| ID | 90 |
|---|---|
| Name | RESPIRATORY FAILURE |
| Cause | Causes: Acute type I respiratory failure: 1. Acute severe ahthma 2. Acute exacerbation of COPD (also causes type II failure) 3. Pulmonary oedema (left ventricular failure) 4. Pulmonary embolism 5. Pneumonia 6. Pneumothorx 7. ARDS Chronic type I respiratory failure: 1. Emphysema 2. Lung fibrosis 3. Lymphangitis 4. Carcinomatosa 5. Right-to-left shunts 6. Anemia Acute type II respiratory failure: 1. Acute severe asthma (when life-threatening) 2. Acute epiglotitis 3. Inhaled foreign body 4. Respiratory muscle paralysis 5. Flail chest injury 6. Sleep apnoea 7. Brain-stem lesion 8. Narcotic drugs Chronic type I respiratory failure: 1. COPD 2. Primary alveolar hypoventilation 3. Kyphoscoliosis 4. Ankylosing spondylitis |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Important investigation: 1. Arterial blood gas analysis and pH. 2. Chest X-Ray |
| Management | Management: Acute respiratory failure: A. The primary aim of management is to increase intracellular O2- 1. Correction of hypoxaemia by the administration of O2 in high concentration by oro-nasal mask. 2. Mechanical ventilation (or tracheostomy) if necessary. 3. Warming the body to improve peripheral circulation B. Treatment of the underlying causes- 1. Treatment of pneumonia, pulmonary oedema - see the management of specific disease. 2. Upper airway obstruction: a. Inhaled foreign body- try to dislodge it by turning child upside down and forcibly compressing the thoracic cage or by laryngoscopy or bronchoscopy. b. Laryngeal oedema, bilateral vocal cord paralysis- - medical treatment of the causes. If fail- - tracheal intubation or tracheostomy. 3. Acute severe asthma- medical treatment. If not rapidly effective-tracheal intubation and IPPV. 4. Chest injury- a. Tension pneumothorax- pleural decompr-ession by intercostal tube, b. Massive haemothorax- drainage of blood through intercostal tube or thoracotomy. c. Flail chest- tracheal intubation and IPPV. Fixation of the ribs & sternal fractures. 5. Brain stem & cervical cord lesion- paralysis of the respiratory muscles-treatment of the cause + tracheal intubation & IPPV. 6. Narcotic poisoning & other drugs- treatment of specific poisoning + TI and IPPV |
| Introduction | Respiratory failure is defined as respiratory dysfunction resulting in abnormalities of oxygenation or CO2 elimination (ventilation) severe enough to threaten the functions of vital organs.’ Arterial blood gas criteria for respiratory failure are arbitrarily established as a PaO2 under 60mm Hg and PaCO2 over 50mm Hg. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Clinical features for the specific disease + disturbance of conciousness + cyanosis, restless, ? heart rate, tachypnoea + flapping tremor, early morning headache + papilloedema, asterixis |
| Preventions | |
| Treatment | |
| Complications | |
| Prognosis | |
| Types | |
| Classification | Classification: Respiratory failure is classified into type I (acute and chronic) and type II (acute and chronic) relating to the absence or presence of hypercapnia (raised PaCO2). In acute type I respiratory failure, PaO2 < 8.0 kPa (i i ), PaCO2 6.6 kPa or low and HCO3 (-). In chronic type I failure, PaO2 < 8.0 kPa (i), PaCO2 6.6 kPa (-) and HCO3 (-). In acute type II respiratory failure, PaO2 < 8.0 kPa (i), PaCO2 > 6.6 kPa (T) and HCO3 (-). In chronic type II failure, PaO2 < 8.0’kPa (i), PaCO2 > 6.6kPa(t)andHCO3(T). |
| Observation | |
| Pathology |
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