alkalotic co235CO2 and hyperventilationlow CO2CO2 and hypoventilationhigh Co2normal pO280-100normal HCO322-26normal SaO295-100%S/sx of ARF- dyspnea - restlessness - intercostal retractions - tachycardia - decreased LOC - dysrhythmiasTreatment for ARF- find the cause! - give fluids to maintain electrolytes - O2 mask - high fowlers - bronchodilatorsacute respiratory distress syndrome (ARDS)Hypoxemia from ARF persists and leads to extravascular lung fluidHow do you know its ARDS?pt is receiving O2 and their SaO2 level is still not changingMain site source of complications in ARDSalveolar capillary membraneS/Sx of ARDS-hypoxemia despite high concentration of delivered O2 -dyspnea/tachypnea -restlessness -rapid/shallow respiration -increased HR -combo of resp and metabolic acidosis -3rd space swelling due to inflammation in alveoli which leads to fluid overloadWhat are you trying to fix when you intubate someone with ARDS? (always non-invasive first)their PEEP - keeps alveoli open to force gas exchangeWhy must the patient be able to protect their airway when on NPPV?air will get pumped into stomach, causing emesis, causing aspirationTreatment for ARDS-Mechanical ventilation with PEEP -diuretics bc they are in fluid overload3 phases of ARDS1. Exudative 2. Proliferative 3. FibroticExudative phase-early changes in breathing -edema and shuntingFibrosing phase-pulmonary HTN -scarring from cell death in alveolar membrane -MODSResolution phase- >14 days -death -if you live, may have neuropsychological deficitsPatho of a pulmonary embolismBlood clot from DVT or VTE is stuck in alveoli, causes ↓ perfusion → V/Q mismatch → to compensate the mismatch vasoconstriction occurs which leads to pulmonary HTN → impaired gas exchange → ↓ tissue perfusion → hypoxia → ARF → ARDSS/sx of PESOB, dyspnea, chest pain, frothy sputum, hemoptysisTreatment for PEThrombolytics, antiplatelets, anticoagulantsex of thrombolyticstPA (activase, alteplase)Antiplatelet medsAspirin Clopidogrel (Plavix)Anticoagulant drugsreduce the likelihood of blood clotting Heparin and WarfarinpneumothoraxAccumulation of air in the pleural space which causes a decrease in vital capacityWhy does the lung collapse in a pneumothorax?loss of the negative pressure in the pleural spaceSimple and massive hemothoraxblood loss is less than or more than 1000tension pneumothoraxa pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels.s/sx of pneumothorax-SOB -flail chest -unequal or absent breath sounds -deviated trachea -this patient will be in ARDSTreatment for Pneumothoraxchest tube -Emergency TX is thoracostomyYour patient is intubated and their O2 sat is low, what is your first action?ASSESS- listen to their lung soundsBest way to ensure correct placement of an ET tubeEnd tidal CO2 or use paper to see if CO2 is being expelledPEEPpositive end-expiratory pressure - Keeps lung inflated during expirationTidal VolumeAmount of air that moves in and out of the lungs during a normal breathFiO2fraction of inspired oxygen; the concentration of oxygen in the air we breathecontrolled ventilationA type of ventilation in which the anesthetist controls the respiratory rate, the tidal volume, and the peak inspiratory pressure. In this type of ventilation, the patient does not make spontaneous respiratory efforts.assist control ventilation-Has a preset rate and preset tidal volume -patient CAN breathe on own, uses own breaths -when patient initiates own breath, vent will give preset tidal volumeSIMVPatient breaths spontaneously in between mandatory breaths and tidal volume is setPressure Support Ventilation (PSV)-Predetermined pressure set on the ventilator to assist the client in respiratory effort -used to wean patient off ventilation