Presentation
Presents the contributions of 70% new authors, from all over the world, in a consistent format to make referencing global perspectives quick and easy. [books.google.com]
We present the case of a 36-year-old woman with a primary alveolar hypoventilation syndrome. [archbronconeumol.org]
Multiple-case presentations from one source of exposure are common. [aneskey.com]
Entire Body System
- Sepsis
Mosby Elsevier, Philadelphia, PA, pp 510–520 Google Scholar Randolph AG, Meert Kl (2003) for the Pediatric Acute lung Injury and Sepsis Investigators Network. [link.springer.com]
[…] of PaO2 to FiO2 Etiology -Direct injury -Indirect injury -Mortality rate of 30% to 50% ALI / ARDS - Direct Injury -Pneumonia (MOST COMMON) -Aspiration -Near drowning -Toxic inhalation -Pulmonary contusion -Oxygen toxicity -Transthoracic irradiation -Sepsis [quizlet.com]
Injury Infectious pneumonia Aspiration, chemical pneumonitisAcute Respiratory Distress Syndrome Pulmonary contusion, penetrating lung injury Fat emboli Near-drowning Inhalation injury Reperfusion pulmonary edema s/p lung transplant Indirect Lung Injury Sepsis [slideshare.net]
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, et al. (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med. 31: 1250–1256. View Article Google Scholar 18. [journals.plos.org]
[…] syndrome [ 56, 77 ] Muscle wasting, hyporeflexia Associated cancer (e.g., small cell of lung) Incremental pattern on EMG chest film Treatment of associated cancer 3, 4-Diaminopyridine Anticholinesterase Critical illness polyneuropathy [ 78, 79, 80, 81 ] Sepsis [aneskey.com]
- Falling
In this play, Ondine, a water nymph, falls in love with a knight named Hans. However, their love is ill-fated, and when Ondine is jilted by Hans, her uncle, the King of the Sea, curses Hans. [medlink.com]
Macroscopically, in the non-falling lungs, massive dense areas are found, whitish-gray in the incision, emitting turbid liquid. [en.medicine-guidebook.com]
All HIV-positive individuals once their CD4 T-cell count falls below 200 cells/mm 3. Prophylaxis should continue until immunity recovers sufficiently. Oral co-trimoxazole by mouth is the drug of choice. [patient.info]
Acute spinal cord lesions at the C5 and C6 levels produce an immediate fall in the vital capacity to 30% of the predicted value, due to loss of intercostal and abdominal muscle function [ 44 ]. [aneskey.com]
- Multiple Organ Dysfunction Syndrome
Organ Dysfunction Syndrome - because you don't have oxygen to perfuse the rest of the body, so the lungs are the beginning of a process that can take over your whole body Clinical Manifestations of ARF CNS, CV, Pulmonary, Renal, GI, and Integument Clinical [quizlet.com]
Decreased oxygen to the cells contributes to impaired tissue perfusion and the development of lactic acidosis and multiple organ dysfunction syndrome. 8 Assessment and Diagnosis The patient with ARF may experience a variety of clinical manifestations, [clinicalgate.com]
- Congestive Heart Failure
Tachycardia Anemia, hypoxia, heart failure, hyperthyroidism S 3 Congestive heart failure Murmur Valvular dysfunction Hepatomegaly, hepatojugular reflux, edema Congestive heart failure Cyanosis, clubbing Chronic severe hypoxemia TABLE 2 History and Physical [aafp.org]
Examples include pneumonia, chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome/acute lung injury (ARDS/ALI) and congestive heart failure (CHF). Untreated hypoxemia jeopardizes the heart and brain. [clinicaladvisor.com]
- Unconsciousness
Critical neural targets for (the level of) human consciousness: Arousal arrest and unconsciousness after sumatriptan administration. Brain Inj 2016 28:1-6. Leppänen T, Töyräs J, Muraja-Murro A, Kupari S, Tiihonen P, Mervaala E, Kulkas A. [epshp.fi]
Respiratoric
- Dyspnea
License: CC BY 2.0 Definition of Dyspnea Dyspnea — The Shortness of Breath Dyspnea is defined as the subjective sensation of chest tightness or shortness of the breath. It can be caused by pulmonary and extrapulmonary causes. [lecturio.com]
Findings Condition History Dyspnea on exertion Cardiac or pulmonary disease, deconditioning Dyspnea during rest Severe cardiopulmonary disease or noncardiopulmonary disease (e.g., acidosis) Orthopnea, paroxysmal nocturnal dyspnea, edema Congestive heart [aafp.org]
Central endobronchial tumors cause cough, hemoptysis, wheezing, stridor, dyspnea, and pneumonitis. Peripheral lesions cause pain, cough, dyspnea, and possible symptoms of pulmonary abscess on cavitation. [fundacionmapfre.org]
