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Transcript of 225897406 Respiratory Failure
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Ronald Chrisbianto Gani
405090223
Faculty of Medicine
Tarumanagara University
EMERGENCY MEDICINE BLOCK
RESPIRATORY FAILURE
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RESPIRATORY FAILURE
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RESPIRATORY FAILURE
• Inadequate blood oxygenation or cabon
dioxide removal
• Classified as
– Hypercapnic Respiratory Failure
– Hypoxemic Respiratory Failure
Fishman’s Pulmonary Diseases & Disorders 4th Ed
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ETIOLOGY
• Central nervous system
– Sedative/narcotic overdose
– Meningoencephalitis
–
Tumirs or vascularabnormalities of medulla
– Strokes
– Severe myxedema
– Hepatic failure
– Advanced Uremia
– Obesity-hypoventilation
syndrome
• Perpipheral Nervous
system or Chest Wall
– GBS
–
Mysathenia Gravis – Polymiositis
– Muscular dystrophies
– Acute Poliomyelitis
–
Traumatic Spinal CordInjury
– Severe kyphoscoliosis
– Flail chest, morbid obesity
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ETIOLOGY
• Airways
– Epiglotitis
– Foreign body aspiration
– Tracheal tumor – COPD
– Asthma
– Advanced cystic fibrosis
• Alveoli
– Pulmonary edema
– Diffuse pneumonia
– Pulmonary hemmorhage – Aspiration of stomach
contents
– Near-drowning
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CLASSIFICATION
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PATHOPHYSIOLOGY
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PATHOPHYSIOLOGY
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MANAGEMENT
• Blood gas analysis for confirmation
• Triage, based on
– Acuity of the respiratory failure
– Degree of hypoxemia, hypercapnia, acidemia
– Presence of co-morbidities (cardiac/renal disease)
• Airway Management
– Emergency intubation or ventilator depends on
clinical condition and arterial blood gas test
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MANAGEMENT
• Correction of Hypoxemia and Hypercapnia
– Hypoxemia correction to PaO2 60mmHg,
higher in patients with coronary or CVD
– May use face mask or Venturi Mask (high flow O2)
– May require intubation or ventilator
• Search for underlying cause
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MANAGEMENT
• Monitoring
– Acute : RR, tidal volume, use of accessory muscles,
paradoxical breathing movement
– Mechanical ventilation related complications
– Status asthmaticus hypotension due to intrinsic
PEEP alter ventilator, implement sedation or
paralytic agents
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COMPLICATIONS
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PROGNOSIS
• Acute hypoxemic respiratory failure
– Survival rate 60%
– Worse outcomes in old patients and patients with
pre-existing lung disease
– 2/3 survivors impaired pulmonary function
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PROGNOSIS
• Acute hypercapnic respiratory failure
– Mortality depends on
• Patient physiological reserve (cardiac, renal, hepatic
status, patient’s age)
• Underlying causes
• Severity of respiratory failure (pH and PCO2)
• Complications after onset (sepsis, pneumonia, GI bleed)
• Cachexia and hime confinement poor outcome
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REFERENCES
• Fishman AP, Elias JA, Fishman JA, Grippi MA,
editors. Fishman’s Pulmonary Diseases and
Disorders. 4th Ed. New York : McGraw-Hill,
2008
• Marx JA, Hockberger RS, Walls RM, Adams JG,
editors. Rosen’s Emergency Medicine
Concepts and Clinical Practice. 7th Ed.Philadelpia : Mosby Elsevier, 2010