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Pulmonary Medicine
Respiratory Emergencies in Geriatric Patients
Pediatric Respiratory Emergencies
Respiratory Disorders
Diagnosis and Treatment
1 What are the six symptoms or issues that raise suspicion of pulmonary diagnosis? Answer
2 How do you diagnose and treat a reported medical emergency? Answer
3 What causes respiratory symptoms? Answer

Pulmonologist
1 What is a pulmonologist/pulmonary specialist? Answer
2 What is pulmonology? Answer
3 What are other names for pulmonology? Answer
4 What are the most common conditions of patients who are admitted to hospital having respiratory conditions? Answer
5 What should a primary care physician know to be successful in other human healthcare settings like intensivist, hospitalist, emergency medicine specialist (emergency room), emergency medicine specialist (first responder), physician-scientist, physician-surgeon? Answer
6 What should every physician know about mathematics in human health care? Answer
7 What should a primary care physician, emergency medical specialist, or any other type of physician know about the human respiratory system? Answer
8 What are the most common complaints patient have with underlying pulmonary conditions? Answer
9 What are the four components of the pulmonary examination? Answer

Anatomy & Physiology of the Respiratory System
1 What human anatomy should a physician know relevant to the human respiratory system? Answer
2 How many respiratory system organs are there in the human body? Answer
3 Can you name the respiratory system organs in the human body? Answer

Respiratory Disorders
1 What Are the Types of Lung Disease? Answer
2 What questions do we need to follow up on? Answer
3 What is respiratory failure? Answer
4 What are other names for respiratory failure? Answer
5 When does a person get combination of acute and chronic respiratory failure? Answer
6 How have computers and Internet enhanced human heath care around the planet earth? Answer
7 What is the difference between types 1 and type 2 respiratory failure? Answer
8 What is acute respiratory failure? Answer
9 What are the individuations of mechanical ventilation in acute hypoxemic respiratory failure? Answer
10 What should an internist know about mechanical ventilation? Answer
11 What are the types of mechanical ventilation? Answer

Pulse oximeter
1 What is normal human value of oxygen saturation Spo2 by pulse oximeter? Answer
2 What do manufacturers of pulse oximeters have to do? Answer
3 What is a pulse oximeter? Answer
4 How to use a pulse oximeter? Answer
5 What does a pulse oximeter reading mean? Answer
6 What is the Perfusion Index (PI) in a pulse oximeter? Answer
7 How accurate is a pulse oximeter? Answer
8 Which finger to use in a pulse oximeter? Answer
9 Why keep a pulse oximeter at home? Answer
10 What is pulse oximetry? Answer
11 Why might you need pulse oximetry? Answer
12 What are the risks of pulse oximetry? Answer
13 How do you get ready for pulse oximetry? Answer
14 What happens during pulse oximetry? Answer
15 What happens after pulse oximetry? Answer

Reference ranges for blood tests
1 What is the range of normal human biochemistry laboratory values? Answer

Type 1 and Type 2 respiratory failure: Prevent, Detect, Intervene
SUCCESSFUL MANAGEMENT OF MIXED RESPIRATORY FAILURE
1 What is respiratory failure? Answer
2 What causes respiratory failure? Answer
3 What are the symptoms of respiratory failure? Answer
4 How is respiratory failure diagnosed? Answer
5 What are the treatments for respiratory failure? Answer
6 What are the types of respiratory failure? Answer
7 What is acute respiratory failure? Answer
8 What are the symptoms of acute respiratory failure? Answer
9 What causes acute respiratory failure? Answer
10 Who is at risk for acute respiratory failure? Answer
11 Who is at risk for acute respiratory failure? Answer
12 What can you expect in the long-term? Answer
13 What is chronic respiratory failure? Answer
14 What are the symptoms of chronic respiratory failure? Answer
15 What causes chronic respiratory failure? Answer
16 How is chronic respiratory failure diagnosed? Answer
17 How is chronic respiratory failure treated? Answer
18 What are the potential complications of chronic respiratory failure? Answer
19 How do you calculate respiratory failure? Answer
20 When does respiratory failure need intensive care? Answer
21 How should you care for elders at home? Answer

Vital signs
1 What are the vital signs of human organ systems functions? Answer
2 What is the normal respiratory rate for a newborn, infant, toddler, preschooler, school age child, and adolescent? Answer
3 What is the normal pulse rate for a newborn, infant, toddler, preschooler, school age child, and adolescent? Answer
4 What is the lower limit of normal systolic blood pressure in a newborn, infant, toddler, preschooler, school age child, and adolescent? Answer


Respiratory acidosis
1 What is the average pH in human blood? Answer
2 What is the pH ranges of human blood? Answer
3 What are examples of various human acid-based disorders? Answer
4 What is respiratory acidosis? Answer
Diagnosis and Treatment

What are the six symptoms or issues that raise suspicion of pulmonary diagnosis?
1. Dyspnea
2. Chest pain
3. Wheezing
4. Hemoptysis
5. Sputum production
6. Cough

Constitutional Symptoms

Fever ; Yes; No
Chills ; Yes; No
Other

Sore Throat / Pain

Symptoms analysis

What human organ system or systems is this symptom relevant to?
Are any environmental harms involved?

Respiratory poisons (Human medicolegal cases)

A woman presents with respiratory insufficiency.
She is neither a smoker nor has consumed any passive smoke.

What are the causes of her chronic obstructive pulmonary disease/respiratory insufficiency?

Respiratory poisoning.
She was given pesticide intentionally to cause poisoning.

Who initiated and/or got involved in her respiratory poisoning?

What harms can respiratory poisoning cause?
Immediate harms.
Chronic harms leading to respiratory insufficiency.

What poisons can cause chronic pulmonary damage?

What poisons can cause acute pulmonary damage?

Has anyone given you anything to consume in the form of food, water, drink, medication, or any other material that might have been poison that caused this damage and harms leading to these symptoms and signs?

What are the most common complaints patient have with underlying pulmonary conditions?
Dyspnoea (breathlessness)
Dyspnoea (breathlessness) in certain situations can be of cardia origin.

What are the four components of the pulmonary examination?
A. Inspection
B. Palpation
C. Percussion
D. Auscultation

Sore throat

What are other names for sore throat?
Acute phyringitis.
Upper respiratory infection.

What are the types of sore throat?
Bacterial, particularly strep throat.
Viral.
Fungal.

Causes

Viruses that cause the common cold and the flu also cause most sore throats. Less often, bacterial infections cause sore throats.

Viral infections

Viral illnesses that cause a sore throat include:
?Common cold
?Flu (influenza)
?Mono (mononucleosis)
?Measles
?Chickenpox
?Coronavirus disease 2019 (COVID-19)
?Croup ? a common childhood illness characterized by a harsh, barking cough

Bacterial infections

A number of bacterial infections can cause a sore throat. The most common is Streptococcus pyogenes (group A streptococcus) which causes strep throat.

