MED SURG EXAM 1 ACUTE RESPIRATORY FAILURE, ARDS,
MECHANICAL VENTILATION, HEMODYNAMIC
MONITORING, PACEMAKERS, IABP, ICD AND CARDIAC
SURGERY.
Whatsissacutesrespiratorysfailures(ARF)?s-sCORRECTsANSWER--
Thesinabilitysofstheslungsstosmaintainsadequatesoxygenationsofsthesbloodswithsorswit
houtscarbonsdioxidesretention.s
-Impairmentsofsgassexchangesissthesmajorsfactor
-
Requirements:sPaO2sisslesssthans60smmsHgsonsRAsorsasPaCO2sgreatersthans50sandsas
pHslesssthans7.35
-Needsansactualsbloodsgassforsasdiagnosis,sbutsaspulsesoxscansbestelling.
Whatsaresthestwostypessofsrespiratorysfailure?sWhatsissthesfirststhingsyousdosforsaspat
ientsinsRF?s-sCORRECTsANSWER-1.sPrimarysHypoxemicsRespiratorysFailures
2.sCombinationsofsHypercarbiasandsHypoxemias
-Sitsupsthespatientsandsputsonsoxygen
Whatsissprimaryshypoxemicsrespiratorysfailure?s-sCORRECTsANSWER--
PaO2sisslesssthans60smmsHgs
-Oxygenssaturationssisslesssthans90%s
-CANsBEsTREATEDsWsOXYGEN.
Whatsissascombinationsofshypercarbiasandshypoxemia?s-sCORRECTsANSWER--
HypoxemiasisspresentsandselevatedsPaCO2s(sgreatersthans50smmHg)s
-Hypercapnea:sinsufficientsCO2sremovals
-Requiressmechanicalsventilationsandsneedstosbesintubated.s
-NormalsforsCOPDspatients.
WhatsissthespathophysiologysofsAcutesRespiratorysFailure?s-sCORRECTsANSWER-
1.sHypoxemias
-V/QsMismatchs
-Impairedsgassdiffusions
2.sHypoxemiasandsHypercapnias
-sV/Qsmismatchs
-Impairedsgassdiffusions
-
Hypoventilation,swhichscausesshypercapnias(nosdeepsbreaths,scansbescausedsbyslotss
ofsopiates,sasheadsinjury,sendsstagessofsALS).
WhatsissV/QsMismatch?s-sCORRECTsANSWER--
AsV/Qs(ventilation/perfusion)smismatchsissasconditionsinswhichstheresissansimbalanc
,esbetweensthesamountsofsairsreachingsthesalveolis(ventilation)sandsthesamountsofsblo
odsreachingsthesalveolis(perfusion)sinstheslungs.
Insashealthyslung,sventilationsandsperfusionsareswell-
matched,smeaningsthatsairsandsbloodsflowstosthesalveolisaresappropriatelysbalancedst
osfacilitatesefficientsgassexchange.s
-
However,sinsconditionsssuchsasspulmonarysembolism,spneumonia,sorschronicsobstru
ctivespulmonarysdiseases(COPD),sthissbalancescansbesdisrupted,sleadingstosasV/Qsmis
match.
WhatsaresthestwostypessofsV/QsMismatch?s-sCORRECTsANSWER-
1.sDeadsspacesventilations
2.sShunt
Whatsissdeadsspacesventilation?s-sCORRECTsANSWER--
sadequatesperfusionsofsthesalveolisbutsinadequatesventilation,s-
leadingstoswastedsventilationsinsareasswheresgassexchangescannotsoccurseffectively.s
-
Thisscanshappensinsconditionsssuchsasspulmonarysembolismsorsareassofslungscollapse
.
Whatsissasshunt?s-sCORRECTsANSWER--
occursswhenstheresissadequatesventilationsofsthesalveolisbutsinadequatesperfusion
-meaningsthatsbloodspassingsthroughstheslungssdoessnotseffectivelyspicksupsoxygen.s
-
Insthisscase,sbloodsbypassessventilatedsalveoliswithoutsparticipatingsinsgassexchange.s
-Conditionsssuchsasspneumoniasorspulmonarysedemascanscausesshunting.
