Respiratory Emergencies

Respiratory Failure A condition that occurs when respiratory A condition that occurs when respiratory system is unable to adequately exchange system is unable to adequately exchange Oxygen and Carbon Dioxide between Oxygen and Carbon Dioxide between environment and tissues of the body environment and tissues of the body

Respiratory Failure  PaO 2 < 60 mmHg  PaCO 2 > 50 mmHg

Types of Respiratory Failure  Type I : Oxygenation Failure (Hypoxemic) Oxygenation Failure (Hypoxemic)  Type II : Ventilation Failure (Hypercapnic) Ventilation Failure (Hypercapnic)

Asthma Factors Determine Severe Asthma History: - Frequent Attacks - Excessive use of - Bronchodilators - Excessive use of - Bronchodilators - Steroids - Steroids - Previous admission to ICU - Previous admission to ICU

Asthma Physical Examination Inability to speak Inability to speak Cyanosis Cyanosis Respiratory rate >30/mt Respiratory rate >30/mt Heart Rate >115/mt Heart Rate >115/mt Pulsus Paradoxus >10 mmHg Pulsus Paradoxus >10 mmHg Silent chest Silent chest

Asthma Blood Gases  Respiratory acidosis  Hypoxemia (Low PO 2 )  Hypercapnia (High PCO 2 )

FVC FEV 1 NORMAL = FVC > 75% TIME

FVC FEV 1 Airway Obstruction = FVC < 75% FEV TIME

Asthma Treatment  Oxygen by Mask  Salbutamol (Ventolin) inhaler  Aminophylline I.V  Corticosteroids

Pulmonary Edema Risk Factors: - Ischemic Heart Disease - Ischemic Heart Disease  Smoking  DM  HTN  ↑ Lipids - Rheumatic Heart Disease - Rheumatic Heart DiseaseSymptoms: - Shortness of Breath - Shortness of Breath - PND - PND - Orthopnea - Orthopnea

Pulmonary Edema Physical Examination: - Gallop Rhythm - Gallop Rhythm - ↑JVP - ↑JVP - Basal Crackles - Basal Crackles - Lower Limb Edema - Lower Limb Edema Investigations: - CXR,ECG,ECHO Treatment : - Oxygen - Diuretics - Diuretics - Digoxin - Digoxin - After load Reduction - After load Reduction

Pneumothorax  Traumatic  Spontaneous -Tall Thin -Tall Thin

Pneumothorax Treatment:  Immediate Needle Insertion (Second Intercostal Space) (Second Intercostal Space)

Pneumothorax Treatment:  Chest Tube Insertion

Pneumonia History: - Cough - Shortness of Breath - Shortness of Breath - Fever - Fever - Sputum - Sputum Examination: - Dullness - ↑ Vocal fremitus - ↑ Vocal fremitus - Bronchial Breathing - Bronchial Breathing - Crackles - Crackles Treatment: - Oxygen - Antibiotics - Antibiotics

Pulmonary Embolism Predisposing factors: - Immobilization - Immobilization - Recent surgery - Recent surgery - Hyper coagulable state - Hyper coagulable state

Massive Pulmonary Embolism Treatment:  Thrombolytic Therapy  Heparin  Warfarin

Acute Respiratory Distress Syndrome Causes: - Aspiration Pneumonia - Aspiration Pneumonia - Near Drowning - Near Drowning - Chest Trauma - Chest Trauma - Severe Pneumonia - Severe Pneumonia

Atelectasis Causes: Foreign body Foreign body Endobronchial lesion Endobronchial lesion Excessive secretions Excessive secretions

Respiratory Failure Type II : Ventilation Failure (Hypercapnic) Ventilation Failure (Hypercapnic)

Causes Of Respiratory Failure Outside The Lung

Respiratory Failure COPD: Causes: Causes:  Emphysema  Chronic Bronchitis

Shortness of Breath on Exertion

Pursed Lip Breathing

FVC FEV 1 NORMAL = FVC > 75% TIME

FVC FEV 1 Airway Obstruction = FVC < 75% FEV TIME

COPD Treatment: Oxygenation Oxygenation Ventolin Inhalation Ventolin Inhalation Atrovent Inhalation Atrovent Inhalation Steroids Steroids Antibiotics Antibiotics