Respiratory EmergenciesRespiratory Emergencies

Respiratory FailureRespiratory Failure

A condition that occurs when respiratoryA condition that occurs when respiratory

system is unable to adequately exchange system is unable to adequately exchange

Oxygen and Carbon Dioxide between Oxygen and Carbon Dioxide between

environment and tissues of the bodyenvironment and tissues of the body

Respiratory FailureRespiratory Failure

PaOPaO22 < 60 mmHg < 60 mmHg

PaCOPaCO22 > 50 mmHg > 50 mmHg

Types of Respiratory FailureTypes of Respiratory Failure

Type I :Type I :

Oxygenation Failure (Hypoxemic)Oxygenation Failure (Hypoxemic)

Type II :Type II :

Ventilation Failure (Hypercapnic)Ventilation Failure (Hypercapnic)

AsthmaAsthma

Factors Determine Severe AsthmaFactors Determine Severe Asthma

History:History: - Frequent Attacks - Frequent Attacks

- Excessive use of - - Excessive use of - BronchodilatorsBronchodilators

- - SteroidsSteroids

- Previous admission to ICU- Previous admission to ICU

AsthmaAsthma

Physical ExaminationPhysical Examination Inability to speakInability to speak CyanosisCyanosis Respiratory rate >30/mtRespiratory rate >30/mt Heart Rate >115/mtHeart Rate >115/mt Pulsus Paradoxus >10 mmHgPulsus Paradoxus >10 mmHg Silent chestSilent chest

AsthmaAsthma

Blood GasesBlood Gases Respiratory acidosisRespiratory acidosis Hypoxemia (Low POHypoxemia (Low PO22))

Hypercapnia (High PCOHypercapnia (High PCO22))

FVC

FEV1NORMAL =

FVC> 75%

0 1 2 3 4 5 6 7 8

TIME

100

75

50

25

FVC

FEV1Airway Obstruction =

FVC< 75%

FEV1

0 1 2 3 4 5 6 7 8

TIME

100

75

50

25

AsthmaAsthma

TreatmentTreatment Oxygen by MaskOxygen by Mask Salbutamol (Ventolin) inhalerSalbutamol (Ventolin) inhaler Aminophylline I.VAminophylline I.V CorticosteroidsCorticosteroids

Pulmonary EdemaPulmonary Edema

Risk Factors:Risk Factors: - Ischemic Heart Disease- Ischemic Heart Disease

SmokingSmoking DMDM HTNHTN ↑↑LipidsLipids

- Rheumatic Heart Disease- Rheumatic Heart Disease

Symptoms:Symptoms: - Shortness of Breath- Shortness of Breath

- PND- PND

- Orthopnea- Orthopnea

Pulmonary EdemaPulmonary Edema

Physical Examination:Physical Examination:

- Gallop Rhythm- Gallop Rhythm

- - ↑JVP↑JVP

- - Basal CracklesBasal Crackles

- Lower Limb Edema- Lower Limb Edema

Investigations:Investigations: - - CXR,ECG,ECHOCXR,ECG,ECHO

Treatment :Treatment : - Oxygen- Oxygen

- Diuretics- Diuretics

- Digoxin- Digoxin

- After load Reduction- After load Reduction

PneumothoraxPneumothorax

TraumaticTraumatic

SpontaneousSpontaneous

-Tall Thin -Tall Thin

PneumothoraxPneumothorax

Treatment:Treatment: Immediate Needle InsertionImmediate Needle Insertion

(Second Intercostal Space)(Second Intercostal Space)

PneumothoraxPneumothorax

Treatment:Treatment: Chest Tube InsertionChest Tube Insertion

PneumoniaPneumoniaHistory:History: - Cough- Cough

- Shortness of Breath- Shortness of Breath - Fever- Fever - Sputum- Sputum

Examination:Examination: - - DullnessDullness

- - ↑ Vocal fremitus↑ Vocal fremitus - - Bronchial BreathingBronchial Breathing - Crackles- Crackles

Treatment:Treatment: - - OxygenOxygen

- Antibiotics- Antibiotics

Pulmonary Embolism Pulmonary Embolism

Predisposing factors:Predisposing factors:

- Immobilization- Immobilization

- Recent surgery- Recent surgery

- Hyper coagulable state- Hyper coagulable state

Massive Pulmonary EmbolismMassive Pulmonary Embolism

Treatment:Treatment: Thrombolytic TherapyThrombolytic Therapy HeparinHeparin WarfarinWarfarin

Acute Respiratory Distress SyndromeAcute Respiratory Distress Syndrome

Causes:Causes:

- Aspiration Pneumonia- Aspiration Pneumonia

- Near Drowning- Near Drowning

- Chest Trauma- Chest Trauma

- Severe Pneumonia- Severe Pneumonia

AtelectasisAtelectasis

Causes:Causes: Foreign bodyForeign body Endobronchial lesion Endobronchial lesion Excessive secretionsExcessive secretions

Respiratory FailureRespiratory Failure

Type II :Type II :

Ventilation Failure (Hypercapnic)Ventilation Failure (Hypercapnic)

Causes Of Respiratory Failure Outside The LungCauses Of Respiratory Failure Outside The Lung

Respiratory FailureRespiratory Failure

COPD:COPD:

Causes:Causes:EmphysemaEmphysemaChronic BronchitisChronic Bronchitis

Shortness of Breath on ExertionShortness of Breath on Exertion

Pursed Lip BreathingPursed Lip Breathing

FVC

FEV1NORMAL =

FVC> 75%

0 1 2 3 4 5 6 7 8

TIME

100

75

50

25

FVC

FEV1Airway Obstruction =

FVC< 75%

FEV1

0 1 2 3 4 5 6 7 8

TIME

100

75

50

25

COPDCOPD

Treatment:Treatment: OxygenationOxygenation Ventolin InhalationVentolin Inhalation Atrovent InhalationAtrovent Inhalation SteroidsSteroids AntibioticsAntibiotics