Respiratory Alkalosis and Respiratory Failure

Question 1

Most common cause of respiratory alkalosis?

Answer 1

Hyperventilation

Question 2

What is respiratory alkalosis?

Answer 2

Decrease in CO2 partial pressure in arterial blood.
Most common acid-base abnormality in critically unwell patients

Question 2

Causes of respiratory alkalosis?

Answer 2

Anything that causes high respiratory rate:
LRTI
PE
Pulmonary oedema
Pneumothorax
ARDS
Anxiety

Compensation for metabolic acidosis

Salicylate (aspirin) poisoning - causes metabolic acidosis and tachypnoea

Cerebral disease

Hyperthermia

Question 3

How do you manage salicylate poisoning?

Answer 3

Activated charcoal
Urinary alkalinisation
Electrolyte replacement

Question 4

Difference between Type 1 and Type 2 respiratory failure?

Answer 4

Type 1 - hypoxaemia (Pa O2 < 8kPa)

Type 2 - hypoxaemia AND hypercapnia (Pa CO2 > 6.5kPa)

Question 5

Causes of hypercapnia?

Causes of hypoxaemia?

Answer 5

Hypoventilation

Failure of oxygenation

Question 6

Causes of Type 1 Respiratory failure

Answer 6

Pneumonia, PE

Question 7

Causes of type 2 respiratory failure

Answer 7

COPD
Opiate overdose

Question 8

Severe T1RF management?

Answer 8

CPAP

Question 9

Contraindications of CPAP and BiPAP?

Answer 9

Confusion
Vomiting
Untreated pneumothorax

Question 10

How to manage severe T2RF?

Answer 10

BiPAP

Question 11

Complications of invasive ventilation?

Answer 11

Dental injury during intubation
Barotrauma
Ventilator associated pneumonia
Tracheomalacia
VTE/pressure ulcers