Critical Care
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| Describe and explain the two major classification of acute respiratory failure (hypoxemic) | Hypoxemic: PaO2 ≤60mmHg on ≥60% FiO2 → Oxygenation failure (inadequate O2 transfer at alveoli and pulmonary capillary bed) – Causes: V/Q mismatch, shunt, impairing diffusion, and alveolar hypoventilation
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| Describe and explain the two major classification of acute respiratory failure (hypercapnic) | PaCO2 >45 with pH <7.35 → Ventilation failure (respiratory system unable to remove sufficient CO2: to maintain normal PaCO2) – Causes: airways and alveoli (airway obstruction and air trapping), CNS (dec. drive to breathe), chest wall, N/M conditions
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| Ventilation/Perfusion mismatch | secretions in airway (ex: COPD), secretions in alveoli (ex: pneumonia, bronchospasm/asthma), Alveolar collapse (atelectasis), Pain
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| Intrapulmonary shunting | blood moves from r-heart to l-heart without oxygenating in the lungs
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| Impaired diffusion | alveolar capillary membranes are damaged > stiff > compromises gas exchange
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| Conditions affecting pulmonary vascular bed | Emphysema and recurrent PE
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| Cause membrane to become more fibrotic (glow gas transport) | ARDS, pulmonary fibrosis, interstitial lung disease
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| Alveolar Hypoventilation | Low ventilation leads to high CO2 and low PaO2 as a result of restrictive lung diseases, CNS diseases, chest wall dysfunction, acute asthma, and N/M disease
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| Renal compensation | Kidneys reabsorb/retain HCO3 as needed, to compensate for state of acidosis (takes days to take effect) → minimizes change in arterial pH
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| Cardiovascular Compensation | Heart + lungs attempting to compensate for increased O2 delivery!
Hypercapnia → vasodilation → cerebral blood flow → mild ICP → HA!
Slower RR @ night → severe morning HA!
Cyanosis = late sign!
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| Interpret signs of impaired ventilatory function. | a. Restlessness, changes in LOC (confusion → coma)
b. Tachypnea / dyspnea / cough
c. Auscultation of lungs
d. Tachycardia
e. Substernal retractions
f. Diaphoretic (+ g-k)
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Created by:
ariellebtan
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