Other causes

Other causes of a sore throat include:
?Allergies. Allergies to pet dander, molds, dust and pollen can cause a sore throat. The problem may be complicated by postnasal drip, which can irritate and inflame the throat.
?Dryness. Dry indoor air can make your throat feel rough and scratchy. Breathing through your mouth ? often because of chronic nasal congestion ? also can cause a dry, sore throat.
?Irritants. Outdoor air pollution and indoor pollution such as tobacco smoke or chemicals can cause a chronic sore throat. Chewing tobacco, drinking alcohol and eating spicy foods also can irritate your throat. ?Muscle strain. You can strain muscles in your throat by yelling, talking loudly or talking for long periods without rest.

?Gastroesophageal reflux disease (GERD). GERD is a digestive system disorder in which stomach acids back up in the food pipe (esophagus).

Other signs or symptoms may include heartburn, hoarseness, regurgitation of stomach contents and the sensation of a lump in your throat.

Also, someone who is HIV-positive might have a chronic or recurring sore throat due to a fungal infection called oral thrush or due to a viral infection called cytomegalovirus (CMV), which can be serious in people with compromised immune systems.

?Tumors. Cancerous tumors of the throat, tongue or voice box (larynx) can cause a sore throat. Other signs or symptoms may include hoarseness, difficulty swallowing, noisy breathing, a lump in the neck, and blood in saliva or phlegm.

Rarely, an infected area of tissue (abscess) in the throat or swelling of the small cartilage "lid" that covers the windpipe (epiglottitis) can cause a sore throat. Both can block the airway, creating a medical emergency.

Risk factors

Although anyone can get a sore throat, some factors make you more susceptible, including:
?Age. Children and teens are most likely to develop sore throats. Children ages 3 to 15 are also more likely to have strep throat, the most common bacterial infection associated with a sore throat.

?Exposure to tobacco smoke. Smoking and secondhand smoke can irritate the throat. The use of tobacco products also increases the risk of cancers of the mouth, throat and voice box.

?Allergies. Seasonal allergies or ongoing allergic reactions to dust, molds or pet dander make developing a sore throat more likely. ?Exposure to chemical irritants. Particles in the air from burning fossil fuels and common household chemicals can cause throat irritation.

?Chronic or frequent sinus infections. Drainage from your nose can irritate your throat or spread infection.

?Close quarters. Viral and bacterial infections spread easily anywhere people gather, whether in child care centers, classrooms, offices or airplanes.

?Weakened immunity. You're more susceptible to infections in general if your resistance is low. Common causes of lowered immunity include HIV, diabetes, treatment with steroids or chemotherapy drugs, stress, fatigue, and poor diet.

Prevention

The best way to prevent sore throats is to avoid the germs that cause them and practice good hygiene. Follow these tips and teach your child to do the same:

?Wash your hands thoroughly and frequently, especially after using the toilet, before eating, and after sneezing or coughing.

?Avoid sharing food, drinking glasses or utensils.

?Cough or sneeze into a tissue and throw it away. When necessary, sneeze into your elbow.

?Use alcohol-based hand sanitizers as an alternative to washing hands when soap and water aren't available.

?Avoid touching public phones or drinking fountains with your mouth. ?Regularly clean telephones, TV remotes and computer keyboards with sanitizing cleanser. When you travel, clean phones and remotes in your hotel room.

?Avoid close contact with people who are sick.

What type of sore throat is resistant to treatment?
Strep throat.

What usually is the first line of treatment for sore throat, particularly strep throat?
This is for individual older than 18 years.
1. Amoxicillin
2. Advil
3. Gargling
4. Choloroseptic spray.
5. Alka-Seltzer Plus Night Severe Cold + Flu

In nonbacterial or non-strep sore throat, antibiotics are not required.
Other treatments mentioned above are required.

What should you do if treatment is not effective within 4-6 days?
Change the treatment.

What should happen next?
Azithromycin 250mg Oral tabs 2 tabs by mouth on the first day- then 1 tab once a day for 4 days.
Ibuprofen 600 mg tabs 1 by mouth every 6 hours as needed.
Gargling
Choloroseptic spray.
Alka-Seltzer Plus Night Severe Cold + Flu

American states? pharmacies should get strepcils throat spray.
This is manufactured in New Zealand.
Up to April 10, 2015, American pharmacies did not have strepcils throat spray.

Why have other sore throat sprays been less effective up to April 10, 2015?
Existing throat sprays other than strepcils have no antibacterial content. This is the only local anesthetic effect that relieves pain temporarily.
A combination of anesthetic and antibacterial sore throat spray should be available.

Flu

What is the flu?
The flu is a respiratory infection caused by a number of viruses.

What are symptoms of the flu?
Body or muscle aches
Chills
Cough
Fever
Headache
Sore throat
http://www.qureshiuniversity.com/Flu.html

Is it a cold or the flu?

Antigenic shift and antigenic drift are there.
Do not count on vaccinations.
What did you understand?

What is the treatment for the flu?
Antihistamines are the best treatments for the flu as of October 12, 2016, especially a combination formula.
A combination of nighttime formula has 325 mg of acetaminophen (pain reliever/fever reducer), 2 mg of chlorpheniramine maleate (antihistamine), 10 mg of dextromethorphan HBr (cough suppressant), and 5 mg of phenylephrine HCI (nasal decongestant) per caplet. This combination has proven to be effective for individuals 18 years old or older.
Take these caplets as required, but not more than 3 per day.

What human anatomy should a physician know relevant to the human respiratory system?
Here is a diagrammatic presentation.


Biology of human respiration.

What should you know about the biology of human respiration?
In some regions, biology of human respiration is taught under the subjects of anatomy, physiology, and biochemistry of respiration. Human Anatomy, physiology, and biochemistry are branches of biology. There are many branches of biology.


Vital signs
What are the vital signs of human organ systems functions?
Consciousness / Level of consciousness
Pulse
Blood pressure
Respiratory rate
Temperature
Pain

What is the normal respiratory rate for a newborn, infant, toddler, preschooler, school age child, and adolescent?
What is the normal pulse rate for a newborn, infant, toddler, preschooler, school age child, and adolescent?
What is the lower limit of normal systolic blood pressure in a newborn, infant, toddler, preschooler, school age child, and adolescent? Normal Vital Signs

 

Pediatric Vital Sign Normal Ranges

 Age Group

 Respiratory Rate

 Heart Rate 

Systolic Blood Pressure

Weight in kilos

Weight in pounds
Newborn 30 - 50 120 - 160 50 - 70 2 - 3 4.5 - 7
Infant (1-12 months) 20 - 30 80 - 140 70 - 100 4 - 10 9 - 22
Toddler (1-3 yrs.) 20 - 30 80 - 130  80 - 110 10 - 14 22 - 31
Preschooler (3-5 yrs.) 20 - 30 80 - 120 80 - 110 14 - 18 31 - 40
School Age (6-12 yrs.) 20 - 30 70 - 110 80 - 120 20 - 42 41 - 92
Adolescent (13+ yrs.) 12 - 20 55 - 105 110 - 120 >50 >110

