So, what things have to happen so a
patient doesn't go into respiratory failure?
Well these are the different areas that you'll
assess and this is what needs to be working well
so the patient doesn't
end up in respiratory failure.
First of all, there has to be adequate
oxygen present in the air the patient is breathing
either it's room air or were
giving them supplemental oxygen
but it's got to be adequate
in the air they're breathing.
Now the airways have to be clear enough
to deliver the oxygen air to the alveoli
and carry CO2 back out through the airways.
So if the airways are clamped down if they're
gunked up, if something like that is going on,
then they're not clear and they're
not able to do that gas exchange.
Now the alveoli need to be intact and clear for
that gas exchange so they can't be filled with fluid
like we talked about it in pulmonary
edema, or a gunk like in pneumonia.
So you've got to have adequate
oxygen in the air the patient's breathing,
the airways have to be clear
enough to deliver the oxygen
and the alveoli have to be intact and
clear for the CO2-O2 gas exchange
Lastly, the bloodstream has to adequately circulate
blood to the lungs and carry it back to the body.
So one more time if any one of
these four areas isn't working efficiently,
your patient's headed
towards respiratory failure.
So they've got adequate oxygenation, either
room air or the supplemental oxygen we give them,
their airways have to be clear so they
can get that oxygen down to the alveoli
and get CO2 to back out of the body,
the alveoli have to be intact and clear
so no pneumonia or pulmonary edema
and in the bloodstream has
to be running by those alveoli
so we can pick up oxygen
and dump off carbon dioxide.
Any one of those four areas isn't working,
we're heading towards respiratory failure.
So any condition that affects the lungs directly or
the muscles, like your diaphragm your intercostals,
your abdominals, the nerves, bones or tissues that
support breathing can cause respiratory failure.
So keep in mind either the lungs are damaged
or all the structures around the lungs that also
support respiratory function are damaged,
that could also cause respiratory failure.
So let's break that downa nd look at some
very specific causes of respiratory failure.
So anything that affects the blood flow into the lungs,
that might be a pulmonary embolus could block the blood flow
that's gonna cause some real problems with
delivering that O2 and CO2 to the rest of the body.
Also lung damage.
So I've got problems with lung damage, I can also have
problems with circulation or perfusion in the lungs.
What about conditions that affect the
nerves and muscles that control breathing?
Exactly, we just talked about some of those
but let me give you some specific examples:
muscular dystrophy, ALS
or spinal cord injuries -
those play a significant role in impairing
the nerves and muscles that control breathing.
Also conditions that affect areas of the brain
that control breathing of patient has a stroke
that may significantly
impact their ability to breathe.
Now we're gonna throw drug and alcohol overdose in here
too but we'll even talk about that a little more later.
Also conditions that affect the flow of air like
COPD (chronic obstructive pulmonary disease), asthma,
cystic fibrosis where you end
up with really gunked up airways.
So we've talked about the flow of blood the
nerves and muscles, the brain, and the flow of air
Lastly, we're gonna look at things
that really affect the gas exchange.
ARDS stands for acute respiratory distress syndrome, this
is really severe and some patients don't survive ARDS.
And lastly, a pneumonia, right?
Those airways fill with fluid and with pus and it
makes it difficult for those alveoli to function.
So you're looking at the slide, woah!
That is busy.
Hey look at the five categories:
flow of blood, nerves and muscles that control
breathing, the brain, flow of air and gas exchange.
Make sure you're rock solid on those five areas then go
back in and lay down examples of what some of those are
and I'll help you have a pretty good snapshot
of the major causes of respiratory failure.
Knowing if your patient has any of
these problems, that's where you're headed
so we're on guard with sharp
assessment skills and then intervene early.
Now I'm gonna show some other causes with
you but I want to make sure you are rock solid
on those ones we just talked about.
So any problem with the spine like scoliosis,
have that weird kind of curve in their spine,
that abnormal curve that can affect
bones and muscles to their use for breathing.
We don't see that a whole lot
but I want you to be aware of it
Now if you have damage to the tissues in the ribs around
the lungs well if someone's kind of cracked their rib,
it hurts for them to breathe because remember those
intercostal muscles kinda lift that ribcage up
and spread it out every time
they breathe, so it hurts to breathe
and you'll see them breathe
really shallow because of the pain.
An injury to the chest can also cause damage.
Inhalation injury - so if you inhale
smoke from a fire or harmful fumes.
So a lot of times, someone who suffers a really serious
injury from the fire, they may not be burned externally
but the inhalation injuries can be very severe and
up with airway oedema and all kinds of problems
from the toxins that are inhaled.
Now lastly, I told you we'll bring that
up again, is a drug or alcohol overdose.
So a lot of times a patient who has too
much of a drug or drink too much alcohol
that's really gonna suppress their respirations
and can also end up with a fatal ending.