respiratory failure انه هنا بشكل جديد

من طرف mr 7oda الأربعاء مارس 10, 2010 12:16 am

Respiratory Failure

1- Definition

-
Respiratory failure is nearly any condition that affects breathing function or
the lungs themselves and can result in failure of the lungs to function
properly.

- is used to describe inadequate gas exchange
by the respiratory
system, with the result that arterial oxygen and/or carbon dioxide levels
cannot be maintained within their normal ranges.

- A
drop in blood oxygenation
is known as hypoxemia;
a rise in arterial carbon dioxide levels is called hypercapnia.

2-Respiratory
failure is divided into type I and type II.

Type
I respiratory failure involves low oxygen, and normal or low carbon
dioxide levels.
Type
II respiratory failure involves low oxygen, with high carbon dioxide.

3-Pathophysiologic Mechanisms
in Acute Respiratory Failure

-The act of respiration
engages 3 processes:

(1) transfer of oxygen across the alveolus,

(2)
transport of oxygen to the tissues,

(3)
removal of carbon dioxide from blood into the alveolus and then into the
environment.

-Respiratory
failure may occur from malfunctioning of any of these processes.

-
In order to understand the pathophysiologic basis of acute respiratory failure,
an understanding of pulmonary gas exchange is essential.
-is used to describe inadequate gas exchange
by the respiratory
system, with the result that arterial oxygen and/or carbon dioxide levels
cannot be maintained within their normal ranges.

4-Causes of respiratory
failure
· Common causes of
type I (hypoxemic) respiratory failure

Chronic
bronchitis and emphysema (COPD)
Pneumonia
Pulmonary
edema
Pulmonary
fibrosis
Asthma
Pneumothorax
Pulmonary
embolism
Pulmonary
arterial hypertension
Pneumoconiosis
Granulomatous
lung diseases
Cyanotic
congenital heart disease
Bronchiectasis
Adult
respiratory distress syndrome
Fat
embolism syndrome
Kyphoscoliosis
Obesity

· Common causes of type II (hypercapnic)
respiratory failure

Chronic
bronchitis and emphysema (COPD)
Severe
asthma
Drug
overdose
Poisonings
Myasthenia
gravis
Polyneuropathy
Poliomyelitis
Primary
muscle disorders
Porphyria
Cervical
cordotomy
Head
and cervical cord injury
Primary
alveolar hypoventilation
Adult
respiratory distress syndrome
Myxedema
Tetanus

5-Symptoms of Respiratory failure

The list of medical symptoms mentioned in various sources
for Respiratory failure may include:

6-Imaging
Studies

Chest
radiograph
o Chest
radiography is essential because it frequently reveals the cause of
respiratory failure. However, distinguishing between cardiogenic and
noncardiogenic pulmonary edema often is difficult.

Echocardiography
o
Echocardiography need not be performed routinely in all patients with
respiratory failure. However, it is a useful test when a cardiac cause of
acute respiratory failure is suspected.

Other
Tests

Patients
with acute respiratory failure generally are unable to perform pulmonary function
tests (PFTs). However, PFTs are useful in the evaluation of chronic
respiratory failure.
- Normal
  values of forced expiratory volume in one second (FEV₁) and
  forced vital capacity (FVC) suggest a disturbance in respiratory control.
- A
  decrease in FEV₁
  -to-FVC ratio indicates airflow obstruction, whereas a reduction in both the
  FEV₁ and FVC and maintenance of the FEV₁
  -to-FVC ratio suggest restrictive lung disease.
- Respiratory
  failure is uncommon in obstructive diseases when the FEV₁ is
  greater than 1 L and in restrictive diseases when the FVC is more than L.

An
ECG should be performed to evaluate the possibility of a cardiovascular
cause of respiratory failure; it also may detect dysrhythmias resulting
from severe hypoxemia and/or acidosis.

7-Complications

Pulmonary
o Common
pulmonary complications of acute respiratory failure include pulmonary embolism,
barotrauma, pulmonary fibrosis, and complications secondary to the use of
mechanical devices.

Cardiovascular
o Common
cardiovascular complications in patients with acute respiratory failure
include hypotension, reduced cardiac output, arrhythmia, pericarditis, and
acute myocardial infarction.

Gastrointestinal
o The major
gastrointestinal complications associated with acute respiratory failure
are hemorrhage, gastric distention, ileus, diarrhea,
and pneumoperitoneum.
o Stress
ulceration is common in patients with acute respiratory failure; the
incidence can be reduced by routine use of antisecretory agents or mucosal
protectants.

Infectious
o Nosocomial
infections, such as pneumonia, urinary tract infections, and catheter-related
sepsis, are frequent complications of acute respiratory failure.

Renal
o Acute renal
failure and abnormalities of electrolytes and acid-base homeostasis are
common in critically ill patients with respiratory failure.

Nutritional
o These include
malnutrition and its effects on respiratory performance and complications
related to administration
of enteral or parenteral nutrition.

8-Medication

-Diuretics
First-line therapy generally
includes a loop diuretic such as furosemide, which inhibits sodium
chloride reabsorption
in the ascending loop of Henle.

