ARF Flashcards
(20 cards)
A 65-year-old man with pneumonia develops increasing oxygen requirement despite high-flow nasal cannula. ABG shows PaO2 55 mmHg on FiO2 0.8. Chest X-ray reveals bilateral infiltrates. What type of respiratory failure is most likely, and what is the primary gas abnormality?
Type I (Acute hypoxemic respiratory failure); primary abnormality is hypoxemia due to intrapulmonary shunting.
A postoperative patient complains of dyspnea and has decreased breath sounds at the base. Chest X-ray shows collapse of lower lobe. What type of respiratory failure is likely, and what is its usual perioperative cause?
Type III respiratory failure (atelectasis); caused by anesthesia and post-op pain leading to hypoventilation.
A 45-year-old man with myasthenia gravis presents with respiratory distress and rising PaCO2. What type of respiratory failure is this and what is the underlying mechanism?
Type II (hypercapnic respiratory failure); due to impaired neuromuscular transmission causing hypoventilation.
A patient with severe sepsis and rising lactate levels develops dyspnea and needs mechanical ventilation. ABG shows hypoxemia. What type of respiratory failure and mechanism are involved?
Type IV respiratory failure; due to hypoperfusion of respiratory muscles in shock.
A 70-year-old smoker with chronic bronchitis presents with worsening dyspnea and ABG shows PaO2 60, PaCO2 65. What type of respiratory failure does this represent and what’s the gas abnormality?
Type II respiratory failure; hypercapnia and hypoxemia due to alveolar hypoventilation.
A patient is being weaned off a ventilator but develops abdominal paradoxical breathing and VC < 10 mL/kg. What does this signify?
Respiratory muscle insufficiency indicating pump failure.
A young adult presents with stridor, rhonchi, and wheezing. What component of the respiratory system is dysfunctional and what measurement would you use to confirm it?
Airway dysfunction; confirm with airway resistance measurement (normal 3–8 cmH2O).
A patient post-thoracic surgery has dynamic hyperinflation, and high Raw. What type of load is this and what might contribute to it?
Resistive load; likely from bronchospasm or obstructive airway disease.
In ARDS, what P/F ratio defines severe hypoxemia, and what radiographic finding is expected?
P/F ratio <100 mmHg; chest X-ray shows bilateral alveolar infiltrates.
A patient with altered sensorium and no use of accessory muscles despite hypoxemia likely has dysfunction of which system?
Controller dysfunction (central nervous system).
A patient with bilateral crackles, low PaO2 despite high FiO2, and diffuse infiltrates on X-ray is diagnosed with ARDS. What type of respiratory failure is this and what causes the hypoxemia?
Type I (Acute hypoxemic respiratory failure); hypoxemia is due to intrapulmonary shunting from alveolar flooding.
What bedside test indicates respiratory drive suppression in a patient with low respiratory rate and elevated CO2?
Carbon dioxide challenge test or P0.1 test can confirm controller dysfunction.
A patient with critical illness polyneuropathy has paradoxical abdominal movement and reduced VC. What type of respiratory component is failing?
Pump dysfunction due to respiratory muscle weakness.
In airway dysfunction, what bedside parameter measures resistance to airflow?
Airway resistance (Raw), normally 3–8 cmH2O/L/s.
A patient develops hypoxemia post-surgery due to alveolar collapse. What is this phenomenon called, and which respiratory failure type does it represent?
Atelectasis; Type III (perioperative) respiratory failure.
What clinical finding is expected in a patient with pulmonary vascular dysfunction and right heart strain?
Distended neck veins (JVD), right-sided S3, or murmur of tricuspid regurgitation.
In ARF, what ventilator mode is best suited for patients with barotrauma or post-thoracic surgery?
Pressure-Control Ventilation (PCV) to limit pressure exposure.
A patient with COPD exacerbation presents with RR 30, PaO2 58, and PaCO2 60. What respiratory failure type is this, and how is it managed?
Type II respiratory failure; managed with BiPAP to assist ventilation and oxygenation.
Which ABG finding indicates that respiratory muscle fatigue is leading to impending failure in a patient on high-flow oxygen?
Rising PaCO2 and decreasing pH despite oxygen therapy.
How does the use of accessory muscles indicate severity of respiratory distress?
It suggests increased work of breathing and potential pump failure.
