1. Classes of ARF
    Hypoxemic & Hypercapnic
  2. Causes of Hypoxemic Resp Failure
    • V/Q Mismatch
    • Shunting
    • Diffusion Limitation
    • Hypoventilation
  3. Causes of Hypercapnic Resp Failure
    • Abnormalities in:
    • Airway & alveoli
    • central nervous system
    • chest wall
    • neuromuscular conditions
  4. Diagnosis of ARF & ARDS
    Pulse Ox, ABG, CXR, CBC, electrolytes, ECG, cultures, V/Q scan/Pulmonary angiography, End Tidal CO2, hemodynamic monitoring
  5. Oxygen Therapy
    Nasal Cannula, face mask, BiPAP/CPAP, mechanical ventilation
  6. Risk of Oxygen Therapy
    • Oxygen Toxicity:
    • exposure >60% O2 for more than 48 hrs

    • CO2 Narcosis
    • Blunted response of chemoreceptors in medulla due to chronic hypercarbia
    • Proved oxygen to improve ABGs
  7. Mobilization of Secretions
    Coughing, positioning, hydration, humidification, chest physical therapy, airway suctioning
  8. How do drugs offer relief?
    relief of bronchospasm, reduce airway inflammation, reduce pulmonary congestion, treat pulmonary infections, reduce anxiety & restlessness
  9. ARDS
    Alveolar capillary membrane becomes damaged and more permeable to fluid.
  10. Fluid filled capillaries in ARDS cause:
    • severe dyspnea, refractory hypoxemia, reduced lung compliance, diffuse pulmonary infiltrates
    • (lung fluid overload)
  11. ARDS' ABGs
    PaO2 < 50 mm Hg OR FiO2 >40% w/ PEEP > 5 cm H2O
  12. Hallmark of ARDS
    PaO2/FiO2 ratio below 200 despite increased FiO2 by mask, cannula, or ETT
  13. Complications of ARDS
    nosocomial pneumonia, barotrauma & volupressure trauma, stress ulcers, renal failure, multi-organ dysfunction syndrome
  14. Selected Aspects of Care (ARDS)
    High flow oxygen therapy, mechanical ventilation with PEEP, prone positioning, lateral rotation therapy, ECMO
  15. Maintenance of Fluid Balance
    • Fine line between overload and depletion
    • Mild fluid restrictions/diuretics prn
    • Assessment: I&O, lung sounds, edema, weight gain/loss
  16. Other Tx Options
    Surfactant replacement therapy, partial liquid ventilation, methylprednisolone, prostaglandin E1, monoclonal antibodies, high frequency jet ventilataion
Card Set
Schell Med Surg