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Flashcards in FN: Respiratory failure Deck (21):
1

TYpe 1

PaO2

2

Type 2

PaO2 6kPA
Alveolar hypoventilation ±V/Q mismatch

3

Causes

V/Q mismatch
Alveolar hypoventilation
Diffusion failure

4

V/Q mismatch (raised A-a gradient)

Vascular:
1. PE
2. PHT
3. Pulmonary shunt (R--> L)
Asthma (early0
Pneumothorax
Atelectasis

5

Alveolar Hypoventilation

Obstructive vs restrictive

6

Obstructive

COPD
Asthm
Bronchiectasis
Bronchiolitis
Intra- and Extra-thoracic (Ca, LN,, Epiglottis)

7

Restrictive

reduced drive: CBS sedation , trauma, tumour
NM disease: cervical cord lesion, polio, GBS, MG
Chest: flail, kyphocoliosis, obesity
Fluid and fibrosis

8

Diffusion failure

Fluid:
1. Pulmonary oedema
2. Pneumonia
3. Infarction
4. blood

Fibrosis

9

A-a gradient

PAo2 = (95 x FiO2) - (PaCo2/0.8)
raised (PAO2 - PaO2) suggest lun pathology

10

Clinical features of hypoxic acute

Dyspnoea
Agitation
Confusion
cyanosis

11

Clinical features of hypoxia chronic

Polycythaemia
PHT
Cor pulmanle

12

Hypercapnoea symptoms

Headache
Flushing and peripheral vasodilation
Flap
Confusion - coma

13

Management

Rx the underlying cause

14

Type 1 management

Give oxygen to maintian SpO2 94-98%
Assisted ventilation if PaO2

15

Type 2

Controlled O2 therapy @ 24% Oxygen aiming for SpO2 88-92% and a PaO2 >8kPa
Check ABG fter 20 min
1. If PaCO2 steady or lower can raised FiO2 if neccessary
2. If PaCO2 raised >1.5 kPa and pt. still hypoxic, consider NIV or respiratory stimulant (e.g. doxapram)

16

Oxygen therapy principles

Critcal patients high flow immediately
Targeted to reach sats of 98 + unless COPD

17

PAtients at risk of hypercapnic resp failure management

1. Start Oxygen therapy at 24% and do an ABG - blud venturi @2-4l/min
Clinically: reduced RR with Oxygen may be a useful sign
If PCI2 6kPA: maintain target SpO2

18

Mechanisms of oxygen delivery

Nasal specs
Simple face mask
Nonrebreathe
Venturi mask

19

Nasal prongs dosage

1-4L/min = 24-40% O2

20

Non-rebreathe mask

REservoir bag allows delivery of high concentrations of O2: 60-90% at 10-15L

21

Venturi mask

yellow: 5%
White; 8%
Blue: 24%
Red: 40%
Green:60%

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