Alterations in respiratory function
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Transcript of Alterations in respiratory function
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Alterations in
Respiratory Function
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Objectives
List the clinical manifestations of common alterations in respiratory function
Outline the critical care management of patients with alterations in respiratory function
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Common Alterations in Respiratory Function
Pulmonary Oedema
Lower Respiratory Tract Infection
Traumatic Injury
Neurological Disease
Adult Respiratory Distress Syndrome
Chronic Obstructive Pulmonary Disease
Upper Respiratory Tract Infection Atelectasis
Industrial Diseases
Obesity
Acute Obstructive Airways Diseases
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Case
75yo ♀ BIBA w/ 1/52 HO ↑ SOB Sp02 86% on RA 98% on HM @ 6LPM.
HR 155, BP 105/55, peripherally cool. T: 38.6 GCS 14 (E: 4 V: 4 M:6)
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Assessment
Physical Assessment ↓ R) chest wall expansion Tactile fermatas ↓ AE R) lower lobe
Blood work-up ↑ WCC
CXR
ECG
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Case
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Case
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Management
O2 therapy Circulatory support IVABs Monitor
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Lower Respiratory Tract Infection
Pneumonia Bacterial Viral Aspiration
Tuberculosis
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Pulmonary Oedema
Alteration in hydrostatic and/or osmotic pressure
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Traumatic Injury
Rib #s
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Traumatic Injury
Rib #s Pleural Effusion
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Traumatic Injury
Rib #s Pleural Effusion Pneumothorax
Tension pneumothorax Heamothorax
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Traumatic Injury
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Chest Drains
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Chest Drains
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Chest Drains
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Chest Drains
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Chest Drains
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Chest Drains
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Chest Drains
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Chest Drains
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Chest Drains
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Chest Drains
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Neurological Disease
Spinal cord disease Motor nerve disease Infectious disease Muscle-wasting disease
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Acute Obstructive Pulmonary Disease
Acute Bronchitis
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Acute Obstructive Pulmonary Disease
Acute Bronchitis Asthma
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Chronic Obstructive Pulmonary Disease
Bronchiectasis
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Chronic Obstructive Pulmonary Disease
Bronchiectasis Cystic Fibrosis Chronic Bronchitis
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Chronic Obstructive Pulmonary Disease
Bronchiectasis Cystic Fibrosis Chronic Bronchitis Pulmonary Emphysema
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Industrial Illness
Organo-phosphate poisoning Asbestosis Coal workers’ pneumoconiosis
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Adult Respiratory Distress Syndrome
“The acute onset of severe respiratory distress and cyanosis that was refractory to oxygen therapy and associated with diffuse CXR abnormality and decreased lung compliance”.
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Adult Respiratory Distress Syndrome
Severe hypoxemia Loss of lung compliance Secondary disease
Reduced perfusion Increased capillary permeability Direct tissue and capillary insult Other mechanism
Despite primary disease, same pathology exists
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Adult Respiratory Distress Syndrome
Signs and Symptoms Tachypnoea Cyanosis Diaphoresis Tachycardia Hyperventilation Scattered crackles Increased work of breathing Agitation Lethargy Decreased LOC
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Adult Respiratory Distress Syndrome
Signs and Symptoms Acute onset (usually within 4 hours or 2-4
days of initial trauma) Bilateral Infiltrates Two Categories:
PaO2/Fio2 ratio < 300 (ALI) PaO2/Fio2 ratio < 200 (ARDS)
(ALI is milder than ARDS that may or may not progress onto ARDS)
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Adult Respiratory Distress Syndrome
Treatment ABC Mechanical ventilation Monitor Treatment of underlying disease Medications Prone Positioning (189±34 v 83±14)
Nutritional Support
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Oxygen Therapy
Nasal Prongs Low flow 2 – 4 LPM
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Oxygen Therapy
Hudson Mask Variable flow 6 – 15 LPM ~40–60%
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Oxygen Therapy
Non-Rebreather Mask High flow Inflate bag ~90-95%
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Oxygen Therapy
Venturi Mask High flow Adjust oxygen to flow rate
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Oxygen Therapy
Bag mask ventilation High flow 100% Respiratory support
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Alterations in
Respiratory Function