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27 q
acute respiratory failure
respiratory assessment
ards/PE
status asthmaticus
thoracic trauma
pneumothorax
ABG values
pH
acidosis 7.35 – 7.45 alkalosis
CO2 respiratory
(breathing too fast) alkalosis 35 – 45 acidosis (breathing too slow)
7.55 29 20
un. Alkal. Alkalosis acidosis getting rid of bicarb
7.01 51 10
un. Acidosis acidosis acidosis un respiratory &metabolic acidosis
7.23 50 29
un. Acidosis acidosis alkalosis
if bet 7.35-7.45
compensated
7.36 61 34
com. Acidosis acidosis alkalosis held onto bicarb
7.45 22 20
com. Alkalosis alkalosis acidosis I got rid of bicarb
Metabolic acidosis
Ketoacidosis
Lactic acidosis
GI loss (diarrhea)
Renal failure
Metabolic alkalosis
Blood transfusion (citrate turns into b
Hypokalemia
GI loss (gastric acids)
Contraction alkalosis (too much Lasix given)
Breath sounds
In pneumonia, breath sounds louder – becomes semisolid so it conducts noise
readily; feels fremitus; will hear bronchial sounds in vesicular area
New school
V/Q mismatch
V-ventilation
Q- perfusion
Ventilation perfusion imbalance
COPD
Asthma
Atelectasis
Emphysema
Hypoventilation
Pulmonary edema
Pulmonary embolism
Aspiration pneumonia
shunt
no contact between blood and alveoli
ARDS; refractory hypoxia – no matter how much oxygen given it won’t matter;
Only PEEP can save your life because additional pressure allows the alveoli to touch
capillary for gas exchange
Shock – vasocontrict even in lungs and blood gets stagnant and
destruction of capillary bed and fluid leaks out and separates alveoli from blood
supply
If on 100% of oxygen for over 24 hours, it’ll given them ARDS because it destroys
type 2 alveoli cells surfactants and alveoli are separated and suffer damage. Water
leaks out more from capillary bed. Distending it helps prevent leakage of fluid.
Prevent lung fluid.
When adjusting the initial settings on a volume ventilator for an adult in respiratory
failure, the tidal volume is usually set at least 10ml per kg or twice normal
Palpation of a tracheal shift to the left may indicate a tension pneumothorax on the
right
Acute pulmonary embolism
Chest pain, dyspnea, cough