-Furosemide
(Lasix)
Administer loop diuretics IV
because this allows for both superior potency and a higher peak concentration
despite increased incidence of adverse effects, particularly ototoxicity.

-Nitroglycerin
(Nitro-Bid, Nitrol)

SL nitroglycerin and Nitrospray are particularly useful in the patient who
presents with acute pulmonary edema with a systolic blood pressure of at least
100 mm Hg.

-Analgesics

Morphine IV is an excellent adjunct in the management of acute pulmonary edema.
In addition to being both an anxiolytic and an analgesic, its most important
effect is venodilation, which reduces preload. Also causes arterial dilatation,
which reduces systemic
vascular resistance and may increase cardiac output.

-Morphine sulfate (Duramorph, Astramorph,
MS Contin)
DOC for narcotic analgesia due
to reliable and predictable effects, safety profile, and ease of reversibility with
naloxone. Morphine sulfate administered IV may be dosed in a number of ways and
commonly is titrated until desired effect is obtained.

-Inotropics
Principal inotropic agents
include dopamine, dobutamine

-Dopamine
(Intropin)
Stimulates both adrenergic and
dopaminergic receptors.

-Norepinephrine
(Levophed)
Used in protracted hypotension
following adequate fluid replacement. Stimulates beta1- and alpha-adrenergic receptors,
which in turn increases cardiac muscle contractility and heart rate

-Bronchodilators
These agents are an important component
of treatment in respiratory failure caused by obstructive lung disease.

-Corticosteroids

Have been shown to be effective in accelerating
recovery from acute COPD exacerbations and are an important anti-inflammatory
therapy in asthma

-Methylprednisolone
(Solu-Medrol, Depo-Medrol)
Usually given IV in ED for initiation of corticosteroid therapy, although PO should theoretically be equally efficacious.

9-Treatment

-Nearly all patients are given oxygen as
the first treatment.

-Then the underlying cause of respiratory
failure mustbe addressed. Antibiotics are used to fight a lung
infection; bronchodilators, like albuterol, and steroid therapy are commonly
prescribed for patients with asthma.
-Nurses and respiratory
therapists have a number of methods to help patients overcome respiratory
failure. These include:

Suctioning the lungs through
a small plastic tube passed through the nose.
This treatment removes
secretions from the airway that the patient is unable to cough up.
Postural drainage therapy,
in which the patient's position is adjusted frequently to help secretions
drain into the central airways.
Chest percussion and mechanical vibrators
are also applied to help loosen deep secretions.
The patient is then encouraged to cough
up the secretions; if the patient isn't strong enough to do this, they are
suctioned out.
Deep-breathing exercises,
which are often prescribed after the patient recovers, help strengthen the
muscles that aid breathing. One technique has the patient breathe out
against pursed lips to increase pressure in the airways, preventing them
from collapsing. -A device called a volumetric incentive spirometer is also
used to encourage deep breathing while giving visual feedback.
The patient inhales slowly through a
plastic tube attached to a clear plastic cylinder; the cylinder contains a
piston and a ball that rests on top of it.
Inhalation raises the
ball; the patient has to inhale deeply enough to move it to a
predetermined mark.

أتمنى من قلبى أن الحصيله
تنال
اعجابكم
وان شاء الله تستفيدوا منها

من طرف ghonem الأربعاء مارس 10, 2010 9:24 pm

حصيلة رائعة يا مستر حوده

ويارب تستفادوا منها

كل حصيلة ونتم بخير

من طرف mr 7oda الخميس مارس 11, 2010 10:40 am

شكرا يا غنيم على المرور

من طرف أمنس السبت مارس 13, 2010 7:19 pm

بجد يا حوده مش عارفه اشكرك ازاى

يـــا مستر حـــوده

وافرت عليا كتير والله

من طرف Moza Alaa السبت مارس 13, 2010 9:25 pm

معلومات قيمة ومهمة جداااااااااااااااااااااا جداااااااااااااااااااااااااا

تسلم إيدك يا مستر حوده على المجهود الرااااااااااائع ده

وإلى الأمام إن شاء الله

ودى ثالث حصيلة وعقبال الباقى إن شاء الله

تقبل مرورى يا حوده

و زى ما قلت فى النهاية كلنا

واااااااااااااااااااااحد

من طرف mr 7oda السبت مارس 13, 2010 9:26 pm

يا امنس لا شكر على واجب

اتمنى الاستفاده لكى

وشكرا على مرورك

وشكرا لك يا احمد على المرور

وطبعا الهدف منها هو المصلحه العامه

وكلنا واحديعنى عصبه مع بعضينا

واتمنى الاستفاده لكل من شاهدها ولو قدر بسيط

respiratory failure انه هنا بشكل جديد

respiratory failure انه هنا بشكل جديد

رد: respiratory failure انه هنا بشكل جديد

رد: respiratory failure انه هنا بشكل جديد

رد: respiratory failure انه هنا بشكل جديد

رد: respiratory failure انه هنا بشكل جديد

رد: respiratory failure انه هنا بشكل جديد