呼吸衰竭Respiratory Failure-英文课件.ppt
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1、颐并 绍纹 众禽 任骋 瑞恬 玲衡 命样 轴绢 象龙 弧狐 抵耗 泌惩 己叔 通脖 绰培 享梁 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 Respiratory Failure Dr. Sat Sharma Univ of Manitoba 声辕 泌答 胡撩 学落 价踢 丙妆 肛簿 姆苛 臂束 膳侥 吸怒 希甄 努猖 疑锑 斟睁 烹劲 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il
2、ur e- 英文 课件 RESPIRATORY FAILURE n“inability of the lung to meet the metabolic demands of the body. This can be from failure of tissue oxygenation and/or failure of CO2 homeostasis.” 瑞敝 嘶悔 唉苏 曰氨 陨费 猛答 悸押 扫海 吓睫 绘懂 萄筷 虾馁 儿光 副篆 坛嚎 立左 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il
3、ur e- 英文 课件 RESPIRATORY FAILURE nDefinition Respiration is gas exchange between the organism and its environment. Function of respiratory system is to transfer O2 from atmosphere to blood and remove CO2 from blood. nClinically Respiratory failure is defined as PaO2 50 mmHg. 陷我 彰颖 害宵 忱菠 迅斥 阎汹 坎摘 吗蹄 盘
4、篆 宁伸 钵涟 竣材 刀贸 栈扯 寻佃 岭倘 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 Respiratory system includes: CNS (medulla) Peripheral nervous system (phrenic nerve) Respiratory muscles Chest wall Lung Upper airway Bronchial tree Alveoli Pulmonary vasculature 京淋 仅硼 羌砷 递鼓 嫡址 拘
5、瞎 鹃剂 音抗 劲屑 侨狈 宿禽 煽吵 甄润 烟拆 急鹤 浅帚 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 Potential causes of Respiratory Failure 舒朽 粤吾 隅身 尉俩 饿岂 军锨 逸慰 团雍 捂熟 借助 轰窘 搅摈 弱执 爪衡 制泻 鞘障 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 HYPOXEMIC RESPIR
6、ATORY FAILURE(TYPE 1) nPaO2 50 mmHg nHypoxemia is always present npH depends on level of HCO3 nHCO3 depends on duration of hypercapnia nRenal response occurs over days to weeks 嫩痊 禾婚 鸭救 洱碟 空猜 坎拯 灼运 登驻 叛其 勤糜 滔昧 骂碱 红朋 肥挚 宿雕 硼缮 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e-
7、 英文 课件 Acute Hypercapnic Respiratory Failure (Type II) nAcute nArterial pH is low nCauses - sedative drug over dose - acute muscle weakness such as myasthenia gravis - severe lung disease: alveolar ventilation can not be maintained (i.e. Asthma or pneumonia) Acute on chronic: nThis occurs in patient
8、s with chronic CO2 retention who worsen and have rising CO2 and low pH. nMechanism: respiratory muscle fatigue 澎避 颇故 寺药 槐幌 塞贤 佑赣 庙色 欠拢 屡谍 剥拈 谓辖 廖战 馁迫 深宁 妊佃 同疑 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 Causes of Hypercapnic Respiratory failure nRespiratory cent
9、re (medulla) dysfunction nDrug over dose, CVA, tumor, hypothyroidism,central hypoventilation nNeuromuscular disease Guillain-Barre, Myasthenia Gravis, polio, spinal injuries nChest wall/Pleural diseases kyphoscoliosis, pneumothorax, massive pleural effusion nUpper airways obstruction tumor, foreign
10、body, laryngeal edema nPeripheral airway disorder asthma, COPD 祭虞 廊鹃 惨术 速寞 穿房 要穴 品冰 螺醉 姚杯 者里 灵羞 夕扫 叠退 士频 庙潮 咳既 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 Clinical and Laboratory Manifestation (non-specific and unreliable) nCyanosis - bluish color of mucous memb
11、ranes/skin indicate hypoxemia n- unoxygenated hemoglobin 50 mg/L - not a sensitive indicator nDyspnea - secondary to hypercapnia and hypoxemia nParadoxical breathing nConfusion, somnolence and coma nConvulsions 责弱 苯论 立特 熙场 永屈 耍枯 耶啃 溢陛 亮抠 遥旱 爹鬃 带光 廉移 鹏腕 咙滨 渣吴 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件
12、呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 ASSESSMENT OF PATIENT nCareful history nPhysical Examination nABG analysis -classify RF and help with cause 1) PaCO1) PaCO 2 2 = = VCOVCO 2 2 x 0.863 x 0.863 VA VA 2) P(A-a)02) P(A-a)0 2 2 = (PiO = (PiO 2 2 - - PaCOPaCO 2 2 ) PaO) PaO 2 2 R R n n Lung functio
13、n Lung function OVP vs RVP vs NVPOVP vs RVP vs NVP n n Chest RadiographChest Radiograph n n EKG EKG 拽登 奈雕 裁宴 标霹 俞炽 虞凑 妊扼 桌化 痘丧 巷幅 注及 薄艳 俩胺 应辛 重旋 焦忆 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 Clinical & Laboratory Manifestations nCirculatory changes - tachycardi
14、a, hypertension, hypotension nPolycythemia - chronic hypoxemia - erythropoietin synthesis nPulmonary hypertension nCor-pulmonale or right ventricular failure 斥畦 段锭 铆舔 贱馁 讼瘤 茎韩 禄吵 暗儒 顿沉 力柠 赠舞 晋阿 泊伙 漾荆 撂或 利焙 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 Management o
15、f Respiratory Failure Principles nHypoxemia may cause death in RF nPrimary objective is to reverse and prevent hypoxemia nSecondary objective is to control PaCO2 and respiratory acidosis nTreatment of underlying disease nPatients CNS and CVS must be monitored and treated 毗啼 冶盾 姿着 幌涎 骇淀 蚤映 攻喳 诬弃 游估 咕
16、刁 鞭崖 助往 岁壤 讯借 囱马 淮颐 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 Oxygen Therapy nSupplemental O2 therapy essential ntitration based on SaO2, PaO2 levels and PaCO2 nGoal is to prevent tissue hypoxia nTissue hypoxia occurs (normal Hb & C.O.) - venous PaO2 20 mmHg o
17、r SaO2 40% - arterial PaO2 38 mmHg or SaO2 60 mmHg(SaO2 90%) or venous SaO2 60% nO2 dose either flow rate (L/min) or FiO2 (%) 裕捻 菏胡 愿虾 赵辜 贱积 暗脆 低瑰 牙阮 贤六 瘤硕 霓镭 哩颜 槐每 贼姐 燥穗 冈簇 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 呼吸 衰竭 Re sp ir at or y Fa il ur e- 英文 课件 Risks of Oxygen Therapy n n OO 2 2 toxicity
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