic pulmonary edema?

A

Increased Capillary hydrostatic pressure

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14
Q

What are some causes of Non-Cardiogenic Pulmonary edema?

A 
Increased Capillary PERMEABILITY
ARDS
HAPE, neurogenic pulm Edema
Opioid Overdose
Eclampsia
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15
Q

What are some of the clinical manifestations of ARDS?

A 
Acute bilateral alveolar infiltrates
Hypoxemia
Dyspnea with inc. RR and HR
Crackles
V/Q mismatch (due to flooded alveoli)
Decreased lung compliance (small tidal volume)
PULMONARY HTN
Confusion, Cyanosis, Diaphoresis
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16
Q

What are some of the most common causes of ARDS?

A

Pneumonia or Infxn (SARS, bacterial, fungal)
Sepsis (indirect injury) (the rest are direct)
Aspiration (drowning, gastric contents)
Inhalation (smoke, chlorine, NO2)
Trauma

17
Q

What is the pathology of ARDS?

A

Alveolar injury recruits interleukins and inflammatory cells.

Damage to epithelium occurs allowing for fluid to rush into interstitium.

Functional surfactant is lost once fluid fills the alveoli

Alveoli collapse

18
Q

ABG of a PT with ARDS might reveal what?

A

Respiratory alkalosis with increased A-a gradient. HYPOXEMIA (hallmark S/Sx)

19
Q

A PT with ARDS may have what findings on CT?

A

Ground glass infiltrates

Bilat alveolar opacities w/ atelectasis

20
Q

What CXR criteria helps to rule in ARDS?

A

NEG cardiomegaly, NEG pleural effusion, NEG Kerley B Lines

POS patchy infiltrates
POS air bronchograms / peribronchial cuffing

21
Q

In order to make a clinical Dx of ARDS; what must the PT have?

A

Resp. symptoms x 1 week
Bilat opacities (pulm infiltrates) on CXR / CT
Resp failure not explained by Cardiac failure or fluid overload
HYPOXEMIA on vent (>200, >100, <100 = mild, mod, severe ARDS respectively)
Pulmonary wedge pressure <18mmHg

22
Q

What is the appropriate treatment for a PT with ARDS? (Hypoxemic, with increased permeability of alveolar-capillary barrier, Pulm edema)

A 
Tx underlying condition
PEEP ventilation (Positive End Expiratory Pressure) in PRONE position
Manage blood glucose
Prophylax for DVT and GI bleeds
Eval. for nosocomial pneumonia
23
Q

Your critically ill PT presents with new onset tachypnea and dyspnea but does not have any consolidation on auscultation. What would should you suspect?

A

Heart failure or ACUTE RESPIRATORY DISTRESS SYNDROME

Pulmonology (17 decks)

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