The resultant paradoxic breathing pattern can contribute significantly to abnormal gas exchange and increased dyspnea [ 14 ]. [aneskey.com]
Severity of respiratory disease was evaluated using Medical Research Council dyspnea score [21] 2 wk before admission by patient's or family's recall. [journals.plos.org]
- Tachypnea
[…] patients who are getting "ICU confusion", so just because they are restless does not mean that they have ARF Clinical Manifestations of ARF: CV chest pain, tachycardic, hypertensive, dysrhythmias - may throw PVCs Clinical Manifestations of ARF: Pulmonary tachypnea [quizlet.com]
[…] combination of one or more findings: altered state of consciousness (from agitation to lethargy), increased work of breathing [nasal flaring, use of accessory muscles, intercostal retraction, Hoover sign, suprasternal and supraclavicular retractions, tachypnea [xlung.net]
Autonomic stress responses include tachypnea, tachycardia, hypertension and diaphoresis. Bradycardia and hypotension are ominous signs that occur as respiratory failure progresses. [clinicaladvisor.com]
Minor criteria included tachypnea over 35 bpm or increase in the respiratory rate compared to its value at admission, pH 2, or pH did not immediately improve with face mask-delivered NIV, the patient was correctly repositioned in the sitting position, [journals.plos.org]
During the exudative phase, the patient presents with tachypnea, restlessness, apprehension, and moderate increase in accessory muscle use. [clinicalgate.com]
- Pulmonary Disorder
Calculation of the alveolar-arterial (A-a) O 2 gradient (inspired P o 2 − [arterial P o 2 + 5 ⁄ 4 arterial P co 2 ]) can help distinguish pulmonary from extrapulmonary disease; a normal gradient essentially excludes pulmonary disorders. [msdmanuals.com]
COPD Asthma Restrictive lung disorders Hereditary lung disorders Pneumothorax Mixed cardiac or pulmonary COPD with pulmonary hypertension and cor pulmonale Deconditioning Chronic pulmonary emboli Trauma Noncardiac or nonpulmonary Metabolic conditions [aafp.org]
This chapter focuses on pulmonary disorders commonly seen in the critical care environment. [clinicalgate.com]
Prominent lung disorders include pneumonia, ARDS/ALI, asthma, chest trauma, aspiration and pulmonary embolism. [clinicaladvisor.com]
- Exertional Dyspnea
[…] when symptoms are atypical for exertional angina or when silent ischemia is suspected as a cause of dyspnea on exertion. [aafp.org]
- Dyspnea at Rest
Findings Condition History Dyspnea on exertion Cardiac or pulmonary disease, deconditioning Dyspnea during rest Severe cardiopulmonary disease or noncardiopulmonary disease (e.g., acidosis) Orthopnea, paroxysmal nocturnal dyspnea, edema Congestive heart [aafp.org]
Cardiovascular
- Hypertension
Devices 261 Evaluation of the Low to Intermediate Risk Patient with 267 PULMONARY PROBLEMS IN THE INTENSIVE CARE UNIT 273 Status Asthmaticus 282 Extrapulmonary Causes of Respiratory Failure 292 Pulmonary Embolism 302 Managing Hemoptysis 311 Pulmonary Hypertension [books.google.com]
Patients with morbid obesity can suffer hypercapnia, hypoxemia, and subsequently polycythemia, pulmonary hypertension and right heart failure. [fundacionmapfre.org]
[…] these are also seen in patients who are not getting enough pain medications and in patients who are getting "ICU confusion", so just because they are restless does not mean that they have ARF Clinical Manifestations of ARF: CV chest pain, tachycardic, hypertensive [quizlet.com]
PRATIQUE DU NO INHALE Page 72 and 73: UTILISATION PRATIQUE DE L ’ALMITR Page 74 and 75: Décroissance des concentrations d Page 76 and 77: TRAITEMENT PHARMACOLOGIQUE DE L’H Page 78 and 79: Contre-indications du NO inhalé Page 80 and 81: 28 26 24 22 20 HYPERTENSION [yumpu.com]
- Heart Failure
failure or valvular heart problems. [aafp.org]
Patients with morbid obesity can suffer hypercapnia, hypoxemia, and subsequently polycythemia, pulmonary hypertension and right heart failure. [fundacionmapfre.org]
Etiology of Dyspnea Causes of Dyspnea Dyspnea is one of the most common manifestations affecting individuals with pulmonary diseases, although it can be caused by other varieties of causes, such as heart failure, ischemic heart disease (IHD), hypobaric [lecturio.com]
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, et al. (2013) ACCF/AHA guideline for the management of heart failure: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. [journals.plos.org]
Examples include pneumonia, chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome/acute lung injury (ARDS/ALI) and congestive heart failure (CHF). Untreated hypoxemia jeopardizes the heart and brain. [clinicaladvisor.com]