REMEMBER:

  • The patient's normal range should always be taken into consideration.
  • Heart rate, BP & respiratory rate are expected to increase during times of fever or stress.
  • Respiratory rate on infants should be counted for a full 60 seconds.
  • In a clinically decompensating child, the blood pressure will be the last to change. Just because your pediatric patient's BP is normal, don't assume that your patient is "stable".
  • Bradycardia in children is an ominous sign, usually a result of hypoxia. Act quickly, as this child is extremely critical.
Temperature

Human Respiratory System
What should a primary care physician, emergency medical specialist, or any other type of physician know about the human respiratory system?
  1. Annotation or definition of human respiratory system.
  2. Biology relevant to human respiratory system.
  3. Biology relevant to respiratory system.
  4. Brief respiratory system medical history, physical examination, lab investigations.
  5. Diagnosis of medical emergencies relevant to human respiratory system.
  6. Diagnosis of medical nonemergency relevant to human respiratory system.
  7. Diagnosis relevant to human respiratory system.
  8. Follow-up of respiratory patient case.
  9. Human arterial blood gases.
  10. Human respiratory system quiz.
  11. Medications relevant to human respiratory conditions.
  12. Pulse oximetry.
  13. Symptoms or complaints relevant to human respiratory system.

How do you diagnose and treat a reported medical emergency?
Initial and Emergency Assessment

First, analyze Glasgow Coma scale, then analyze vital signs including consciousness.

When was the patient normal?

____________________________________

Can the patient open both eyes spontaneously?

____________________________________

Can the patient talk or make noise relevant to age?

____________________________________

Can the patient walk or move extremities relevant to age?

____________________________________

If yes, Glasgow Coma scale is 15.

Glasgow Coma scale of 15 means the patient is not in a coma. vv The patient can have less serious medical issues. v
Go ahead with vital signs, including consciousness.

When should a trauma patient get Critical Care?
1. Acute respiratory failure
2. Neuralgic injury
3. Organ failure
4. Anemia
5. Coagulopathy
6. Thermal dysregulation
7. Sepsis
8. Unnecessary fluid administration
9. Damage control sequelae
10. Acid-based imbalance.
11. Any vital signs abnormality.

What is the oxygen saturation by pulse oximetry?

A ? Airway
B ? Breathing
C ? Circulation
C ? Consciousness
S ? Safety

A ? Airway

Is the patient?s airway compromised?

Does the patient?s position need to be changed?

If patient is choking on thick secretions, consider oral suctioning (check suction equipment).

B ? Breathing

?Assess rate and ease of breathing.
?Assess the effectiveness of the oxygen delivery

Oxygen supplementation

Is the oxygen flow connection intact? Is the rate, flow, and percentage as ordered?

Based on your assessment, consider the need for potential oxygen supplementation.

C ? Circulation

?Assess for the presence of a radial pulse.
?Assess skin colour, moisture, and temperature for signs of decreased tissue perfusion (pale, dusky, cool, or clammy skin).

Note whether the pulse is too fast, too slow, or absent.
If a radial pulse is not detectable, check for a carotid pulse.
If no pulse is present, call for help and start CPR.

C ? Consciousness

?Check the patient?s level of consciousness (LOC).

Is the patient alert, drowsy, disoriented, restless, agitated, unconscious?
Note if there is a change from the patient?s normal or previously noted LOC.

S ? Safety

?Ensure the patient is safe and free from risk of harm or injury at all times.
Check for name band and allergy band.
Check oxygen saturation level.


Check that suction is working.
Check brakes on the bed, bedrail position (up, if required), bed is at the appropriate level, and call bell is within reach.
Are there any fall risk indicators?
Taking a Respiratory History
How do you ask patients about their medical history?
Assessment of Non-emergency Case

History and Physical Examination

1. Person Profile
2. Chief Complaint
3. History of Present illness
4. Past Medical History
5. Social History:
6. Review of systems:
  1. Are you having any trouble breathing?

  2. Do you have any chest pain with breathing? If so, what is the pain like, when does it occur, and what relieves it?

  3. Do you have a cough? If yes, what does the cough sound like, when does it occur, do you bring up any phlegm (sputum) when you cough, what does the phlegm look like?
    Normal sputum is thin, clear to white in color, and tasteless and odorless. Yellow-green colored sputum may indicate a bacterial infection and rust-colored sputum is characteristic of pneumonia.

  4. Are you ever short of breath?
    If so, does your shortness of breath occur at rest or with activity?
    Ask the patient specific questions about shortness of breath that impacts daily living, such as being able to carry groceries from a _____, or being able to clean floors or do laundry.

  5. Do you have any problems breathing at night?
    If so, do you use pillows to help you get in a position to breathe easier?

  6. What is your Email address?

  7. What is your name?

  8. What is your date of birth?

  9. What is your mailing address?

  10. What is your telephone number?

  11. Where is the patient now?

  12. How old is the patient?

  13. What is the gender of the patient?

  14. What are the sources of medical history?

  15. What best describes the patient?: Child Adolescent girl Adolescent boy Woman Man

  16. In general, how is your physical and mental health? Excellent Good Fair Poor

  17. Do you have any appointments scheduled with doctors or other specialists? Yes No

  18. Have you been in the hospital in the last month? Yes No

  19. Do you have health problems that you need help with right away? Yes No

  20. Do you need extra help to access services, such as a wheelchair ramp, a computer screen reader or large print materials? Yes No

  21. Screening for survival needs

    Do you have enough of these resources from the state?
    Food
    Clothing
    Housing
    Health care
    Transportation
    Security
    Education
    Consumer goods
    Communication Do you need any of these resources to be enhanced?

  22. What are the issues?

  23. Is your complete medical history ready?
    Yes
    No

  24. What is the number on your medical card?
    A medical card number is usually a nine digit number.

  25. What state or entity has issued this medical card?

  26. What is your height?

  27. What is your weight?

  28. Have you ever worked in any of the following occupations or environments?
    Pottery worker
    Cotton mill worker
    Pipe coverer
    Insulation worker
    Farmer
    Sandblaster
    Talc worker
    Beryllium worker
    Carpenter
    Aluminum worker
    Woodworker
    Plastic worker
    Mica worker
    Pulp mill worker
    Painter
    Railroad worker
    Smelter
    Mining
    Silica dust
    Foundry
    Textile manufacturing
    Insulation product manufacturing

  29. Do you exercise regularly, if yes what type of exercise do you do?

  30. Have you ever smoked cigarettes, cigars or pipe?
    Yes
    No
    If yes, how many years have you/did you smoke?
    ____________
    If yes, how many cigarettes a day (average consumption)?
    ____________
    If yes, do you currently smoke?
    ____________
    If you are no longer smoking, when did you quit?
    ____________

  31. Do you drink alcohol?
    Yes
    No
    If yes, Daily: ____________ per day
    Occasionally: ____________ per month
    Rarely: ____________ per year

  32. Are you allergic to any medications?

  33. Do you have any allergies?
    If yes, how does your allergy affect your breathing?

  34. Do you smoke now or have you ever smoked?
    If yes, how many years did you smoke and how many packs of cigarettes did you smoke daily? Question 35 What kind of work do you do/did you do?
    In your work are/were you exposed to substances such as asbestos, chemicals, or cigarette smoke?

