418 CU5 PDF

• Respiratory emergencies may range from "shortness of breath" to complete respiratory arrest
• Pulmonary Embolism is a thrombotic or non-thrombotic embolus that lodges in the pulmonary artery system
• Risk factors for Pulmonary Embolism:

  • Injury or damage leading to blood clot formation
  • Inactivity for prolonged periods
  • Medical conditions or treatment procedures that cause blood to clot easily (e.g. surgery, DVT, etc.)
• Clinical manifestations of Pulmonary Embolism:

  • Virchow's triad: venous stasis, coagulation problems, vessel wall injury
  • Chest pain
  • Tachycardia, tachypnea
  • Anxiety, restlessness
  • Clammy or bluish skin
• Diagnostics for Pulmonary Embolism:

  • CXR to rule out other disorders with the same presenting manifestations
  • ABG analysis
  • D-dimer test to detect clot fragments from clot lysis
  • ECG
  • V/Q scan / Pulmonary angiography / spiral CT scan
• Treatment for Pulmonary Embolism:

  • Oxygenation (ET and mechanical ventilation)
  • Heparin therapy
  • Surgery - umbrella filter, pulmonary embolectomy
  • Prevention of development of DVT
• Acute Respiratory Distress Syndrome (ARDS) is a syndrome with inflammation and increased permeability of the alveolocapillary membrane
• Risk factors for ARDS:

  • Critically ill patients
  • Age (60y/o and above)
  • Malignancy (cancers)
  • Cigarette smoking, COPD
• Causes of ARDS:

  • Aspiration pneumonia or systemic illness (e.g. burns, sepsis, drug overdose)
• Clinical manifestations of ARDS:

  • Restlessness
  • Hyperventilation, tachycardia, SOB
  • Hypoxemia
  • Severe: hypotension, cyanosis, decreased UO
• Diagnostics for ARDS:

  • Chest x-ray reveals "white out" lungs
• Treatment for ARDS:

  • Fluid management to maintain tissue perfusion
  • Corticosteroid therapy to decrease permeability of the alveolocapillary membrane
  • Nutrition - enteral feeding
  • Supplemental oxygen: Mechanical Ventilation
• Acute Respiratory Failure is a change in respiratory gas exchange jeopardizing normal cellular function
• Types of Acute Respiratory Failure:

  • Type I (Hypoxemic) involves low oxygen, and normal or low carbon dioxide levels
  • Type II (Hypercapnic) involves low oxygen, with high carbon dioxide
• Causes of Acute respiratory failure in adults:

  • Impaired ventilation
  • Impaired gas exchange
  • Airway obstruction
  • Ventilation-perfusion abnormalities
• Chronic obstructive pulmonary disease (COPD) is an umbrella term to describe various diseases like chronic bronchitis, emphysema, chronic asthma
• Assessment for COPD:

  • Patient's history
  • Consider current treatment, exercise tolerance, previous admissions
  • Assess for cough, sputum, cyanosis, tachypnea, wheeze, accessory muscle usage, chest expansion, fever, dehydration, confusion or reduction in conscious level, pain
• Management for COPD:

  • Non-invasive ventilation (NIV)
  • Intensive care
• Pneumonia is an inflammation of the lung, characterized by exudation into the alveoli
• Common microorganisms causing Pneumonia:

  • Streptococcus pneumoniae (90% of cases)
  • Haemophilus influenzae
  • Staphylococcus aureus
  • Legionella species
• Types of Pneumonia:

  • Community acquired
  • Hospital acquired
  • Ventilator associated
  • Aspiration
  • Atypical
• Assessment findings for Pneumonia:

  • Clinical findings are often referred to as consolidation
• Clinical findings of ventilator-associated pneumonia (VAP) include:

  • Consolidation
  • Reduced expansion on the affected side
  • Percussion dullness over the area of consolidation
  • Bronchial breath sounds and adventitious crackles
  • Tachypnea and central cyanosis
  • Fever, sweats, and rigors
  • Cough and sputum
• Diagnostics and laboratory tests for VAP:

  • Sputum microscopy, culture, and sensitivity
  • Chest X-ray (CXR)
  • Arterial blood gas (ABG) and pulse oximetry
  • Full blood count (FBC), Urea & Electrolytes (U&E), C-reactive protein (CRP), and Liver function tests (LFTs)
• Initial (ED) management of VAP:

  • Supplemental oxygen to maintain saturations >93%
  • Intravenous (IV) fluids if the patient is dehydrated
  • Medications: IV antibiotics, analgesia, antipyretic
  • Bronchoalveolar lavage for specific cases
• Nursing management for VAP:

  • Upright positioning
  • Timely antimicrobial therapy
  • Monitoring hemodynamics, fluid, electrolytes, and imbalances
  • Adherence to infection prevention and control
  • Ventilator-associated pneumonia care bundle
• Ventilator-associated pneumonia (VAP) develops 48 hours or later after mechanical ventilation via endotracheal tube or tracheostomy. It results from colonization of the lower respiratory tract and lung tissue by pathogens. Intubation compromises the integrity of the oropharynx and trachea, allowing oral and gastric secretions to enter the airways. VAP is the most frequent post-admission infection in critical care patients and significantly increases mechanical ventilation days, length of critical care stay, and overall hospital stay.
• Risk factors for VAP:

  • Immunocompromised individuals
  • Elderly patients
  • Those with chronic illnesses like lung disease, malnutrition, and obesity
• Preventive strategies for VAP:

  • Elevation of the head of the bed
  • Sedation level assessment
  • Oral hygiene
  • Subglottic aspiration
  • Tube cuff pressure management
  • Stress ulcer prophylaxis
• Severity scoring of pneumonia:

  • CURB-65 score assesses severity, risk of death, and ICU admission
  • Guides subsequent treatment and hospital admission decisions
• Clinical signs of pneumonia and sepsis:

  • Pyrexia (>38°C)
  • Abnormal white blood cell count
  • New-onset purulent sputum
  • Increased respiratory secretions/suctioning requirements
  • Worsening gas exchange
• COVID-19 symptoms:

  • Common: fever, dry cough, shortness of breath
  • Less common: aches, sore throat, diarrhea, conjunctivitis, headache, loss of taste or smell, rash
  • Serious: difficulty breathing, chest pain, loss of speech or movement
• Prevention measures for COVID-19:

  • Maintain physical distance
  • Wear a mask
  • Clean hands frequently
  • Stay in a separate room if exposed
  • Keep rooms well-ventilated
  • Seek medical care if danger signs appear
• Medical treatments for COVID-19:

  • Supportive care with oxygen
  • Dexamethasone for severe cases
  • Antiviral agents like Remdesivir, Tocilizumab, and others
• Coronaviruses:

  • Family of viruses causing illnesses from common cold to severe critical illness
• Other medical terms related to respiratory conditions:

  • COPD: Chronic obstructive pulmonary disease
  • Embolism: Obstruction of a blood vessel by a mass
  • Respiratory failure: Failure of the respiratory system's gas exchange functions
  • Pneumothorax: Collapsed lung due to air entering the pleural cavity