Pulmonary

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)

HCO3 metabolic (kidneys)

acidosis 23 – 27 alkalosis
respiratory metabolic
pH CO2 HCO3
7.12 28 11
un. Acidosis alkalosis acidosis un

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

causes of acid-base imbalances

respiratory acidosis
drugs, cardiac arrest
muscle weakness (MG, ALS, GB)
pulmonary disease COPD
respiratory alkalosis
hypoxemia – low O2 causes you to breath faster and blowing off bicarb
CNS disorder (dec ICP when in RA state)
ASA overdose (give bicarb)
Cirrhosis, sepsis

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

Scattered rhonchi - intermittent rumbling on inspiration and exhalation only in

large airway – then suction
Ateclactatis – softer

3 normal breath sounds

bronchial – harsh. On expiratory
bronchovesicular - I. E.
Vesicular – I

Acute respiratory failure

Old school
Type 1 hypocapnic failure – low CO2
Ventilation perfusion imbalance
Pulmonary edema
Pulmonary embolism
Aspiration pneumonia
Asthma
ARDS (first 2 stages)

Type 2 hypercapnic failure – high CO2

Respiratory mechanical performance
Drug overdose
COPD, CVA, spinal cord: ALS, GB, MG (gin and tonic)
Pneumothorax
Decreased phosphates (tidal volume loss)

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.

Takes 2 days it takes ARDS to show up on x-ray.

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

ARDS in early stages – tachypnea, normal PCWP, respiratory alkalosis; NOT

hypercapnia
Good interventions
Lasix
Pulmonary toilet
Frequent position changes
PEEP
Not good – NS rapid bolus to maintain hydration; wanna keep them dry

Palpation of a tracheal shift to the left may indicate a tension pneumothorax on the
right
Acute pulmonary embolism
Chest pain, dyspnea, cough

Not in massive pulmonary embolism (will get Right sided failure)

Pulmonary rales (will see increased CVP, distended neck veins, liver engorgement)