Unit 2_ Respiratory And Burn 2023-09-18 02_02_15

Pulmonary Embolism Types of embolism: • Solid: IV catheter end (why do we check to see if the tip is intact), glass (why do we use filtered needles. • Liquid: blood most common. • Air: injection, chest trauma, scuba diving. How does it happen? • Most common, starts out at DVT and then becomes loose, eventually landing in the lungs. • Obstructing, causing reduced gas exchange. -For a DVT patient: assess respiratory. -Causes pulmonary tissue hypoxia. Risk factors: • Smoking (becoming a trend for this unit!) • Sedentary lifestyle or just a prolonged period of immobility. • Surgery • Obesity • Clotting disorders • Pregnancy • Estrogen therapy (BCP) • HF Signs and Symptoms: • Cardiac (perfusion) -Hypotension -Syncopal episodes -Tachycardia • Respiratory (gas exchange) -Dyspnea (sudden) -Chest Pain -Decreased oxygen saturation • Psychosocial -Anxiety (abrupt) -impending doom Labs: • D-dimer -Positive: can give an indication of PE -Negative: elevation can also be a false positive. • ABG Levels -Early: respiratory alkalosis (low PaCO2, hyperventilation). -Late: metabolic acidosis (build-up of lactic acid from tissue hypoxia). Diagnostics: • Computed Tomography Chest Angiography -Contrast through the chest -Large bore IV (AC or higher) • Oxygen -Place patient on NC or facemask (critical patient may require additional) • Heparin -Stops growth on current clots and stops formation of clots, with time the body will reabsorb those clots that are already formed. Medication: • To prevent the formation of additional clots and the growth of the current clot. • Heparin • TPA-clot bluster • Lovenox • Coumadin/Warfarin (takes a bit to kick start PO Warfarin, so for now Heparin and Warfarin). Education: • Smoking cessation • Medication • Follow-up • Diet • Risk for bleeding • Travel • Exercise

Acute Respiratory Failure -Respiratory system failure. Ventilation (V) and perfusion (Q) need to almost perfectly match for adequate gas exchange (normal healthy person V/Q=0.8). When either component is experiencing problems, a V/Q mismatch occurs, causing gas exchange to be reduced, therefore causing acute respiratory failure. • Patient may have: -ventilatory failure -oxygenation failure -combination of both • Hypoxemic (oxygenation)- Type 1 • Ventilatory (hypercapnic)- Type 2 • Decrease in VQ= inadequate air flow (normal perfusion- COPD) • Increase in VQ= decrease perfusion- V= normal Type1: Oxygenation Failure/ Hypoxemic • V/Q mismatch/impaired oxygen diffusion at the alveolar level. • Not enough oxygen is passed to the bloodstream. • PaO2 is less than 60. • PaCO2 is normal to low. Caused by: • Breathing air with low oxygen levels. • Impaired diffusion at the alveolar level. • Abnormal hemoglobin that fails to bind oxygen. Common causes: • Drowning • Pneumonia • CHF with pulmonary edema • High altitudes • PE (perfusion blocked) • ARDS (shunting) • Abnormal HGB • COPD (mucous in airways) Type 2: Ventilatory Failure/ Hypercapnic (mechanics) • Impaired ventilation is a reduced ability of the lungs to adequately expand. • Too little oxygen reaches the alveoli and carbon dioxide is retained. • PaCO2 is greater than 45. • pH is less than 7.35 (acidic). Caused by (extrapulmonary or intrapulmonary): • Physical problem in the lung. • Defect in the brain’s respiratory control center. • Poor muscle function (diaphragm). Common causes: Extrapulmonary • Myasthenia gravis • Guillain-Barre Syndrome • Spinal cord injuries • Opioid over-use • Massive obesity Intrapulmonary • Pneumothorax • Pulmonary edema • Chest trauma (GSW, knife wounds) Combined • Impaired gas exchange at the alveolar- capillary membrane causes: -retained CO2 -poor oxygen diffusion -Hypoxemia/outcome worse with both rather than just one type -low PaO2 -high PaCO2 Caused by: • Chronic bronchitis • Cystic fibrosis • Diseased alveoli (oxygenation failure) AND • Increased work of breathing- causing muscle fatigue (ventilation failure) Signs and Symptoms: • LOC • Dyspnea • Orthopnea • Tachycardia • Tachypnea • Hypercapnia (confusion, HAs, decrease LOC) • Hypoxemia (increase HR, RR, BP) • Change in RR and/or pattern • Recent hx Treat the Pt while you investigate the cause: • Oxygen therapy • Steroids • Antibiotics • Analgesia Monitor: • Frequent VS, ABGs, CBC, sputum sample, chest x-ray, neuro