  35. Do you have a personal or family history of asthma, tuberculosis, lung cancer, cystic fibrosis, bronchitis, emphysema, or any other lung disease?

  36. Evaluation, Diagnosis, Treatment by Other Doctors
    Questions you need to answer.

    Has any other doctor evaluated, diagnosed, and treated the patient in previous one year?

  37. What is the profile of the doctor who diagnosed and treated this case?

  38. What explanation has the doctor given about cause or causes of this medical condition?

  39. What did the doctor recommend?

  40. How long do the recommendations of doctor need to continue?

  41. When did the doctor last follow up the case?

  42. How did the doctor calculate the percentage of respiratory insufficiency?

    43. I have read and agree to the Terms & Conditions.

    These are basic questions.
    There are many more.

    Once the above listed relevant questions about comprehensive patient assessment are answered and received, you will get another questions list relevant to age, gender, location, problems, or issues, if any.

    This will be followed by specific recommendations.

Classification of Pulmonary Disorders
History
Physical Examination
Pulmonary Function Tests
    Standard PFTs
    Spirometry
    Flow-Volume Loops
    Lung Volumes
    DLCO
    Pimax, Pemax
CXR
ABG
Cases
Pulmonary Testing Normal
Pulmonary Testing
Obstruction Restriction
Asthma Lung Disease
COPD Muscle Disease
--------- Chest Wall
Pediatric respiratory emergencies.
Adult respiratory medical emergencies.
Respiratory Symptoms
Respiratory Disorders

Respiratory Symptoms
What other symptoms might occur with respiratory symptoms?

Respiratory symptoms may accompany other symptoms that vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the respiratory tract may also involve other body systems.

Pulmonary symptoms that may occur along with respiratory symptoms

Respiratory symptoms may accompany other symptoms affecting the respiratory system including:

?Absence of breathing (apnea)
?Cough that gets more severe over time
?Coughing up blood (hemoptysis)
?Coughing up clear, yellow, light brown, or green mucus
?Difficulty breathing
?Loose, wet cough that produces thick white or yellow phlegm
?Rapid breathing (tachypnea)
?Shortness of breath
?Wheezing (whistling sound made with breathing)

Cardiovascular symptoms that may occur along with respiratory symptoms

Respiratory symptoms may accompany symptoms related to the cardiovascular system including:

?Absence of heart beat (asystole)
?Angina (chest pain due to decreased blood supply to heart muscle)
?Chest pain or pressure
?Irregular heart beats (arrhythmia)
?Low heart rate (bradycardia)
?Rapid heart rate (tachycardia)

Other symptoms that may occur along with respiratory symptoms

?Respiratory symptoms can accompany other symptoms including:
?Anxiety
?Bluish lips, nails or skin
?Enlargement of lymph nodes
?Fever and chills
?Runny nose (nasal congestion)
?Sore throat
?Sweating
?Thickening of tissue beneath the nail beds (clubbing)

Serious symptoms that might indicate a life-threatening condition In some cases, respiratory symptoms can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

?Bluish lips, nails or skin
?Confusion or loss of consciousness for even a brief moment
?Difficulty breathing
?High fever (higher than 101 degrees Fahrenheit)
?Rapid breathing (tachypnea) or shortness of breath
?Rapid heart rate (tachycardia)
?Shallow breathing (hypopnea)
?Wheezing (whistling sound made with breathing)

Causes

What causes respiratory symptoms?

Respiratory symptoms are common symptoms of lung and heart disease, emotions, or injury.

Chronic obstructive pulmonary disease (COPD, includes emphysema and chronic bronchitis) and asthma are common causes of respiratory symptoms. Other common causes include infections, such as pneumonia or acute bronchitis. Inflammation also causes respiratory symptoms, commonly seen in pleuritis or chronic bronchitis.

Heart conditions can lead to respiratory symptoms, especially in severe cases, such as congestive cardiac failure. Anxiety and panic attacks are common causes of respiratory symptoms and include rapid breathing that may result in hyperventilation or fainting.

Pulmonary causes of respiratory symptoms

Respiratory symptoms may be caused by respiratory system disorders including:

?Acute bronchitis
?Asthma or allergies
?Bronchiectasis (widening of the airways)
?Bronchiolitis (inflammation of the small airways) or bronchitis
?Chronic obstructive pulmonary disease (COPD, includes emphysema and chronic bronchitis)
?Decreased inspired oxygen levels from high altitude
?Lung cancer or metastatic tumors
?Pulmonary aspiration (inhaling blood, vomited material or other substances into lungs)
?Pulmonary hypertension (high blood pressure in the arteries of the lungs)
?Respiratory infections, such as cold or flu
?Tuberculosis (serious infection affecting the lungs and other organs)

Cardiovascular system causes of respiratory symptoms

Respiratory symptoms can also be caused by cardiovascular system disorders including:

?Cardiomyopathy (weakened or abnormal heart muscle and function)
?Cardiovascular disease (due to atherosclerosis or hardening of the arteries, or other causes)
?Congenital heart disease
?Congestive heart failure (deterioration of the heart?s ability to pump blood)
?Myocardial infarction (heart attack)

Emotional causes of respiratory symptoms

Respiratory symptoms can also be caused by emotional disorders including:

?Anger
?Anxiety
?Fear
?Panic attack

Serious or life-threatening causes of respiratory symptoms

In some cases, respiratory symptoms may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

?Alcohol or drug overdose
?Anaphylaxis (life-threatening allergic reaction)
?Chest trauma
?Choking on a foreign object in your airway
?Epiglottitis (life-threatening inflammation and swelling of the epiglottis, a tissue flap between the tongue and windpipe)
?Myocardial infarction (heart attack)
?Pneumonia
?Pneumothorax (collapsed lung)
?Pulmonary embolism (blockage of a pulmonary artery due to blood clot)

Questions for diagnosing the cause of respiratory symptoms

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your respiratory symptoms including:

?When did you first notice your respiratory symptoms?
?When do you feel respiratory symptoms?
?Do you have any other symptoms?
?What medications are you taking?
?Do you have any allergies?

