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1

Causes of airway obstruc

Tongue
Anaphylaxis
FB
Ext comp eg tum
Trauma

2

Upper airway anatomy

Upper airway-
Nose and paranasal sini
Oral cavity
Nasopharynx base skull to soft palate
Oropharynx to superior epiglottis
Hypopharnx to inferior cricoid cartilage
Larynx
Lower airway-
Trachea
Principle, secondary and segmental bronchi
Terminal bronichiole
Respiratory bronchiole
Avleolar ducts and sacs

3

Identify resp failure

Hypoxia- dyspnoea, restless, agitated, confused, cyanosis. If chronic then polycythemia, pulm HTN.
Hypercapnia- headache, periph vasodilation, tachyc, bounding pulse, flap, drowsy.

4

Causes acute resp failure

T1- pneumonia, PO, PE, asthma, ARDS
Chronic eg COPD, fibrosis
T2- very severe asthma or COPD or pneum, end stage fibrosis, OSA, anaphylaxis
Also sedatives, CNS tum, trauma, NMDs, chest wall, compl obstruc

5

Resp failure

T1- paO2 under 8kPa, normal or low pCO2
Due to VQ mism
T2- pO2 under 8, pCO2 over 6kPa
Due to alv hypoventil +/- VQ mism

6

Resp failure mx

T1- O2, assisted ventilation
T2- controlled O2, assisted ventil, maybe intubation
O2 eg nasal under 4L, simple over 5L, venturi 24-8 for COPD, NRB
Monitoring- bloods, ABG, CXR, sputum and blood cult, spirom.

7

Hypoxia

Hypoxaemic- resp fail
Anaemic- low Hb or CO
Circulatory- shock, PVD
Cytotoxic- cyanide

8

Bradypnoea causes

Airway obstruction and exhaustion- asthma, COPD, OSA, oedema
RICP
Obesity
Alcohol, drugs, sedation
Cardiogenic shock
CNS disorder
Hypothyroid

9

tachypnoea causes

Obstructive disorders- asthma, COPD
Pneumonia
Fibrosis
PE
Pneumothorax
pleural effusion
HF
Anxiety
Arrhythmia
Anaemia

10

Resp ix

Bloods- FBC, UE, CRP, ABG or VBG, LFT, clotting, D dimer, CA markers, a1 antiT
CXR
Sputum and blood cult
Spirometry

11

ABG interp

PH low and CO2 high- resp acidosis
PH low and CO2 low and HCO3 low- metab acid
PH high and CO2 low- resp alk
PH high and HCO3 high- metab alk

12

NIV ventil indics
BIPAP and CPAP

COPD resp acidosis pH 7.25-7.35
T2 RF
Cardiogenic PO unresp to CPAP
Tracheal intubation weaning

13

techs to assist ventil

CPAP- usually nasal, constant pos press, upper airways splinted open, improves VQ match
CPAP IS NOT NIV
BiPAP- 2 levs of pos press (IPAP and EPAP)

14

Modified wells score

3- symps eg swell, pain
3- other dx less likely than PE
1.5- HR over 100
1.5- immob over 3d, or surg in last 4wk
1.5- prev PE or DVT
1- haemoptysis
1- malig

Score over 4 means PE likely, 4 or less means unlikely

15

shock px

Hypot under 90
Tachyc usually over 100
Alt conciousness or syncope
Poor periph perfus- cool, clammy, pallor, high CRT
Oliguria under 50ml/hr
Tachyp

16

Shock causes

Hypovol- bleed, DNV, burns, pancreatitis, sepsis
Cardiogenic-
Primary eg MI, arrhythmia, valve, myocarditis
mechanical or Secondary eg tamponade, massive PE, tens pthorax
Distributive- septic more comm in eld or v yng, DM, renal/liver fail, imm comprom. Anaphylactic

17

Shock mx

ABCDE
High O2
IV access and take bloods
Obs
ABG
ECG
CXR
Catheter and UO
Fluids if req
Ionot or vasoactive meds
Assisted ventil
Specif- lap, thrombolysis, PCI, pericardiocentesis, antidotes, abx

18

Acute renal failure causes

STOP most comm- sepsis, toxin, obstruc eg prostate, parenchymal eg ATN
Pre- DEHYD, shock eg sepsis, A stenosis
Intrinsic- ATN, drugs (Mb, ACEi, AG, NSAID), HTN, infec, nephritis, vasculitis
Post- obstruc eg prostate, stones, CA, stricture, fibrosis.

19

Acute renal failure px

Malaise, lethargy, nausea, reduc UO
High urea and cr
Elec imbal
Signs of cause eg sepsis, dehyd, vol overload, mass, renal bruit, pos dip or cult

20

Acute renal fail mx

Tx cause
Tx fluid balance
Tx elec imbal and acidosis
Review meds
Monitor- UE, VBG, urinalysis, USS, UO
Indics for dialysis- hyperK, fluid overload, acidosis, dialysable toxin, uraemia (pericarditis, LOC, NV)

21

Acidosis causes

Resp- hypoventil in COPD, asthma, PO, CNS depression, obesity, GB, MG
Metab-
With normal anion gap (3-12)- reataining H (RTA, addisons) or losing HCO3 (diarr)
With high anion gap- methanol, uraemia, DKA, lactate, other poison

22

alkalosis causes

Resp- hyperventil eg anx, hypoxia, PE, pneumonia, asthma, PO
Metab-
Chloride responsive eg vom, diuretic, CS
Chloride resis eg cushings, hypoK

23

Acidosis px

Fatigue, drowsy
Confusion
SOB, rapid shallow breathing
Headache
Lack appetite
Jaundice
Tachyc

24

alkalosis px

Confusion
Tremor, tetany
Light headed
NV
Numbin and tingling

25

Mx of acid base disturbance

Tx cause
Oxygen if req
Tx elec imbal
Acidosis- sodium bicarb, CPAP

26

Tachyc causes

Arrhythmia- ST, SVT, flutter, atrial tachyc, AF, AVRT, VT, pre excited AF, torsades, VF
HTN or hypot
IHD
Valve dis
Anaemia
Exercise
Stress
Cardiomyopathy
Infection and fever
Smoking
Drugs eg alc, caffeine, cocaine, medications
Elec imbal
Hyperthyroid

27

Bradyc causes

Arrhythmia- SAN dis, HB AVN dis
IHD
Congenital heart dis
Myocarditis
Hypothyroid
Elec imbal
OSA
Rheumatic dis
Meds

28

Oliguria causes

Dehydration
Obstruc
Sepsis and other vasc collapse
Low CO
Intrinsic renal eg ATN, glom dis, vasc lesions

29

Hypotension causes

Dehyd eg DNV
Blood loss
Severe inflammation
Myocarditis
Valve dis
PE
Tamponade
Bradyc

30

Hypernatraemia

Causes- iatrogenic, DNV, burn, DI, DKA, conns
Px-lethargy, weak, thirst, irrit, confus, coma, seiz, dehyd
Mx- hydration, maybe saline if hypovol
Tx cause