week 3 Respiratory Disorders
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Questions and Answers

What are the two main factors involved in oxygen causing CO2 retention in COPD patients?

V/Q mismatch and the Haldane effect

What happens to hypoxic pulmonary vasoconstriction when oxygen is administered to COPD patients?

It is reduced.

What happens to patients who cannot increase their minute ventilation when CO2 is displaced by oxygen?

They experience a higher PaCO2.

What are some conditions, besides COPD, that can be at risk of CO2 retention due to oxygen administration?

<p>Severe asthma, community-acquired pneumonia, obesity hypoventilation syndrome, and neuromuscular conditions</p> Signup and view all the answers

What is the result of increased dead space ventilation in COPD patients?

<p>Higher PaCO2 due to overall lack of ventilation at the alveolar level</p> Signup and view all the answers

What is the term that describes the difference in the quantity of carbon dioxide carried in oxygenated and deoxygenated blood?

<p>The Haldane effect</p> Signup and view all the answers

What is the definition of pneumonia?

<p>Acute inflammation of the lung parenchyma</p> Signup and view all the answers

What is the most common type of pneumonia presenting to the emergency department?

<p>Community-acquired pneumonia</p> Signup and view all the answers

What is the result of increased capillary permeability in pneumonia?

<p>Diffusion of O2 and CO2 is altered</p> Signup and view all the answers

In pneumonia, what is the direction of the A-a gradient change?

<p>Increased</p> Signup and view all the answers

What is the primary cause of respiratory distress in patients?

<p>Ventilatory problems, infectious processes, impaired CNS drive, heart failure, and metabolic problems</p> Signup and view all the answers

What is the definition of chronic bronchitis?

<p>A chronic cough with sputum production for at least 3 months per year for 2 consecutive years</p> Signup and view all the answers

What is the pathophysiological effect of emphysema on the lungs?

<p>Destruction of lung units distal to terminal bronchioles leading to abnormal permanent airspace enlargement</p> Signup and view all the answers

What are the common features of chronic obstructive pulmonary disease (COPD)?

<p>Combination of chronic bronchitis and emphysema, often with asthma</p> Signup and view all the answers

What is the primary goal of COPD treatment?

<p>Relieve hypoxia</p> Signup and view all the answers

What is the definition of respiratory failure?

<p>Inability of the lungs to provide adequate oxygenation or ventilation</p> Signup and view all the answers

List the major causes of respiratory failure.

<p>Cardiovascular, respiratory, metabolic, mechanical, and extra-pulmonary factors</p> Signup and view all the answers

What are the clinical features of respiratory failure?

<p>Dyspnoea, coughing, cyanosis, tachypnea, and use of accessory muscles</p> Signup and view all the answers

What is the management of respiratory failure?

<p>Oxygen therapy, bronchodilators, corticosteroids, antibiotics, and non-invasive ventilation (NIV)</p> Signup and view all the answers

Signs of life-threatening asthma

<p>Inability to speak • Silent chest • Sweating &amp; vomiting • Panic • SaO2&lt; 90% with O2</p> Signup and view all the answers

Chronic Bronchitis Clinical diagnosis

<p>Long-standing inflammation of the lower airways Coughing and mucus for at least 3 months a year for 2 years in a row</p> Signup and view all the answers

Emphysema Pathological diagnosis

<p>Destroys the alveoli Lungs lose elasticity Alveoli become enlarged</p> Signup and view all the answers

COPD Treatment

<p>• Relieve hypoxia – hypoxia kills faster than hypercarbia • Titrate oxygen to SpO2 88-92% • Positioning – seated / semi-seated • Bronchodilators – salbutamol &amp; Ipratropium – MDI / neb • NIV –BiPAP for ventilatory support &amp; alveolar recruitment • Corticosteroids • Antibiotics</p> Signup and view all the answers

Pneumonia Management

<p>Antibiotic therapies • commence as soon as possible • broad spectrum until the specific organism is isolated • Respiratory support a needed • Oxygen to correct hypoxia • Enable expectoration – Chest Physiotherapy • Bronchodilator therapies – open airways/loosen consolidation • Fluids and Electrolyte management • Nutritional support</p> Signup and view all the answers

Pulmonary Embolism Treatment

<p>Closely observe – continuous Sp02 and cardiac monitoring. • Oxygen • Fluid loading • Anticoagulation • Thrombolytics (massive PE) • ETT &amp; IPPV • Inotropes • Surgery</p> Signup and view all the answers

Asthma Pathophysiology

<p>Chronic inflammatory disorder of the lower airways Bronchial hyper-responsiveness • Airway remodelling occurs secondary to the inflammation: Thickening and Fibrosis of bronchiole</p> Signup and view all the answers

Asthma Treatment

<p>• Bronchodilators • 12x salbutamol &amp; 8 Atrovent via MDI with spacer • Can give 5mg salbutamol &amp; 500mcg ipratropium neb • Repeat / continuous bronchodilators • May need K+ replacement • Oxygen – titrate to 93-95% • If no response, add IV Magnesium Sulfate • Systemic corticosteroids – 100mg Hydrocortisone • Ventilate………. NIV or invasive…….Difficult • Zeep &amp; permissive hypercapnea • Increased I:E ratio, longer expiratory time • Continue to treat underlying cause</p> Signup and view all the answers

What is an A-a gradient?

