Respiratory Failure

Emergency Medicine Resident Half-Day September 22nd, 2010 Tyler Johnston

and management of acute respiratory failure . classification.Respiratory Failure ‡ Anatomy and Physiology relevant to the identification.

Respiration ‡ Ventilation = getting gases into lungs ‡ External Respiration = alveolar gas exchange ‡ Internal Respiration = tissue gas exchange ‡ Intra-cellular respiration .

Why oxygen again? ‡ Need O2 to perform last steps of oxidative phosphorylation (OP) in mitochondria ‡ Oxidative phosphorylation allows ATP formation ‡ ATP required for intracellular energy transfer and cellular metabolism ‡ NO ATP CELLS DIE! .

resp rate) ‡ Hypoxic Drive (10-15%) ‡ Low O2 detected in medulla ‡ CNS Receptors ‡ Both CO2 and O2 but not pH . carotid) transmitted to CNS receptors inducing ventilation (inc. pH by peripheral chemoreceptors (aorta.Drive to Breath ‡ Hypercapnic Drive (80-90%) ‡ Excess CO2 dissolved in the blood is sensed as dec.

Respiratory Anatomy Q i k imeΠan a Un ompresse e ompressor are nee e to see t is pi t re .

Respiratory Anatomy ‡ Remember surfactant for maintaining surface tension of alevoli (e. ARDS interrupts surfactant and alveoli collapse) ‡ Tracy will tal about gas exchange in depth .g.

Respiratory Physiology .

Respiratory Physiology ‡ Must create pressure gradient to get O2 into alveoli ‡ Atmospheric pressure normally 760 mmHg outside the lungs ‡ Intrapleural pressure normally 756 mmHg (-4mmHg) would cause air to enter lungs ‡ B T recoil of lungs provides + 4mmHg .

.Creating negative intrathoracic pressure uic Ti e an a TI ( nco presse ) eco pressor are nee e to see this picture.

Recognizing RF ‡ Brian¶s going to tal about physical and clinical signs and symptoms .

4 ‡ Normal pCO2 = 40 ‡ Normal pO2 = 100 .ABGs and RF ‡ CO2 + H2O H2CO3 H+ + HCO3‡ 60% CO2 carried in blood as carbonic acid ‡ Normal pH = 7.

PCO2 > 50 ‡ Respiratory failure can be one or both of these failing to occur (classification later) .PaO2 < 60 ‡ Failure to ventilate (¡CO2 out) .Respiratory Failure ‡ Failure to oxygenate (¡O2 in) .

e.Physiology of RF HYPOXEMIC: ‡ 1) inability to get enough O2 to the alveolus for gas exchange (FB. gas exchange) . asthma) ‡ 2) inability to get enough O2 across alveolus (i.

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