What are the potential complications of respiratory symptoms?
Because respiratory symptoms can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

?Heart failure
?Myocardial infarction (heart attack)
?Organ failure or dysfunction
?Respiratory failure and respiratory arrest
?Spread of cancer
?Spread of infection
?Stroke

What are the signs of respiratory problems? Respiratory symptoms are common symptoms of lung or heart conditions, emotions, or injury. The medical terms for respiratory symptoms include dyspnea (difficulty breathing), tachypnea (rapid breathing), hypopnea (shallow breathing), hyperpnea (deep breathing), and apnea (absence of breathing). Breathing problems may occur in conditions affecting the lungs alone or may be seen in association with more generalized conditions, such as dehydration or infections.

Chronic obstructive pulmonary disease (COPD, includes emphysema and chronic bronchitis) and asthma are common causes of respiratory symptoms. Other common causes include infections, such as pneumonia or acute bronchitis. Inflammation causes respiratory symptoms, as seen in pleuritis or chronic bronchitis. Depending on the cause, respiratory symptoms may originate from one or both lungs and may be accompanied by rapid heart rate (tachycardia), low blood pressure (hypotension), or other cardiovascular signs and symptoms.

Heart conditions can lead to respiratory symptoms, especially in severe cases, such as congestive cardiac failure. Anxiety and panic attacks are common causes of respiratory symptoms and include rapid breathing that may result in hyperventilation and fainting. Airway obstruction causes respiratory symptoms that may include rapid shallow breathing. Lung injury from chest trauma can also lead to respiratory symptoms.

In some cases, respiratory symptoms can be a sign of a serious or life-threatening condition. Seek immediate medical care (call _______) for serious symptoms, such as sweating and severe difficulty breathing, severe sharp chest pain that may be combined with pale or blue lips, fast heart rate, high fever (higher than 101 degrees Fahrenheit), fainting, or change in level of consciousness or lethargy.

Pulmonologist
What is a pulmonologist/pulmonary specialist?
A pulmonologist, or pulmonary disease specialist, is a physician who possesses specialized knowledge and skill in the diagnosis and treatment of pulmonary (lung) conditions and diseases. Pulmonology is classified as an internal medicine subspecialty.

What are other names for pulmonologist?
Respiratory physician.
Pneumonologist.
Respirologist.

What is pulmonology?
Pulmonology is a medical specialty that deals with diseases involving the respiratory tract.
Pulmonology is considered a branch of internal medicine, and is related to intensive care medicine.

What are other names for pulmonology?
Chest medicine
Respiratory medicine

What are the most common conditions of patients who are admitted to hospital having respiratory conditions?
Bronchial asthma
Chronic obstructive lung disease

What should a primary care physician know to be successful in other human healthcare settings like intensivist, hospitalist, emergency medicine specialist (emergency room), emergency medicine specialist (first responder), physician-scientist, physician-surgeon?
Make sure you know about mathematics in human health care.

What should every physician know about mathematics in human health care?
If you ask me, I can consider teaching you mathematics in human healthcare that every physician should know.

Respiratory Disorders
What Are the Types of Lung Disease?
Intensive Care Unit
Diseases of the Airways
Asthma
Chronic Obstructive Pulmonary Disease
Chronic Bronchiectasis & Cystic Fibrosis
Obstruction of Large Airways
Interstitial Lung Disease
Idiopathic Interstitial Pneumonia
Pulmonary Manifestations of Collagen Vascular Diseases
Sarcoidosis
Pulmonary Alveolar Proteinosis
Pulmonary Langerhans'-Cell Histiocytosis, Lymphangioleiomyomatosis, & Bronchiolitis Obliterans with Organizing Pneumonia
Diseases of the Alveolar Space
Acute Respiratory Distress Syndrome
Eosinophilic Pneumonias
Lung Transplantation
Diseases of the Pulmonary Vasculature
Pulmonary Arterial Hypertension
Pulmonary Thromboembolism
Vasculitis & the Diffuse Alveolar Hemorrhage Syndromes
Diseases of the Pleura
Pneumothorax/Hemothorax
Pleural Effusions, Excluding Hemothorax
Empyema
Diseases of the Mediastinum
Diseases of the Mediastinum
Disorders of Ventilatory Control
Acute Ventilatory Failure
Chronic Ventilatory Failure
Mechanical Ventilation: Invasive and Noninvasive
Sleep Apnea & the Upper Airway Resistance Syndrome
Evaluation of Sleepiness & Sleep Disorders Other Than Sleep Apnea: Narcolepsy, Restless Leg Syndrome, & Periodic Limb Movements
Medical Conditions That Often Cause Daytime Sleepiness
Occupational & Environmental Lung Diseases
Pneumoconiosis
Hypersensitivity Pneumonitis
Drug-Induced Lung Disease
Occupational Asthma
Acute Inhalational Injury
Infectious Lung Disease
Bacterial Pneumonia
Viral & Atypical Pneumonia
Fungal Pneumonias
Mycobacterial Diseases of the Lungs
Pulmonary Complications of HIV Disease
Neoplastic Lung Diseases
Bronchogenic Carcinoma & Solitary Pulmonary Nodules
Pleural Malignancies & Benign Neoplasms of the Lung
Evaluation of the Patient with Pulmonary Disease
Pulmonary Anatomy & Physiology
The History & Physical Examination in Pulmonary Medicine
Diagnostic Imaging
Laboratory Evaluation
Procedures in Pulmonary Medicine
Pulmonary Function Tests
What are normal results for lung function tests?
Because everyone?s bodies and lungs are different sizes, normal results differ from person to person. For instance, taller people and males tend to have larger lungs whereas shorter people and females have smaller lungs. A person?s lungs grow until they are in their mid-twenties and then after that, lung function falls slightly every year. There are standards that your health care provider uses that are based on your height, weight, age, and gender. These numbers are called the predicted values. If your numbers match the standard, the percent of the predicted number will be 100%. Your own lung function can be tracked over time to help see if you have had a change.

What are pulmonary function tests?
Pulmonary function tests (PFTs) are noninvasive diagnostic tests that provide measurable feedback about the function of the lungs. By assessing lung volumes, capacities, rates of flow, and gas exchange, PFTs provide information that, when evaluated by your doctor, can help diagnosis certain lung disorders.

A normally-functioning pulmonary system operates on many different levels to ensure adequate balance. One of the primary functions of the pulmonary system is ventilation, the movement of air into and out of the lungs.

Some medical conditions may interfere with ventilation. These conditions may lead to chronic lung disease. Conditions that interfere with normal ventilation are categorized as restrictive or obstructive. An obstructive condition occurs when air has difficulty flowing out of the lungs due to resistance, causing a decreased flow of air. A restrictive condition occurs when the chest muscles are unable to expand adequately, creating a disruption in air flow.

Pulmonary function tests may be indicated to determine the presence, location, cause, and characteristics of the problem, and to guide treatment.

Pulmonary function tests is an inclusive term that refers to several different procedures that measure lung function in different ways. Some of the more common values that may be measured during pulmonary function testing include:

?Tidal volume (VT). This is the amount of air inhaled or exhaled during normal breathing.

?Minute volume (MV). This is the total amount of air exhaled per minute.