- Tachycardia
233 Supraventricular Tachycardia 242 Temporary Cardiac Pacing 253 Permanent Pacemakers and Antiarrhythmic Devices 261 Evaluation of the Low to Intermediate Risk Patient with 267 PULMONARY PROBLEMS IN THE INTENSIVE CARE UNIT 273 Status Asthmaticus 282 [books.google.com]
Tachycardia Anemia, hypoxia, heart failure, hyperthyroidism S 3 Congestive heart failure Murmur Valvular dysfunction Hepatomegaly, hepatojugular reflux, edema Congestive heart failure Cyanosis, clubbing Chronic severe hypoxemia TABLE 2 History and Physical [aafp.org]
NIV should usually be continued until pH is normal, and respiratory distress and tachycardia have resolved. [breathe.ersjournals.com]
[…] increased work of breathing [nasal flaring, use of accessory muscles, intercostal retraction, Hoover sign, suprasternal and supraclavicular retractions, tachypnea (RR > 30 bpm), paradoxical breathing], central cyanosis (including lips and tongue), sweating, tachycardia [xlung.net]
Guillain–Barré syndrome may be associated with autonomic dysfunction including new-onset hypertension (57%), sinus tachycardia (50%), postural hypotension (43%), or facial flushing (25%) [ 90 ]. [aneskey.com]
- Cyanosis
She began presenting symptoms at infancy, with cyanosis during the sleep, being diagnosed of cyanotic congenital malformation of the heart; she subsequently developed diurnal cyanosis, fatigue, purpura, and lower limbs edema. [archbronconeumol.org]
Clinical Manifestations of ARF: GI decreased GI motility - patient on TF will have residuals, decreased O2 to the stomach, decreased bowel sounds, N&V, and abdominal distention Clinical Manifestations of ARF: Integument initially, won't see anything - cyanosis [quizlet.com]
Extremities: looking for evidence of edema, signs of deep venous thrombosis and clubbing (note peripheral cyanosis is not a reliable sign of hypoxemia in the absence of central cyanosis). [clinicaladvisor.com]
Tachycardia Anemia, hypoxia, heart failure, hyperthyroidism S 3 Congestive heart failure Murmur Valvular dysfunction Hepatomegaly, hepatojugular reflux, edema Congestive heart failure Cyanosis, clubbing Chronic severe hypoxemia TABLE 2 History and Physical [aafp.org]
[…] consciousness (from agitation to lethargy), increased work of breathing [nasal flaring, use of accessory muscles, intercostal retraction, Hoover sign, suprasternal and supraclavicular retractions, tachypnea (RR > 30 bpm), paradoxical breathing], central cyanosis [xlung.net]
Neurologic
- Agitation
[…] perfuse the rest of the body, so the lungs are the beginning of a process that can take over your whole body Clinical Manifestations of ARF CNS, CV, Pulmonary, Renal, GI, and Integument Clinical Manifestations of ARF: CNS restlessness, antsy, confusion, agitation [quizlet.com]
This is characterized by the combination of one or more findings: altered state of consciousness (from agitation to lethargy), increased work of breathing [nasal flaring, use of accessory muscles, intercostal retraction, Hoover sign, suprasternal and [xlung.net]
During the fibroproliferative phase, the patient’s signs and symptoms progress to agitation, dyspnea, fatigue, excessive accessory muscle use, and fine crackles as respiratory failure develops. 40, 41 TABLE 15-2 PHYSIOLOGY AND ASSOCIATED PHYSICAL EXAMINATION [clinicalgate.com]
Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289(22):2983–91. PubMed Epub 2003/06/12. eng. [annalsofintensivecare.springeropen.com]
The most commonly used is an echocardiogram using intravenous injections of agitated saline which employs tiny air bubbles to provide contrast. [clinicaladvisor.com]
Workup
Serum
- Hypercapnia
[…] of hypercapnia on outcome. [annalsofintensivecare.springeropen.com]
V/Q dysfunction mechanisms in the pulmonary parenchyma may cause hypoxemia and/or hypercapnia. [xlung.net]
Significant arterial hypercapnia is unlikely to occur with an inspiratory pressure more negative than -30 cm H 2 O; however, arterial hypercapnia may be present with a vital capacity as high as 55% or as low as 20% of the predicted value [ 15, 16 ]. [aneskey.com]
However, 5 of 21 (23.8%) recordings that showed an absence of nocturnal hypoventilation at the chosen threshold showed hypercapnia on mABG. [hal-univ-bourgogne.archives-ouvertes.fr]
Treatment
Emphasizes the treatment of corrected congenital heart disease for coverage of the clinical management of cardiac problems in the adolescent and young adult. [books.google.com]
