Term
| acute respiratory failure |
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Definition
•A sudden and life-threatening deterioration of the gas exchange function of the lungs and the failure to provide adequate oxygen or ventilation for the blood
Can be inability to diffuse O2 or inability to secrete O2
can also show
•An arterial pH of < 7.35
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Term
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Definition
A paO2 < 50mmHg
inadequate O2 transfer (circulation)
Hypoxic-not because low pulse ox-> from poor o2 transfer
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Term
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Definition
A paCO2 > 50mmHg
•increased paCO2, elevation in circ CO2
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Term
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Definition
•- insufficient CO2 removal which then increases PaCO2 (hypercarbia)
COPD-patients don’t eliminate CO2, inhale fine
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Term
•Inability to properly exchange (diffuse) O2 and (eliminate) CO2 are caused by 2 problems….
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Definition
•Ventilation error
•Perfusion error
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Term
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Definition
•The healthy adult lung receives each minute an alveolar ventilation of about 4 liters and a pulmonary blood flow of 5 liters. What is the average resting ventilation:perfusion(V/Q) ratio?
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•V/Q = (4L/min) /(5 L/min) = 0.8
•Normal V/Q ratio is 0.8
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•A normal ventilation-to-perfusion relationship is required to keep PaCO2 and PaO2 in the normal range.
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Term
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Definition
•A V/Q ratio < 0.8 indicates dead-spacing in the lungs
•indicating a relative shunt. (Problem ventilating)-air cannot get in and reach aveloi, but circulation is fine
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•A V/Q ratio between 1 and infinity indicates ventilation with no perfusion-there is ventilation but there is no blood (Ex PE)
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Term
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Definition
perfusion without ventilation
V/Q=0 |
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Term
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Definition
vent w/o perfusion
V/Q of infinity |
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Term
| vent and perf is at it's greatest when.. |
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Definition
•When?
•The client is awake
•Where?
•The base of the lungs
•Why?
•Gravity
•Both on perfusion and ventilation
Normal is when its at its greatest
Why you sit a patient up if their struggling to breathe, can enhance ventilation/perfusion in that position
Px in respiratory distress->best position-high fowlers (even over semi fowlers)
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Term
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Definition
| act of insp and exp of air |
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Term
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Definition
hypercapnia
•Impaired CNS function
•Muscular dysfunction
•Pulmonary dysfunction
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Term
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Definition
transport of oxygenated blood across capillaries
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Term
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Definition
hypoxemia
•Heart (Failure to pump)-CO could determine this, pump problem-can’t move blood through circulation
•Emboli (Pulmonary)-only portion of blood able to be oxygenated
•Shunting
•Infection (sepsis)-
Sepis-decreased cardiac output in septic shock, occurs fast and capillaries fail to contract and capillary collapse occurs-systemic perfusion failure
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Term
| most common causes of respiratory failures |
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Definition
•COPD
•Shock (Hypovolemic, cardiac - MI)
•Trauma (Head/chest/spine)
•Septic Shock
•Stroke
•Medication overdose-controlled substances
•Neuromuscular disorders – ex.amyolyticlateral sclerosis (ALS)
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Term
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Definition
•Tachycardia
•Restlessness-fearful
•Cyanosis
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Term
| s and s of hypercapnic px |
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Definition
•Increased ICP
•Headache
•Confusion-low oxygen from more abundant CO2
•Lethargy
•Nausea/Vomiting-due to inc in intracranial pressure
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Term
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Definition
•Treat underlying cause(s) may correct the problem....
•But you need to correct the symptoms as well.
•Give supplemental oxygen where needed
•Positioning (elevate HOB)
•Suctioning PRN
•Bronchodilators, steroids-Bronchodilator-Beta 2 agonist (albuterol), Prednisone, Solumedrol (IV version)-steroids
•Ongoing patient monitoring (ABG, pulse Ox)
•Prepare for intubation/mechanical ventilation
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Term
| acute respiratory distress syndrome |
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Definition
•A clinical syndrome characterized by sudden and progressive lung damage resulting in pulmonary edema, severe hypoxia, and possibly death.
•Characterized by decreased ‘lung compliance. (alveloi fill with fluid)
•Significant pulmonary edema.
•Death occurs in about 50% of patients, but usually as a result of non-pulmonary organ failure.
