1. Define respiratory failure, how is it characterized?
What is the difference between pump and lung failure -what are the classic examples?
- Impaired gas exchange that causes hypoxemia, hypercapnia or both
- [O2 and/or Co2 levels cannot be maintained at physiologically normal levels]
Characterizations: Acute/Chronic; Lung/Pump
- Lung failure (hypoxemia) - impaired gas exchange (e.g. ARDS)
- Pump failure (hypercapnea) - impaired ventilation (e.g. drug overdose)
4. What are examples of pump vs. lung failure
- Pump failure
- Brain: OD, CVA, Heart trauma
- Neuro: MG, Polio, GB, Spinal cord trauma/tumor
- Chest wall: Flail Chest, Kyphosis, Burn Eschar
- Upper Airway: Vocal cord paralysis/paradoxical motion; tracheal stenosis/laryngospasm
- Lung failure
- Lower Airway & Lung: COPD, ARDS, PE, pna, Alveolar hemorrhage
- Heart: CHF, Valvular disease
5. What can you use to diagnose respiratory failure?
7. What are the symptoms you will find in respiratory failure?
- 1. H&P
- 2. Lab workup
- *not just looking to classify, e.g. acute/chronic, lung/pump... but you want to subdiagnose, e.g. acute vs chronic
- CNS: headache, visual disturbance, confusion, memory loss, hallucination, LOC (CNS vulnerable to ischemic changes)
- Resp: Dyspnea (resting vs. exertion), cough, sputum (e.g. copd), chest pain
6. Why are ABGs so essential in respiratory failure? What information does it give?
How is acute vs. chronic defined?
- ABG is the most important test to subclassify respiratory failure, e.g. acute vs chronic or lung vs pump
- Provides an indication of the duration and severity of respiratory failure
- Gives 3 types of information:
- - Presence and degree of hypoxemia (PaO2)
- - Presence and degree of hypercapnia (PaCo2)
- - Arterial blood pH
Acute/Chronic determined based on PaCo2 vs pH (acute = high PCO2/low pH; chronic = high PCO2/normal pH)
8. What can you give for pump failure? for lung failure?
- Pump failure (hypercapnea)
- - correct electrolyte imbalance
- - nutrition
- - rehab
- - reduce wob (CPAP, PPV)
- Lung failure (hypoxemia)
- - Medicate (bronchodilators, steroids, methylxanthines, antibiotics, oxygen)
- - Surgery (bullectomy, lung transplant)