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Questions and Answers
What is a defining characteristic of respiratory failure?
What is a defining characteristic of respiratory failure?
- Normal levels of carbon dioxide
- Increased PaO2 above 60 mmHg
- Elevated blood pH
- Inadequate gas exchange leading to hypoxia (correct)
Which of the following conditions is NOT a cause of respiratory failure?
Which of the following conditions is NOT a cause of respiratory failure?
- Severe asthma
- High blood pressure (correct)
- Pneumonia
- COPD
What symptom is associated with hypoxia during respiratory failure?
What symptom is associated with hypoxia during respiratory failure?
- Confusion (correct)
- Drowsiness
- Tremor/flap
- Hypertension
Which type of respiratory failure requires controlled oxygen therapy?
Which type of respiratory failure requires controlled oxygen therapy?
What is a common feature of ventilator masks used in oxygen therapy?
What is a common feature of ventilator masks used in oxygen therapy?
Which finding would indicate hypercapnia in a patient?
Which finding would indicate hypercapnia in a patient?
What is the primary aim of investigations in respiratory failure?
What is the primary aim of investigations in respiratory failure?
In managing Type I respiratory failure, what therapeutic approach should be prioritized?
In managing Type I respiratory failure, what therapeutic approach should be prioritized?
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Study Notes
Definition of Respiratory Failure
- Respiratory failure is characterized by inadequate gas exchange, leading to hypoxia (PaO2 < 60 mmHg).
- Causes include alveolar hypoventilation and potential ventilation/perfusion (V/Q) mismatch.
Causes of Respiratory Failure
- Pulmonary Diseases:
- Severe asthma
- Chronic obstructive pulmonary disease (COPD)
- Pneumonia
- End-stage pulmonary fibrosis
- Obstructive sleep apnea
- Reduced Respiratory Drive:
- Sedative drugs
- CNS tumors
- Trauma
- Neuromuscular Diseases:
- Cervical cord lesions
- Diaphragmatic paralysis
- Poliomyelitis
- Myasthenia gravis
- Guillain–Barré syndrome
- Thoracic Wall Diseases:
- Flail chest
- Kyphoscoliosis
Clinical Features
- Symptoms of hypoxia include:
- Dyspnea
- Restlessness
- Agitation
- Confusion
- Central cyanosis
- Long-term hypoxia can lead to:
- Polycythemia
- Pulmonary hypertension
- Cor pulmonale
- Symptoms of hypercapnia include:
- Headache
- Peripheral vasodilation
- Tachycardia
- Bounding pulse
- Tremor/flap
- Papilledema
- Confusion
- Drowsiness
- Coma
Investigations
- Blood tests: Full blood count (FBC), urea & electrolytes (U&E), C-reactive protein (CRP), arterial blood gases (ABG).
- Radiology: Chest X-ray (CXR).
- Microbiology: Sputum and blood cultures if febrile.
Management Strategies
-
Type I Respiratory Failure:
- Treat the underlying cause.
- Administer oxygen via facemask to alleviate hypoxia.
- Consider assisted ventilation as needed.
-
Type II Respiratory Failure:
- Address the underlying cause.
- Utilize controlled oxygen therapy.
- Employ assisted ventilation, with intubation considered if other treatments fail.
- Oxygen delivery methods include:
- Nasal Cannulae: Well-accepted by patients; offers imprecise O2 delivery and potential nasal soreness.
- Simple Face Mask: Varies O2 delivery based on inflow rate; risk of CO2 accumulation.
- Venturi Mask: Provides controlled FiO2 at high flow rates; start at 24-28% for COPD patients.
- Non-rebreathing Mask: Equipped with a reservoir bag; capable of delivering high O2 concentrations (60-90%).
- Non-invasive Ventilation: Such as CPAP/BiPAP.
- Invasive Ventilation: Considered in severe cases.
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