-Anatomicsshuntsorscapillarys(intra-pulmonary)sshunts
-
Bloodsflowsgoessintosarterialssystems(capillaries)swithoutscomingsintoscontactswsoxy
genatedsalveolis(akascapillarysshunt
Whatsaresissuesswithsventilationsandsperfusion?s-sCORRECTsANSWER--
V/QsMismatchs(stillsmovementsinsthesareasofsissue).sEithersproblemswithsventilations
butsgoodsperfusion=srefractoryshypoxemiasORsproblemswithsperfusionsandsgoodsven
tilation,swhichsexhibitsssymptomssofsaspulmonarysembolus.s
-
Intrapulmonarysshunting:salvelolisisscompletelysblockedsoffsevensthoughstheresissgoo
dsperfusion,sbutstheresissnosventilationswhatsoever.sBloodsisscomingsthroughswithsno
soxygen,ssosoxygensissnotsgettingstosthesheart.sThississthesworstscasesofsV/Qsmismatch
.s
-DeadsSpaces
-DiffusionsDefect
Whatsissdeadsspaces-sCORRECTsANSWER--
Wheresventilationsissworking,sbutstheresissnosperfusionstosthatsarea.sOxygenscannotsg
, etstosthesblood.sSEVEREsV/Qsmismatch,scouldsbesasgiantspulmonarysembolus.sAsPEsm
anifestationscouldsbesdeadsspace.
Whatsissasdiffusionsdefect?s-sCORRECTsANSWER--
Astypesofsproblemswithsgasstransfers
-Normallysgasstransferssacrosssthesalveolar-capillarysmembranes
-
ansalterationsinsthescapillarysmembraneswillsaffectsgasstransfers(increasedsthicknesss
ofsmembrane=decreasedspermeability.sDecreasesinssurfacesarea=atelectasis).
Whatsissalveolarshypoventilation?s-sCORRECTsANSWER--
Hypoventilationscausesshypercapnia,swheresreductionsofsthesventilationsbys1/2scaus
essasdoublingsofsthesPaCO2
-Hypoxemia
Whatsarescausessofsalveolarshypoventilation?s-sCORRECTsANSWER--
CentralsNervoussSystems(CNS)s
-Chestswalls(hunchback,scannotsexpandschestswalls,smuscularsdystrophy)s
-Respiratorysmuscless(exampleswouldsbesastrauma)s
-Airways
WhatsaresthessignssandssymptomssofsARF?s(Hypoxemia)s-sCORRECTsANSWER-
Dyspnea,stachypnea,scyanosis,srestlessness,sconfusion,sapprehension,simpairedsjudg
ment,stachycardiasandsdysrhythmias,sHTN,smetabolicsacidosiss(nosatpsformationsands
lacticsacidsbuildsup)
-lowslevelssofso2sinsthesblood,sblueslipssandsbluesnailsbeds,ssattingsinsthes70s.
WhatsaressignssandssymptomssofsARF?s(Hypercapnia)s-sCORRECTsANSWER-Dyspnea
→
srespsdepres,sheadache,s(CO2sdilatessvessels)sworrysaboutsicp,spapilledema,stachys&s
HTN,sdrowsinessstoscoma...stooshighstosfastschangessbreathingsinstinctsinsmedulla,ssy
stemicsvasodilation,srespsacidosis,seyesdilation
-papilledema
DiagnosissofsARF?s-sCORRECTsANSWER-Hxsorsconditionsthatspredisposessarf?
Acutesonsetsofsrespsdistress?sChestsxraystosseesbilateralsinfiltrates
Arterialsbloodsgas
WhatsissthesmanagementsofsARF?s-sCORRECTsANSWER--
Goal:smaintainsoxygenationsandsventilation
-O2stherapys(allsyousreallysneedstosknowsandssitsthemsup)s
-NC→sfacesmask→snonsrebreather→sfacialsCP
-Secretionsmetabolism