?Vital capacity (VC). This is the total volume of air that can be exhaled after maximum inspiration.

?Functional residual capacity (FRC). This is the amount of air remaining in lungs after normal expiration.

?Total lung capacity. This is the total volume of lungs when maximally inflated.

?Forced vital capacity (FVC). This is the amount of air exhaled forcefully and quickly after maximum inspiration.

?Forced expiratory volume (FEV). This is the volume of air expired during the first, second, and third seconds of the FVC test.

?Forced expiratory flow (FEF). This is the average rate of flow during the middle half of the FVC test.

?Peak expiratory flow rate (PEFR). This is the maximum volume during forced expiration.

Some PFTs involve the use of a spirometer.

The spirometer is an instrument that measures the amount of air breathed in and/or out and how quickly the air is inhaled and expelled from the lungs while breathing through a mouthpiece. The measurements are recorded on a device called a spirograph.

Other test results are derived from calculations based on the results of certain spirometry procedures. In addition to measuring the amount and rate of air inhaled and exhaled, these tests can also indicate how well oxygen and carbon dioxide are being exchanged in the alveoli.

Some PFTs, such as thoracic gas volume or other lung volume measurements, may be determined by plethysmography. During plethysmography, a person sits or stands inside an air-tight box that resembles a short, square telephone booth to perform the tests.

The normal values for PFTs vary from person to person. The amount of air inhaled and exhaled in your test results are compared to the expected average in someone of the same age, height, sex, and race. In addition, results are compared to your previous test results, if previous testing has been done. If you have abnormal PFT measurements or if your results are different from previous tests, you may be referred for other diagnostic tests to establish a medical diagnosis.

Anatomy of the respiratory system


How many respiratory system organs are there in the human body?

Can you name the respiratory system organs in the human body?

The respiratory system is made up of the organs involved in the exchange of gases, and consists of the:

?Nose
?Pharynx
?Larynx
?Trachea
?Bronchi
?Lungs

The upper respiratory tract includes the:

?Nose
?Nasal cavity
?Ethmoidal air cells
?Frontal sinuses
?Maxillary sinus
?Larynx
?Trachea

The lower respiratory tract includes the lungs, bronchi, and alveoli.

What are the functions of the lungs?
The lungs take in oxygen, which cells need to live and carry out their normal functions. The lungs also get rid of carbon dioxide, a waste product of the body's cells.

The lungs are a pair of cone-shaped organs made up of spongy, pinkish-gray tissue. They take up most of the space in the chest, or the thorax (the part of the body between the base of the neck and diaphragm).

The lungs are enveloped in a membrane called the pleura.

The lungs are separated from each other by the mediastinum, an area that contains the following:

?The heart and its large vessels
?Trachea (windpipe)
?Esophagus
?Thymus
?Lymph nodes

The right lung has three sections called lobes. The left lung has two lobes. When you breathe, the air enters the body through the nose or the mouth. It then travels down the throat through the larynx (voice box) and trachea (windpipe) and goes into the lungs through tubes called mainstem bronchi.

One mainstem bronchus leads to the right lung and one to the left lung. In the lungs, the mainstem bronchi divide into smaller bronchi and then into even smaller tubes called bronchioles. Bronchioles end in tiny air sacs called alveoli.

Different measurements that may be found on your report after spirometry include:
?Expiratory reserve volume (ERV)
?Forced vital capacity (FVC)
?Forced expiratory volume (FEV)
?Forced expiratory flow 25% to 75%
?Functional residual capacity (FRC)
?Maximum voluntary ventilation (MVV)
?Residual volume (RV)
?Peak expiratory flow (PEF).
?Slow vital capacity (SVC)
?Total lung capacity (TLC)
Arterial blood gas analysis
    Respiratory acidosis
    Respiratory alkalosis
    Diabetic ketoacidosis
    Lactic acidosis
    Metabolic acidosis
Arterial Blood Gases
The Test

How is it used?
When is it ordered?
What does the test result mean?
Is there anything else I should know?

The 6 Easy Steps to ABG Analysis:
1. Is the pH normal?
2. Is the CO2 normal?
3. Is the HCO3 normal?
4. Match the CO2 or the HCO3 with the pH
5. Does the CO2 or the HCO3 go the opposite direction of the pH?
6. Are the pO2 and the O2 saturation normal?

Step 1: Analyze the pH The first step in analyzing ABGs is to look at the pH. Normal blood pH is 7.4, plus or minus 0.05, forming the range 7.35 to 7.45. If blood pH falls below 7.35 it is acidic. If blood pH rises above 7.45, it is alkalotic. If it falls into the normal range, label what side of 7.4 it falls on. Lower than 7.4 is normal/acidic, higher than 7.4 is normal/alkalotic. Label it.

Step2: Analyze the CO2 The second step is to examine the pCO2. Normal pCO2 levels are 35-­-45mmHg. Below 35 is alkalotic, above 45 is acidic. Label it.

Step 3: Analyze the HCO3 The third step is to look at the HCO3 level. A normal HCO3 level is 22-­-26 mEq/L. If the HCO3 is below 22, the patient is acidotic. If the HCO3 is above 26, the patient is alkalotic. Label it.

Step 4: Match the CO2 or the HCO3 with the pH Next match either the pCO2 or the HCO3 with the pH to determine the acid-­-base disorder. For example, if the pH is acidotic, and the CO2 is acidotic, then the acid-­-base disturbance is being caused by the respiratory system. Therefore, we call it a respiratory acidosis. However, if the pH is alkalotic and the HCO3 is alkalotic, the acid-­- base disturbance is being caused by the metabolic (or renal) system. Therefore, it will be a metabolic alkalosis.

Step 5: Does the CO2 or HCO3 go the opposite direction of the pH? Fifth, does either the CO2 or HCO3 go in the opposite direction of the pH? If so, there is compensation by that system. For example, the pH is acidotic, the CO2 is acidotic, and the HCO3 is alkalotic. The CO2 matches the pH making the primary acid-­-base disorder respiratory acidosis. The HCO3 is opposite of the pH and would be evidence of compensation from the metabolic system.