Steroid treatment should be started at the same time as the antimicrobial therapy and withdrawn before antimicrobial treatment is complete. [patient.info]
The use of NIV can be considered here but the main focus at this stage should be to optimise medical treatment. [breathe.ersjournals.com]
Clinicians should encourage every patient willing to make a quit attempt to use the counseling treatments and medications recommended in this Guideline. 4 Brief tobacco dependence treatment is effective. [clinicalgate.com]
Prognosis
Pathophysiology is emphasized throughout, providing a sound basis for discussions of the diagnosis, treatment, and prognosis that follow. [books.google.com]
Prognosis The use of ART has made significant changes to the prognosis of HIV-related pulmonary infections. [patient.info]
An AECOPD requiring hospitalisation has a poor prognosis, with an in-patient mortality rate of 7.7% [ 14 ] and a median survival of 3.6 years from the first admission [ 15 ]. [breathe.ersjournals.com]
Etiology
Hypercapnic (ventilatory failure) PaCO2 >45 mmHg with acidosis (pH Etiology: Extrapulmonary causes -Disorders that affect the brain (cause hypoventilation) -The spinal cord -Neuromuscular system -The thorax -The pleura -The upper airways Etiology: Intrapulmonary [quizlet.com]
Historical note and terminology Congenital central alveolar hypoventilation syndrome was first described in 1970, and the genetic etiology was finally elucidated in 2003 ( Mellins et al 1970 ; Amiel et al 2003 ). [medlink.com]
As the etiology, pathophysiology, and treatment of ALI is the same as for ARDS, the discussion will use the broader term of ALI. 37 Etiology A wide variety of clinical conditions is associated with the development of ALI. [clinicalgate.com]
It often has multiple etiologies. [aafp.org]
Epidemiology
Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology [brainscape.com]
Epidemiology DNA studies suggest that P. jirovecii is frequently found in healthy adults in the normal community. It can cause a transient infection in an immunocompetent host. [patient.info]
Epidemiology The epidemiology of hypoxemia and hypercapnea parallel the epidemiology of disorders of the lungs, heart and other organ systems which lead to gas exchange abnormalities. [clinicaladvisor.com]
Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, et al. (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million [journals.plos.org]
Pathophysiology
Pathophysiology is emphasized throughout, providing a sound basis for discussions of the diagnosis, treatment, and prognosis that follow. [books.google.com]
Pathophysiology of dyspnea. New England Journal of Medicine, 333(23), 1547-1553. Stenton, C. (2008). The MRC breathlessness scale. Occupational Medicine,58(3), 226-227. [lecturio.com]
Key words: Acute Respiratory Failure, Oxygen therapy, artificial ventilation and pathophysiology. [xlung.net]
[…] spinal cord -Neuromuscular system -The thorax -The pleura -The upper airways Etiology: Intrapulmonary causes -Disorders that effect the lower airway and alveoli -Pulmonary circulation -The alveolar-capillary membrane (asthma, pulmonary embolism) Type 1: Pathophysiology [quizlet.com]
Pathophysiology Hypoxemia is the result of impaired gas exchange and is the hallmark of acute respiratory failure. Hypercapnia may be present, depending on the underlying cause of the problem. [clinicalgate.com]
Prevention
These patients are at a higher risk of deep venous thrombosis, so they should be recommended to make short trips when driving or many stops in long trips to walk and move their legs, and prevent possible PTE. [fundacionmapfre.org]
Desaturation A number of activities can prevent desaturation from occurring. [clinicalgate.com]
• Hyper Page 96 and 97: CONSEQUENCES SUR LES CIRCULATIONS R Page 98 and 99: CONSEQUENCES SUR LE Qs/Qt AUGMENTAT Page 100 and 101: TRAITEMENT DE L’HYPERCAPNIE DIMIN Page 102 and 103: DIMINUER L’ESPACE MORT ALVEOLAIRE Page 104: VENTILATION MECANIQUE : PREVENTION [yumpu.com]
Mechanical Ventilation Mechanical ventilation (invasive or non-invasive) is indicated on ARF with the following objectives: Respiratory discomfort relief Correction of respiratory acidosis and hypoxemia Reversion of muscle fatigue Reversion and/or prevention [xlung.net]
[…] incentive spirometer; coughing if secretions are present -Importance of taking medication -Factor modification (smoking) -Breathing technique (pursed lip breathing) -Pathophysiology of disease -Specific etiology -Energy conservation methods -Infection prevention [quizlet.com]