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ARF, Sinus problems - Coggle Diagram
ARF
Pulmonary risk factors
- Smoking history: type (cigarettes, cigar, pipe); amount per day and duration
- Childhood respiratory diseases/symptoms
- Family history of respiratory disease
- Environmental exposures: location (e.g., home, work , region,) type , duration
- Obesity or nutritional depletion.
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Interventions
- Monitor SpO₂ باستمرار وأعطي Oxygen therapy، ولو مش كافي → CPAP أو Mechanical ventilation.
- ضع المريض في High-Fowler’s position، وساعده على deep breathing & incentive spirometry.
- Manage pain لتقليل hypoventilation، وساعد في airway clearance (suction – humidification).
- Positioning: good lung down (unilateral)، أو right lung down/تغيير الوضع كل ساعتين (bilateral).
- Prevent aspiration: رفع رأس السرير 30°، تأكد من cuff inflation، وقدم عناية فموية مستمرة.
- Prevent infection: hand hygiene، aseptic technique، care of lines & catheters.
- Collaborate مع الطبيب: أدوية (sedatives, analgesics, NM blockers)، التغذية (↑fat ↓carbs لتقليل CO₂)، weaning plan.
- Promote rest & sleep (فترات نوم 2–4 ساعات متواصلة).
- Improve communication (لو intubated: كتابة، صور، إشارات).
- Progressive ambulation & physiotherapy لتحسين respiratory muscles.
Main causes of hypoxemia
Alveolar hypoventilation
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Leads to: Hypoxemia + Hypercapnia
Commonly due to extrapulmonary disorders (neuromuscular diseases, chest wall deformities, CNS depression).
V/ Q mismatching
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Causes
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Fluid-filled alveoli (e.g., pneumonia, pulmonary edema)
inpulmonary shunt
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Causes: atelectasis, alveolar flooding (pus, blood, fluid)
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Diffusion impairment
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Causes: pulmonary fibrosis, ARDS, pulmonary edema.
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classification of ARF
Acute hypoxemic type 1:
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Oxygenation failure, not ventilation failure
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Combined:
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Causes : Asthma exacerbation
Emphysema with infection
Severe pneumonia
Pulmonary edema
Pulmonary embolism
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Treatment
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- Correct or compensate for the gas exchange abnormality (optimize oxygenation & ventilation).
- Identify and treat the underlying cause (infection, obstruction, edema, drug overdose, etc.).
Managment
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Acute Hypercapnic type
Assess for CNS depression (sedatives, narcotics) → give Naloxone if opioid overdose.
Assess for bronchospasm (COPD, asthma) → give bronchodilators + corticosteroids.
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Assessment
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Symptoms
Pulmonary
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Cough ± Sputum, Hemoptysis
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Paroxysmal nocturnal apnea, Snoring, Sleep disturbances, Daytime drowsiness
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Clinical findings
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Hypoxemia
Peripheral cyanosis of the skin , lips, or nail
Def: a sudden and lifethreatening deterioration in pulmonary gas
exchange,
Impaired ventilation or perfusion
Pao2 <50, paco2>50, pH <7.35
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