Step 6: Analyze the pO2 and the O2 saturation. Finally, evaluate the PaO2 and O2 sat. If they are below normal there is evidence of hypoxemia.
Normal Values (At sea level): Range:
pH 7.35-­-7.45
pCO2 35-­-45 mmHg
pO2 80-­-100 mmHg
O2 Saturation 95-­-100%
HCO3-­- 22-­-26 mEq/L
Base Excess + or -­- 2
NOW LET?S PUT THE 6 STEPS INTO ACTION WITH AN EXAMPLE:
pH 7.27 acidotic
CO2 53 acidotic
pO2 50 low
O2 sat. 79% low
HCO3 24 normal
Step 1: The pH is less than 7.35, therefore is acidotic.
Step 2: The CO2 is greater than 45, and is therefore acidotic.
Step 3: The HCO3 is normal.
Step 4: The CO2 matches the pH, because they are both acidotic. Therefore the imbalance is respiratory acidosis. It is acidotic because the pH is acidotic, it is respiratory because the CO2 matches the pH.
Step 5: The HCO3 is normal, therefore there is no compensation. If the HCO3 is alkalotic (opposite direction) then compensation would be present.
Step 6: Lastly, the PaO2 and O2 sat are low indicating hypoxemia.
The full diagnosis for this blood gas is:
Uncompensated respiratory acidosis with hypoxemia.
This patient has an acute respiratory disorder.
HERE?S ANOTHER EXAMPLE:
pH 7.52 alkalotic
CO2 29 alkalotic
pO2 100 normal
O2 sat. 98% normal
HCO3 23 normal
Step 1: The pH is greater than 7.45, therefore is alkalotic.
Step 2: The CO2 is less than 35, and is therefore alkalotic.
Step 3: The HCO3 is normal.
Step 4: The CO2 matches the pH, because they are both alkalotic. Therefore the imbalance is respiratory alkalosis. It is alkalotic because the pH is alkalotic; it is respiratory because the CO2 matches the pH.
Step 5: The HCO3 is normal, therefore there is no compensation. If the HCO3 is acidotic (opposite direction) then compensation would be present. Step 6: Lastly, the PaO2 and O2 sat are normal indicating normal oxygenation.
The full diagnosis for this blood gas is:
Uncompensated respiratory alkalosis. This patient is probably hyperventilating.


HERE IS ANOTHER
EXAMPLE:
pH 7.18 acidotic
CO2 44 normal
pO2 92 normal
O2 sat. 95% normal
HCO3 16 acidotic
Step 1: The pH is less than 7.35, therefore is acidotic. Step 2: The CO2 is normal. Step 3: The HCO3 is less than 22, and is therefore acidotic. Step 4: The HCO3 matches the pH, because they are both acidotic. Therefore the imbalance is metabolic acidosis. It is acidotic because the pH is acidotic, it is metabolic because the HCO3 matches the pH. Step 5: The CO2 is normal, therefore there is no compensation. If the CO2 is alkalotic (opposite direction) then compensation would be present. Step 6: Lastly, the PaO2 and O2 sat are normal indicating normal oxygenation. The full diagnosis for this blood gas is: Uncompensated metabolic acidosis. This patient probably has an acute metabolic disorder such as DKA.


10 LET?S TRY ANOTHER:
pH 7.60 alkalotic
CO2 37 normal
pO2 92 normal
O2 sat. 98% normal
HCO3 35 alkalotic
Step 1: The pH is greater than 7.45, therefore is alkalotic.
Step 2: The CO2 is normal.
Step 3: The HCO3 is greater than 26, and therefore is alkalotic.
Step 4: The HCO3 matches the pH, because they are both alkalotic. Therefore the imbalance is metabolic alkalosis. It is alkalotic because the pH is alkalotic, it is metabolic because the HCO3 matches the pH.
Step 5: The CO2 is normal, therefore there is no compensation. If the CO2 is acidotic (opposite direction) then compensation would be present.
Step 6: Lastly, the PaO2 and O2 sat are normal. The full diagnosis for this blood gas is: Uncompensated metabolic alkalosis. This patient probably is losing stomach acid from vomiting or NG tube drainage.


11 ONE LAST EXAMPLE:
pH 7.30 acidotic
CO2 30 alkalotic
pO2 68 low
O2 sat. 92% low
HCO3 14 acidotic
Step 1: The pH is less than 7.35, therefore is acidotic.
Step 2: The CO2 is less than 35, and is therefore alkalotic.
Step 3: The HCO3 is less than 22, and therefore is acidotic.
Step 4: The HCO3 matches the pH, because they are both acidotic. Therefore the imbalance is a metabolic acidosis. It is acidotic because the pH is acidotic, it is metabolic because the HCO3 matches the pH.
Step 5: The CO2 is alkalotic and goes the opposite direction of the pH, so there is compensation. Because the pH is not in the normal range the compensation is called partial.
Step 6: Lastly, the PaO2 and O2 sat are low indicating hypoxemia. The full diagnosis for this blood gas is: Partially-­-compensated metabolic acidosis with hypoxemia. There are a number of conditions that can cause metabolic acidosis: renal failure, diarrhea, poisonings, diabetic ketoacidosis, and shock, to name a few. This patient is probably in shock, because his metabolic acidosis associated with poor oxygenation.

How is it used?

Blood gas measurements are used to evaluate your oxygenation and acid/base status. They are typically ordered if you have worsening symptoms of an acid/base imbalance, difficulty breathing, or shortness of breath. Blood gases may be ordered along with other tests, such as electrolytes to determine if an electrolyte imbalance is present, glucose to evaluate blood sugar concentrations, and BUN and creatinine tests to evaluate kidney function.

If you are on continuing supplemental oxygen therapy, blood gases may be used to monitor the effectiveness of that treatment.

When is it ordered?

Blood gas tests are ordered when you have symptoms of an oxygen/carbon dioxide or pH imbalance, such as difficulty breathing, shortness of breath, nausea or vomiting.

Blood gas measurements may be ordered when you are known to have a respiratory, metabolic, or kidney disease and are experiencing respiratory distress.

When you are "on oxygen" (ventilation), you may have your blood gases measured at intervals to monitor the effectiveness of treatment.

Blood gases may also be ordered when you have head or neck trauma, injuries that may affect breathing. When you are undergoing prolonged anesthesia ? particularly for cardiac bypass surgery or brain surgery ? you may have your blood gases monitored during and for a period after the procedure.

Checking the blood gases from the umbilical cord of newborns may uncover respiratory problems as well as determine the baby's acid/base status. Testing is usually only done if a newborn's condition indicates that he or she may be having difficulty breathing.

What does the test result mean?

Abnormal results of any of the blood gas components may mean that:

  • you are not getting enough oxygen
  • you are not getting rid of enough carbon dioxide
  • there is a problem with kidney function

The results of the PO2 component of the tests for blood gases relates to how much oxygen you are able to breathe in and the amount of oxygen in your blood. Low levels may mean you are not getting enough oxygen while results that are within normal range usually mean your oxygen intake is sufficient.

The results of the other components of the tests for blood gases are interrelated and the results must be considered together. Certain combinations of results, if abnormal, may indicate a condition that is causing acidosis or alkalosis:

  • Respiratory acidosis is characterized by a lower pH and an increased PCO2 and is due to respiratory depression ? not enough oxygen in and carbon dioxide out. This can be caused by many things, including pneumonia, chronic obstructive pulmonary disease (COPD), and over-sedation from narcotics.
  • Respiratory alkalosis, characterized by a raised pH and a decreased PCO2, is due to over ventilation caused by hyperventilating, pain, emotional distress, or certain lung diseases that interfere with oxygen exchange.
  • Metabolic acidosis is characterized by a lower pH and decreased HCO3-; the blood is too acidic on a metabolic/kidney level. Causes include diabetes, shock, and renal failure.
  • Metabolic alkalosis is characterized by an elevated pH and increased HCO3- and is seen in hypokalemia, chronic vomiting (losing acid from the stomach), and sodium bicarbonate overdose.

