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respirotery failure

الكلية كلية طب حمورابي     القسم الكلية ذات القسم الواحد     المرحلة 4
أستاذ المادة مشتاق عبد العظيم جواد وتوت       4/23/2011 4:39:14 AM

   Respiratory Failure د مشتاق وتوت


 @Identification: is a condition in which pulmonary gas exchange fails to maintian normal arterial Oxygen & CO2 levels in the body. @ Classifications:  divided into 2 types (I&II) according to the absence or presence of hypercapnea.  
Pathophysiology: type I: localised Type 1 respiratory failure is defined as hypoxemiawithout hypercapnia, and indeed the PaCO2 may be normal or low. It is typically caused by a ventilation/perfusion (V/Q) mismatch; the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lungs.

 type II: generlised, Type 2 respiratory failure is caused by increased airway resistance; both oxygen and carbon dioxide are affected. Defined as the build up of carbon dioxide levels (PaCO2) that has been generated by the body. The underlying causes include:

  • Reduced breathing effort (in the fatigued patient)
  • A decrease in the area of the lung available for gas exchange (such as in emphysema). 
     @Managment: Acute or Chronic Underlying ( heart / lung ) diseases Drugs history Wheezing? wheeze? Crackles? Diminish breath sound? Air-space consolidation? S/S of heart failure Clubbing finger
    Work up
    LAB:
    Arterial blood gas; Pulse oxymeter
    CBC, CRP
    Cardiac enzyme
    Electrolytes: K, Pi, Mg… Ca, Na….
    Biochemistry data,
    EKG (cardiac echo)
    Chest X-ray (chest CT, lung scan)
    Lung function test
    PA catherter
    Neurological exam (Brain CT, EEG……)

() O2 therapy: () Ventilation: indicated if: 1- hypoxic despite appropriate O2 therapy 2- progressive hypercapnea 3- acute respirotery acidosis 4- exhausted ventilation either by NIV or mechanical ventilation. ()complications: *systemic hypotension *pulmonary hpt *polycythemia *tachycardia *cerebral dysfunction (confusion to coma).
Oxygen therapy: 1- high conc: 40-60%, high flow mask, type I RF , need humidification 2- low  conc: 24-28% , venturi mask, type II RF, no need humidification 3- chronic O2 delivery: throgh cylinders, delivered at home, low conc. Via nasal cannulae toxic effect of O2: *100% O2 is irritant & toxic if given for more than a few hours *retrolental fibroplasia, blidness, tonic clonic seizure. *in adults cause pul odema & later on fibrosis  
ARDS: *Its acute, diffuse pulmonary inflammatory response to either direct (via airway or chest truma) or indirect (blood-borne) *frequently associated with multiple organ failure *criteria: 1- hypoxemia 2- CXR show diffuse bilateral infilteration 3- absence of raised LT atrial pressure 4-impaired lung compliance
Treatment: 1- treat underlying disease 2- O2 therapy 3- ventilation 4- prone ventilation 5- inhaled nitric oxide 6- CS


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .