26 terms
R. Part 3 - Acute Respiratory Failure (ARF)
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What is acute respiratory failure?
failure of your lungs to have adequate oxygen exchange - results in hypoxia, then hypoxemia
what is the hallmark of acute respiratory failure?
hypoxemia as a result of impaired gas exchange
What is the etiology of ARF?
it can be divided into intrapulmonary and extrapulmonary
Etiology: Intrapulmonary
this is a lung problem - COPD, PE, pneumonia, asthma, all of the respiratory problems that lead to respiratory failure
Etiology: Extrapulmonary
this is not a lung problem - brain injury, stroke, spinal cord injury, overdose of mediaction - something has wiped out your drive to breathe - "when my patient had a stroke, they lost the ability to maintain their airway, and now needs a vent"
ARF defined
Type 1 and type 2
ARF defined: Type 1
hypoxemic and normocapnic
ARF defined: Type 2
hypoxemic and hypercapnic
ARF defined: PaO2 <
50 - anytime your O2 is less than your PCO2, you are not well off - normal is 80-100
ARF defined: +/- PCO2 >
50 - normal is 35-45
ARF - PaO2 and PCO2
your CO2 is going to be low no matter what, if you have acute respiratory failure. Checking to see if the O2 is less than your PCO2 - this is BAD
ARF defined: if chronically ______ pH < ____
hypercapnic; 7.5
Overall ARF defined =
type 1 or type 2, PaO2 < 50, +/- PCO2 > 50
Anytime a patient has a pH of < ____, they will be intubated/ ventilater
7.25
Causes of ARF
inadequate airway, inadequate ventilation, inadequate respiration - not getting good gas exchange in the blood
Causes of ARF results in
alveolar hypoventilation; hypoxemia is the result of V/Q mismatch
Complications of ARF
Hypoxemia, hypoxia, decreased tissue perfusion, and MODS
Complications of ARF: decreased tissue perfusion
lactic acid production
Complications of ARF: MODS
Multiple Organ Dysfunction Syndrome - because you don't have oxygen to perfuse the rest of the body, so the lungs are the beginning of a process that can take over your whole body
Clinical Manifestations of ARF
CNS, CV, Pulmonary, Renal, GI, and Integument
Clinical Manifestations of ARF: CNS
restlessness, antsy, confusion, agitation - these are also seen in patients who are not getting enough pain medications and in patients who are getting "ICU confusion", so just because they are restless does not mean that they have ARF
Clinical Manifestations of ARF: CV
chest pain, tachycardic, hypertensive, dysrhythmias - may throw PVCs
Clinical Manifestations of ARF: Pulmonary
tachypnea - to get more O2, accessory muscle use - intercostal retractions and tripoding
Clinical Manifestations of ARF: Renal
decreased urinary output - goal is for UO to be a minimum of 30 cc's per hour or 1 cc per kg per hour - if UO decreases with other signs listed here, think decreased O2
Clinical Manifestations of ARF: GI
decreased GI motility - patient on TF will have residuals, decreased O2 to the stomach, decreased bowel sounds, N&V, and abdominal distention
Clinical Manifestations of ARF: Integument
initially, won't see anything - cyanosis is a LATE sign, worry about peptic ulcers since the patient is not perfusing the skin well