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Acute Respiratory Distress Crit care tute: 02/04 (Evaluation Goals…
Acute Respiratory Distress Crit care tute: 02/04
Dyspnoea:
Subjective, difficult, laboured, uncomfortable breathing
Resp Distress:
Clinical Picture of difficult breathing. Look at RR
Resp Failure
Inability of the Resp Sys. to maintin gas Exchange. Insufficient oxygenation and/or alveolar Worrying signs: Fatigue, bradypnoea, Cyanosis
Evaluation Goals
Detect and Correct
Hypoxia + hypercarbia
(VBG/ABG)
Hypoxia
cyanosis, tachycardia/ Tachypnoea, Agitation, ↓ GCS, Seizures
Hypercapnia
Complications: Seizure. coma, Death, stroke/MI,Arrythmias, Neuronal damage, metabolic acidosis, AKI
Identify Need for Assisted Ventilation
Non-Invasive Ventilaiton (NIV)
Invasive
TARGETED Hx and Exam → ddx
Initial
DIagnostic Plan
Treatment and Strategy
based on Diagnosis
ED Management
O2 Supplementation
Non-invasive Ventilation
Invasive + pressure Ventilation
Disposition → Where patient going?
Causes
Life Threatening
Tension Pneumothorax
Obstructive Shock, Cardiac Arrest
"Normal pneumothorax" can progress into tension with positive pressure ventilation
TX:
Need Decompression; Lateral Thoracotomy
Minimal Sympoms, <3cm → O2 and observe
Symptomatic, >3cm → small bore chest drain
10 days persistent: call for help
Massive PE
Types of PE: Massive, Submassive, "Regular"
Tx:
Thrombestomy ( Inventioal radiology); Thrombolysis
APO
Gray, SOB, Chest Pain, Sweaty, Severe Hypertension "Pink frothy sputum"
Tx:
O2, Diuressis, CPAP ( Non-invasive Ventilation (NIV)
Causes
Cardiac:
LHF failure secondary to: * decompensation
MI,
AF,
SVT,
Non-compliance,
Acute Valvular Abnormalies,
ACS,
Mycoarditis,
Fluid Overload
Non-cardiac:
*Near Drowning
Inhalation (toxic Gas/Smoke)
Septicaemia
Ureamia
Re-expansion
High Altitude
Clinical Features
A: ↓LOC, Secretions, Aspiration risk
B: Dypnea, orthopnea, Tachypnoea, Distress
C: Tachy, ↑ BP , S3 (specific Sign), ↑JVP, Peripheral Oedema
Management
A/B: O2 high flow 2L non-rebreather, positioning, suck secretions, consider NIPPV(CPAP) for resp distress, resp acidosis, hypoxia
*C:
Monitoring and Venous Access
Frusemide
→ niave (20-40mg), Reg meds: 1.5x dose
GTN
→ sublingual/infusion (↓preload)
NIPPV
(Cpap)
Treat arrhythmias, Treat Ischaemia
Morphine ( if pain and nort at risk of Resp. Depression)
Catheter
Re-assess B -blockers
Investigations
ECG: Ichaemia, Infarction, Arrythmia, LVH
XRAY: Pul. oedema, cardiomegaly etc.
Blds: FBC, trops, U+E's, ABG, BNP
Beside Echo (If Available)
Anaphylaxis
Tx:
IM Adrenaline 10mcg /kg to max of 0.5mL In lateral thigh, repeat in 5 minutes if no improvement
Upper Airway obstruction
Neuromuscular Weakness
Opiods, ETOH, Overdose,Cervical Lesion
Common
Asthma
COPD
APO
ACS
Pneumonia
Psycogenic
Assessment
1. Work of breathing
Tripoding (Mechanical advantage), accessory muscle use, Pursed lips, nasal flaring, tracheal tug, Stridor
2. Effectiveness of Respiratory Function
RR, O2 sats,
3. Respiratory Decompensation
RR, O2 sats, ABG's
4.Diagnosis of Cause
Common Pitfalls
Recognise Impending Resp. Failure
Look for hypoxia → marker of desaturating
Etiologies of Resp Failure ina patient with Chronic Resp failure (eg PE in COPD)
Considering inititiation of NIV → endotracheal intubation that might have been avoided (APO and COPD)
Over - reliance on pulse oximetry ( Eg: CO Poisoning)