Mega Principles - Respiratory Rate

Question 1

Normal Respiratory Rate?

Answer 1

12-20 (Resuscitation Council 2015)

Question 2

British Thoractic Society - when worry?

Answer 2

Anyone with RR of 30 and above (BTS, date?)

Question 3

What does it relate to?

Answer 3

Sepsis
Pneumonia
Anaphylactic Shock
Asthma

ABCDE Assessment

Question 4

Sepsis Campaign - when worry?

Answer 4

Anyone with RR of 22 and above (Sepsis Campaign, 2017)

Question 5

Resuscitation Council 2015 - when worry?

Answer 5

Anyone with RR of 25 and above (Resuscitation Council 2015)

Question 6

What are respiratory rates a sensitive indicator of?

Answer 6

Fast particularly, a sensitive indicator of clinic deterioration

Question 7

Mega Principle - respiratory rate &…?

Answer 7

pH

Question 8

Respiratory Rate and pH - relationship?

Answer 8

pH goes down? Respiratory Rate goes up

AND VICE VERSA

Question 9

Normal pH

Answer 9

7.35-7.45
Under 7.35 = acidotic
6.8 - incompatible with life

Question 10

Why, when sick, does pH go down?

4 x reasons

Answer 10

1. LACTID ACID - ANAEROBIC RESPIRATION

Inability to breathe in oxygen?
Inability to deliver oxygen to cells?
Switch from AEROBIC to ANAEROBIC respiration

Biproduct of anaerobic respiration = LACTIC ACID (more lactic acid, lower the pH)

2. CARBON DIOXIDE - AEROBIC RESPIRATION

When sick, body requires more work - breathe faster, heart beats faster, respiratory muscles are used more

In normal health (aerobic) - make ATP, CO2, H20, heat
We make C02 - essentially functions in the body as an acid, more CARBON DIOXIDE, more acid

3. POOR URINE OUTPUT

Kidney - excretes waste in urine - e.g. urea, ammonia

Low urine output? therefore retain acid

4. RUN OUT OF BUFFERS

Buffers (e.g. some proteins, albumin, fibrinogen cancel out acids, haemoglobin)

Limited supply of buffers - if persistently acidotic, run out of buffers, pH goes down

Question 11

What happens when acidotic to cause fast breathing?

Answer 11

As pH falls, cell function deteriorates

Body wants pH between 7.35-7.45

One way of maintaining pH = via respiratory rate

The faster you breathe, the faster you expel C02

(CO2 acts as acid)

PATHWAY:

CHEMORECEPTORS IN NECK measure blood pH -> MEDULLA OBLONGATA controls resp rate ->
PHRENIC AND RESPIRATORY NERVES ->
INCREASE RESPIRATORY RATE

pH normalises…