<p>The difference between the alveolar oxygen tension (PAO2) and the arterial oxygen tension (PaO2) in the blood.</p> Signup and view all the answers

What is the main difference between obstructive and restrictive lung disease?

<p>Obstructive lung disease, such as COPD, is characterized by airflow obstruction, restrictive lung disease, such as pulmonary fibrosis, is characterized by decreased lung volume and difficulty expanding the lungs.</p> Signup and view all the answers

Study Notes

Common Respiratory Disorders

  • The learning outcomes for this topic include identifying the causes, pathophysiology, clinical features, diagnostic features, and management of acute respiratory disorders such as COPD, pulmonary embolism, pneumonia, and asthma.

Causes of Respiratory Distress

  • Respiratory distress can be caused by ventilatory problems, whether obstructive or restrictive, acute or chronic, or impaired pulmonary ventilation or perfusion.
  • Infectious processes, impaired CNS drive, heart failure, metabolic problems, and normal responses to increased activity can also cause respiratory distress.

Taking a Good History

  • Taking a thorough medical history is essential in assessing patients, not just in the emergency department but in every area of healthcare.
  • Important questions to ask include the length of time the symptoms have been present, the onset (gradual or abrupt), and the position of comfort.
  • It is also essential to ask about orthopnea, coughing, haemoptysis, pain, and other symptoms.

Focused Assessment

  • A focused assessment should include an evaluation of the ABCs (airway, breathing, and circulation) and signs and manifestations of shortness of breath.
  • Other essential factors to assess include cough, sputum, fever, chest pain, and haemoptysis.

Dyspnoea Causes

  • Dyspnoea can be caused by cardiovascular, respiratory, metabolic, mechanical, or extra-pulmonary disorders.
  • Acute dyspnoea without prior heart or lung disease can be particularly challenging to diagnose.

Chronic Lung Disease

  • Chronic lung disease can be obstructive (cannot get air out) or restrictive (cannot get air in).
  • Examples of obstructive chronic lung diseases include asthma, bronchiectasis, chronic bronchitis, emphysema, COPD, and COAD.
  • Restrictive chronic lung diseases include interstitial pulmonary fibrosis, asbestosis, cystic fibrosis, and others.

COPD

  • COPD affects 5% of the population and may present as life-threatening respiratory failure.
  • It is a common co-morbidity and often combines chronic bronchitis and emphysema, with or without asthma.

Chronic Bronchitis

  • Chronic bronchitis is a clinical diagnosis characterized by a chronic cough with sputum production for at least three months per year for two consecutive years.
  • It involves long-standing inflammation of the lower airways, mucus production, infections, wheezing, coughing, and mucus for at least three months a year for two years in a row.
  • Vital capacity is decreased, tidal volume is normal or decreased, and alveolar ventilation is reduced.

Emphysema

  • Emphysema is a pathological diagnosis characterized by the destruction of lung units distal to terminal bronchioles, leading to abnormal permanent airspace enlargement.
  • It destroys alveoli, causing loss of recoil, air trapping, and increased residual volume, leading to pulmonary hypertension and cor pulmonale (right heart failure).
  • Smokers are at risk, and symptoms include shortness of breath, barrel chest, and blue discoloration.

COPD Treatment

  • Relieve hypoxia by titrating oxygen to SpO2 88-92%.
  • Position patients in a seated or semi-seated position.
  • Administer bronchodilators, such as salbutamol and ipratropium.
  • Use non-invasive ventilation (NIV) with BiPAP for ventilatory support and alveolar recruitment.
  • Consider corticosteroids and antibiotics.

Pneumonia

  • Pneumonia is an acute inflammation of the lung parenchyma, with a 10% mortality rate in Australia.
  • It is the second most common hospital-acquired infection, with the highest mortality rate for hospital-acquired infections.
  • It is a common cause of death in the elderly.

Pneumonia Classification

  • Pneumonia can be classified into community-acquired pneumonia, hospital-acquired (nosocomial) pneumonia, pneumonia in the immunocompromised patient, and aspiration pneumonia.

Community-Acquired Pneumonia

  • Community-acquired pneumonia is the largest majority of presentations to the emergency department.
  • It can be typical (common bacteria) or atypical (uncommon bacteria), and is mostly managed in the community.

Hospital-Acquired Pneumonia

  • Hospital-acquired pneumonia is acquired during a hospital stay, after 72 hours of admission.
  • It is the leading cause of death among hospital-acquired infections, with a broad range of causative organisms, some being antibiotic-resistant.

Pneumonia Risk Factors

  • Risk factors for pneumonia include advanced age (>65 years), smoking history, stroke or swallowing difficulty, URTI, tracheal intubation, prolonged immobility, immunosuppressive therapy, non-functional immune system, malnutrition, dehydration, and co-morbidities such as CAL, diabetes, CHD.

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Common Respiratory Disorders 2024 PDF

Description

Identify the causes, symptoms, and management of common respiratory disorders including COPD, Pulmonary Embolism, Pneumonia, and Asthma in critical care settings.

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