•Death rate much higher in sepsis (80%)
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Term
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Definition
•Severe infection (localized or systemic) most common
•Trauma with or without lung contusion
•Aspiration of gastric contents
•Shock
•Infection
•Pneumonia
•Toxic inhalation-not always happens, but can happen ex sustained exposure to toxins at work
•Pancreatitis
•Fat embolism
•Near-drowning
•Multiple blood transfusions-due to antibody reactions
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Term
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Definition
onset may be delayed but prgress is fast
•Aspiration
•Pulmonary infections
•Air, fat, or amniotic fluid emboli
•Near-drowning-(fluid entering the lungs), can occur hours later
•Pulmonary contusion
•Inhalation of toxic gases and dusts
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Term
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Definition
•Sepsis
•Shock
•Transfusion
•Trauma
•Overdose
•Pancreatitis
•Eclampsia
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Term
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Definition
acute exudative phase
fibrosing phase (avelotis)
resoltion |
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Term
| acute exudative phase of ards |
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Definition
| Characterized by profound hypoxia and associated with alveolar inflammation. Pro-inflammatory mediators (cytokines) lead to edema and diffuse alveolar damage. Occurs during first 2-4 days |
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Term
| fibrosing (avelolitis phase) of ARDS |
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Definition
| The response to injury. Coincides with recovery over 1-2 weeks; patients continue to be hypoxic and have increased dead space and decreased lung compliance |
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Term
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Definition
1.may require 6-12 months. However, most return to baseline lung functioning.
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Term
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Definition
•-Pathology basically involves inflammation in the alveoli, then increased pulmonary capillary permeability thus resulting in severe ventilation/perfusion mismatch.
•-The blood returning to the heart is poorly, oxygenated.
-The blood returning back to the lungs (from pulmonary veins) for gas exchange is pumped through non-ventilated/non-functioning areas of the lungs (because of the edema), resulting in 'shunting |
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Term
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Definition
•Tachypnea and tachycardia can begin during the first 12-24 hours…then acute respiratory distress by the 48th hour-nothing super alarming yet
•Lethargy, obtundation (dull to sensitivity)
•Flat neck veins, no peripheral edema
•Moist, cyanotic skin
•Physiologic gallop-S3
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Term
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Definition
•Find mean of volume ex
•50% vol at 95% and 50% vol at 70=82.5% hyoxemic
•Interventions-100% via non rebreather mask
•Raise 95 to 100%-mean raises to 85% percent
•Notice that this is why ARDS and PE’s are so deadly
•Oxygen dissociation curve-faster pulse ox gets away from 100, amount of oxygen circ in that paitients blood decreases
•Pulse ox not a tried and true method-why we do abGS
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Term
| ards assessment-auscultation |
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Definition
broncial breath sounds are prevented from being converted to vesicular breath sounds because of consilidation
Hear fluid, significantly decreased breath sounds
Normal is resounance
Why copd breath sounds dec-barrel chest-enlarged chest wall but not lungs-stethoscope further from lungs physiologically, lungs not fully expanding, decelasiticity,
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Term
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Definition
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Term
| treatment modalities for ARDS |
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Definition
•Treatment is very challenging.
•ARDS develops and becomes more severe over 12-48 hours.
•Does not respond to supplemental oxygen therapy.
•Always intubated...but even this is difficult due to 'stiff lungs.’ (decreased lung compliance)
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Term
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Definition
•Treat underlying condition(s).
•Treat potential infection.
•Continuous patient monitoring (Fluid Volume, ABG)
•Little help with medications (diuretics, antihypertensives)
•Fluid balance (daily weights, caution with IV fluids)
•Probable sedation while intubated and mechanically ventilated.
•Mechanically ventilated with use of PEEP (Peak end expiratory pressure-keeps amount of continuous pressure in the lungs and always keeps the airways as open as possible w/o any effort of px-so when the lungs deflate they don’t totally deflate)
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Term
•CAVH (continuous arteriovenous hemofiltration)
for ARDs |
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Definition
•Helps in the management of fluid overload and acid-base imbalance.
•Blood circulates usually without a blood pump through a small hollow-fiber hemofilter.
•Access to the circulation is by the femoral artery and vein.
•The patient's blood circulates through the hemofilter wherein the plasma and water is filtered and collected in the collection bag.
•Replacement fluid is infused into the venous return line where heparin may also be administered.
