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Cards In This Set
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What is Acute Resp. Failure?
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Altered gas exchange (Pao2 , 60, PsCO2 > 45, pH < 7.3)
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Causes of failure of oxygenation?
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Hypoventilation, intrapulmonary shunting, V/Q mismatch, diffusion defects, low CO, low HGB level, tissue hypoxia
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What is Intrapulmonary Shunting?
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Blood shunted from R to L side of heart w/o oxygenation (physiological: perfusion exceeds
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Causes of intrapumonary shunting
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Atrial.septal defects, atalectasis, pneumonia, pulmonary edema
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What are causes of Ventilation/Perfusion mismatching?
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Alveolar dead space/ blocking blood-flow (ex. PE, PULMONARY INFARCTION, cardiogenic shock, ventilation with high Vt)
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In what condition does diffusion of O2 and CO2 not occur?
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Fluid alveoli, pulmonary fibrosis
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In what condition does failure of ventilation not occur?
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Hypercapnea d/t alveolar hypoventilation (hypoxemia), VQ mismatch (silent unit)
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What is the silent unit in VQ mismatch?
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Silent unit ventilation and perfusion decr. caused by pneumothorax and severe ARDS
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Signs and symptoms of Resp. failure?
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CHANGES IN LOC, resp. cardiovascular, nutrition, psychosocial, chest x-ray, pulm func tests, ABGs, pulse ox and CO2
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What are some interventions of resp. failure?
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Patent airway, optimize O2 delivery, minimize O2 demand, treat cause of ARF, prevent complicaitons
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Medical management of ARF?
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O2, bronchodilators, corticosteroids, sedation, transfusions, therapeutic paralysis, nutritional support, hemodynamic monitoring
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What is Acute Resp. Distress Syndrome (ARDS)?
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Noncardiogenic pulmonary edema
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What is the Dx criteria for ARDS?
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PaO2/FiO2 ratio less than 200 (not recovering from adequate oxygen), Pulm wedge pressure < 18, bilateral infiltrates
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Causes of ARDS
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DIRECT: ASPIRATION PNEUMONIA, near-drowning, O2 toxicity, prolonged mech. vent., multisystem trauma.
INDIRECT: CONTUSION d/t CAR CRASH, sepsis, multisystem trauma, cardiopulm bypass, drug OD, eclampsia, multiple transfusions, hypotension, radiation |
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Patho of ARDS
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1. Systemic inflammatory response, 2. Inflammatory mediators released, 3. damage to alveolar cap. membrane (fluid-filled lungs), 4. incr. cap permeability, 5. pulmonary edema, 6. microatalectasis, 7. stiff lungs (decr. compliance), 8. decr. surfactant, 9. impaired gas exchange, 10. VQ mismatch
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