Professional Documents
Culture Documents
EMERGENCIES
Samuel Harmin
Introduction
Respiratory insufficiency
Character
Respirations should have a regular rhythm,
occurring at regular intervals
Sounds
Breath sounds can be heard by using a
stethoscope
Dyspnea classification
pathophysiology, anatomic, disorders
EXTRA Obstruction
clinical: inspiratory stridor
of proximal
FLOW thorax age:/ larger
infant airway
below five
disorders
INTRA Obstruction
clinical: expiratory
of distaleffort
/
thorax age:smaller airway
infants, < 5 years bronchiolitis
Definition
Ventilation Oxygenation
FATIGUE
TRESHOLD
TIME
PaO2 < 60
Hypoxemic mmHg
PaCO2 > 45
mmHg
Hypercapnic
Hypoxia Hypercar
bia
Hypoxia
Hypocarb
ia
A reduced rate
and/or depth
Tachypnea of breathing
ASD, VSD,
Pulmonary AVM,
Pneumonia,
Asthma, COPD
Management of Respiratory Failure
Chronic
inflammatory
disorder of airways
Etiology and
Bronchial hyper-
pathophysiol responsiveness
ogy
Asthma
Limited airflow or
obstruction
reverses Episodic
spontaneously or
with treatment
...asthma
Dyspnea
Signs of respiratory
Signs/ distress
Coughing
Symptoms Expiratory wheezing
Tachypnea
Cyanosis
Patient position?
Drowsy or stuporous?
Physical Signs/symptoms of
Exam dehydration?
Chest movement?
Quality of breath sounds?
ABC
Humidified oxygen
Rehydration
Management nebulized beta-2 agents
Ipatropium
Corticosteroids
Aminophylline
Pneumonia
Inflammation of the alveoli caused by bacteria, virus,
Mycoplasma organisms, aspiration, or inhalation.
Broncho bronchioles become clogged with thick
Definition mucopurulent mucus consolidates into patches in nearby
lobes.
Lobar pneumonia
Bronchopneumonia
Classification
Interstitial pneumonia
Pneumonitis
Hypoglycemia
Hypovolemia
Evaluation
Score:
> 4 = Clinical respiratory distress; monitor arterial blood gases
> 8 = Impending respiratory failure
Respiratory Distress Syndrome
Increased WoB
...pathophysiology
Atelectasis keeps
PVR high
Increased PAP
Lung hypoperfusion
R-L shunting may
re-occur across the
Ductus Arteriosus
and the Foramen
Ovale
Clinical findings: Physical
Tachypnea Decreased breath
(60 BPM or >) sounds with crackles
Retractions Cyanosis on room air
Nasal flaring Hypothermia
Expiratory grunting Hypotension
Helps generate
autoPEEP
Apnea
Clinical Findings: Lab
ABGs: initially respiratory alkalosis and
hypoxemia that progresses to profound hypoxemia
and combined acidosis
Increased Bilirubin
Hypoglycemia
Surfactant instillation!!!
May cause a sudden drop in elastic
resistance!
Prognosis/Complications
Prognosis is good once infant makes it past
the peak (48-72 hours)