•no oxygenation happening-but it's helping with fluid displacement
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Term
| advantages of CAVH for ARDS |
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Definition
•It is very effective in removing fluid which may help patients in pulmonary edema or acute respiratory distress syndrome.
•It does not cause hemodynamic instability since there is little change in plasma osmolarity.
•Allows control of electrolyte and acid-base balance.
•The procedure is relatively simple and does not require highly technical equipment, unlike hemodialysis.
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Term
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Definition
•The obstruction of the pulmonary artery or branch(s) by a thrombus which originates in the venous system or the right side of the heart.
•Causes a ventilation/perfusion (V/Q) mismatch (greater than 0.8)
Varicose veins not risk factor for PE
Can cause shortness of breath and sudden sharp pain over affected region
May have no symptoms-pain poorly described
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Term
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Definition
•Burns
•Cancer-major one
•Pregnancy, Childbirth
•Genetics
•protein C, protein S, and antithrombin III deficiencies, Activated protein C resistance (factor V Leiden) are most common
•Fractures
•Heart attack
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Term
| more causes of PE-what is the most common |
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Definition
•Arrhythmias (A-FIB!!!)-more common
•Obesity
•Tobacco use
•Long-term bed rest
•Severe injury
•Stroke
•Surgery (especially ortho/neuro)
•Use of birth control pills or estrogen
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Term
| presenting signs and symptoms of PE |
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Definition
•Signs of DVT may or may not be present (Leg swelling or pain).
•Tachypnea, wheeze sometimes
•Hypoxia
•Tachycardia-HR>100 bpm
•Low-grade fever
•Distended neck veins
•Chest pain (Usually not like MI)
•Lungs: Clear, decreased breath sounds or egophony due to pleural effusion
•Acute corpulmonale (shock-systemic hypotension, syncope, cyanosis, right ventricular gallop, pleural friction rub, hemoptysis)
•Homan sign (pain elicited with compression of the calf)
•CXR and EKG changes (not diagnostic)
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Term
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Definition
•Patient presentation...must meet criteria for diagnosis.
•Lab tests: D-Dimer, ABG, CBC, PT/PTT, and Stool guaiac prior to initiating anticoagulation therapy.
•EKG and CXR changes help
D-dimer not specific but is 100% sensitive
If you have a high clinical probability-d dimer needs to be performed- if pos you have a clot but it may not be a PE
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Term
| diagnostic imaging test for PE |
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Definition
•Pulmonary angiogram is the gold standard-over 99% accurate but has more risk factors
•Sprial CT of chest with IV contrast-less invasive, cheaper, can miss PE’s 2% of the time
•V/Q scan-horrible, but only says low, moderate, or high probability
•Cardiac 2-D Doppler if necessary (see right ventricular strain and pulmonary HTN)
•MRI not useful at all.
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Term
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Definition
•Pulmonary angiogram is the gold standard-over 99% accurate but has more risk factors
•Sprial CT of chest with IV contrast-less invasive, cheaper, can miss PE’s 2% of the time
•V/Q scan-horrible, but only says low, moderate, or high probability
•Cardiac 2-D Doppler if necessary (see right ventricular strain and pulmonary HTN)
Need to treat what caused the PE in the first place
Will use warfarin (Coumadin) for treatment-does not dissolve clots
•MRI not useful at all.
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Term
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Definition
•Heparin IV/LMWH (lovenox) (Heparin usually preferred)
•Then warfarin. Goal? To stabilize INR between 2.5-3.0. Once INR 'therapeutic,' stop heparin.
•Duration of warfarin absolute minimum is 3 months, usually one year, sometimes for life based on risk factors.
•Thrombolysis: 100 mg of tissue plasminogen activator (tPA) infused over 2 hours; must continue other forms of chronic anticoagulation.
•tPA very controversial based on risk and is only considered 2nd line treatment.
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Term
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Definition
| greenfield filter placed in vena cava to collect formed emboli |
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Term
| mortality and complications of PE |
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Definition
•Heparin IV/LMWH (lovenox) (Heparin usually preferred)
•Then warfarin. Goal? To stabilize INR between 2.5-3.0. Once INR 'therapeutic,' stop heparin.
•Duration of warfarin absolute minimum is 3 months, usually one year, sometimes for life based on risk factors.
•Thrombolysis: 100 mg of tissue plasminogen activator (tPA) infused over 2 hours; must continue other forms of chronic anticoagulation.
•tPA very controversial based on risk and is only considered 2nd line treatment.
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