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Medicine Notes Clinical Respiratory Notes

Respiratory Failure Notes

Updated Respiratory Failure Notes

Clinical Respiratory Notes

Clinical Respiratory

Approximately 29 pages

This series of notes is on clinical respiratory. It includes respiratory basics, physiology, common diseases, treatment and complications. These notes were made using a variety of textbooks, notes from tutorials with consultants and knowledge gained on the ward with doctors. These notes helped me a achieve a good grade of 77% in the end of year exams....

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The following is a more accessible plain text extract of the PDF sample above, taken from our Clinical Respiratory Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Respiratory Failure

  • 2 Types

TYPE ABG ANALYSIS CAUSES

I

Oxygenation Failure

(Commoner)

  • PaO2= Low <8kPa (60mmHg)

  • PaCO2= Normal/Low

  • Hypoxaemic w/ normo-hypocapnia

    • Preserved regions gas exchange respond hypoxemia-> hyperventilating to remove CO2

  • V/Q mismatch

  • Intrapulmonary shunts

  • Low inspired O2

II

Ventilator Failure

  • PaO2= Low <8kPa

  • PaCO2= High PaCO2 >6.5kPa (49mmHg)

  • Hypoxaemia w/ hypercapnia

  • Chest wall defect

  • Resp. muscle weakness

  • Resp. centre drive decreased

  • Severe pulmonary disease

  • Type 1 Causes (V/Q mismatch commonly causes)

    • ASTHMA

    • EMPHYSEMA

    • INTERSTITIAL LUNG DISEASE

    • PNEUMONIA

    • PULMONARY EMBOLISM

    • PULMONARY OEDEMA (ARDS)

  • Type 2 Causes

    • PULMONARY DISEASE

      • Asthma

      • COPD

      • PNEUMONIA

      • END-STAGE PULMONARY FIBROSIS

      • OSA

    • REDUCED RESP DRIVE

      • SEDATIVES

      • CNS TUMOUR

      • TRAUMA

    • NEUROMUSCULAR DRIVE

      • CERVICAL CORD LESION

      • DISPHRAGMATIC PARALYSIS

      • POLIO

      • MYASTHENIA GRAVIS

      • GUILLAIN BARRE SYNDROME

    • THORACIC WALL DISEASE

      • FLAIL CHEST

      • KYPHOSIS

  • Clinical features

    • Hypoxaemia (decreased PaO2)

      • Change in A-a difference; Healthy= 15mmHg

        • Scatter of V/Q ratios

        • Physiological shunts

CAUSES PAO2 PaO2 A-a O2 THERAPY?
Altitude Decreased Decreased Normal YES
Hypoventilation Decreased Decreased Normal YES
VQ mismatch Normal Decreased Increased YES
Shunt (bronchial blood; coronary venous; cardiac shunt) Normal Decreased Increased Limited
Diffusion deficit (lung disease) Normal Decreased Increased YES
V/Q IMPLICATON Example
0.8 Normal
0 No vent but perfusion (shunt) Airway obstruction; Intrapulmonary shunt; Cardiac shunt
Infinity No perfusion (dead space) PE
<0.8 Ventilation less than perfusion Partial airway obstruction (asthma; foreign body)
>0.8 Decreased pulmonary flow Cardiac failure (vasoconstriction; small emboli)

  • Hypoxia (decreased O2 in whole body or tissue)

    • Signs

      • Dyspnoea

      • Restlessness

      • Agitation

      • Confusion

      • Central cyanosis

    • Long-standing= Polycythaemia; Pulmonary hypertension; Cor pulmonale

  • Hypercapnia

    • Headache

    • Peripheral vasodilatation; Tachy; Bounding pulse; Tremor/flap

    • Papilloedema

    • Confusion; Drowsiness; Coma

  • Investigations (Find underlying cause)

  • Management

    • Type 1

      • O2 (35-60%) by facemask to correct hypoxia

      • Assisted...

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