Combinations of results that may be seen in certain conditions are summarized below:

pH result Bicarbonate result PCO2 result Condition Common causes
Less than 7.4 Low Low Metabolic acidosis Kidney failure, shock, diabetic ketoacidosis
Greater than 7.4 High High Metabolic alkalosis Chronic vomiting, low blood potassium
Less than 7.4 High High Respiratory acidosis Lung diseases such as pneumonia, COPD
Greater than 7.4 Low Low Respiratory alkalosis Hyperventilation, pain, anxiety

If left untreated, these conditions can create an imbalance that can eventually be life-threatening. Your doctor will provide the necessary medical intervention for you to regain your body's normal balance, but the underlying cause of the imbalance must also be addressed.

Is there anything else I should know?

Arterial blood sample collection is usually more painful than regular venipuncture. You will experience moderate discomfort, and a compress is required for some time to prevent any bleeding from the site.

Sometimes mixed venous blood taken from a central line is used in particular situations, such as in cardiac catheterization labs and by transplant services. Careful interpretation of the results is required. Peripheral venous blood, such as that taken from a vein in the arm, is of no use for oxygen status.

Common Questions

1.  Can this test be done in a doctor's office?

Blood gas measurements, performed by trained personnel, are usually done in a hospital, emergency room, surgical center, ambulance, or large laboratory setting since the analysis should be done immediately after sample collection and specialized equipment is required. Most doctors do not have such capabilities in their offices.

2.  I've had pneumonia before and currently have asthma. Why has my doctor never ordered this test on me?

Most cases of pneumonia or asthma can be diagnosed by symptoms and monitored by listening to your chest sounds or by examining the results of spirometry tests or chest x-rays. Most of the time, asthma will respond to your usual medications and pneumonia to rest and possibly antibiotics. Blood gas tests may be necessary if you have severe or acute breathing problems or prolonged, chronic ones. In these cases, blood gas tests are usually done in an emergency room or hospital setting.

3.  Is there any other way to measure my oxygen levels?

A pulse oximeter is a noninvasive (no needlestick to obtain a blood sample is required) way of continuously monitoring O2 saturation only. A small clip-like device (called a sensor) is attached to the end of the finger or earlobe. The sensor reads light that is transmitted through the skin. Pulse oximeters are useful for monitoring trends in O2 saturation, but their accuracy can be affected by the presence of abnormal forms of hemoglobin, like carboxyhemoglobin (see below), low blood pressure due to poor perfusion, and very low levels of hemoglobin due to severe anemia.

4.  Why does my lab report also list carbyoxyhemoglobin? What is it?

If your blood gases were measured using an instrument known as a co-oximeter, then your lab report may also list results for carboxyhemoglobin and other altered forms of hemoglobin. A co-oximeter is a blood gas analyzer that can measure concentrations of these hemoglobin derivates in addition to the usual blood gas measurements. A co-oximeter is not always used, so these values are not reported for all blood gas tests.

Carboxyhemoglobin is an altered form or derivative of hemoglobin that forms when carbon monoxide binds to hemoglobin. Levels of carboxyhemoglobin are often elevated with carbon monoxide poisoning, and a co-oximeter is used to measure carboxyhemoglobin levels and to monitor oxygen therapy. Hemoglobin binds to carbon monoxide about 210 times more strongly than to oxygen. This significantly decreases hemoglobin's ability to carry oxygen through the body, which can lead to a serious, life-threatening condition.

Other hemoglobin derivates include sulfhemoglobin (or sulfmethemoglobin) and methemoglobin, which may result from the ingestion of certain medicines or exposure to chemicals. These altered forms of hemoglobin, like carboxyhemoglobin, cannot function properly in carrying oxygen and are commonly measured by a co-oximeter.


pH
CO2
HCO3

Normal Arterial Blood Gas Values

pH 7.35-7.45
PaCO2 35-45 mm Hg
PaO2  80-95 mm Hg
HCO3  22-26 mEq/L
O2 Saturation 95-99%
BE  +/- 1

Four-Step Guide to ABG Analysis

  1. Is the pH normal, acidotic or alkalotic?
  2. Are the pCO2 or HCO3 abnormal?  Which one appears to influence the pH?
  3. If both the pCO2 and HCO3 are abnormal, the one which deviates most from the norm is most likely causing an abnormal pH. 
  4. Check the pO2.  Is the patient hypoxic?

I used Swearingen's handbook (1990) to base the results of this calculator.  The book makes the distinction between acute and chronic disorders based on symptoms from identical ABGs.  This calculator only differentiates between acute (pH abnormal) and compensated (pH normal).  Compensation can be seen when both the PCO2 and HCO3 rise or fall together to maintain a normal pH.  Part compensation occurs when the PCO2 and HCO3 rise or fall together but the pH remains abnormal.  This indicates a compensatory mechanism attempted to restore a normal pH.  I have not put exact limits into the calculator.  For example, it will perceive respiratory acidosis as any pH < 7.35 and any CO2 > 45 (i.e. a pH of 1 and CO2 of 1000).  These results do not naturally occur.

pH PaCO2 HCO3
Respiratory Acidosis
Acute < 7.35 > 45 Normal
Partly Compensated < 7.35 > 45 > 26
Compensated Normal > 45 > 26
Respiratory Alkalosis
Acute > 7.45 < 35 Normal
Partly Compensated > 7.45 < 35 < 22
Compensated Normal < 35 < 22
Metabolic Acidosis
Acute < 7.35 Normal < 22
Partly Compensated < 7.35 < 35 < 22
Compensated Normal < 35 < 22
Metabolic Alkalosis
Acute > 7.45 Normal > 26
Partly Compensated > 7.45 > 45 > 26
Compensated Normal > 45 > 26

Mixed Disorders

It's possible to have more than one disorder influencing blood gas values.  For example ABG's with an alkalemic pH may exhibit respiratory acidosis and metabolic alkalosis.  These disorders are termed complex acid-base or mixed disorders.

*This table is able to classify most clinical blood gas values but not all.  In cases where blood gas values do not fall into any of the above classifications, an answer "unable to determine" will appear when using the interpreter.  For example a pH of 7.428, pCO2 43.6, and a HCO3 of 29.1 do not match any of the classifications (I found these results in someone's chart).  While the pH and pCO2 are normal, the HCO3 is abnormally high.


Respiratory Failure
Answers to questions a physician on duty or physician?s supervisor on duty must know.

What is respiratory failure?
What are other names for respiratory failure?
What causes respiratory failure?
What are the types of respiratory failure?
What is the difference between acute and chronic respiratory failure?
What recommendations are there from a physician for chronic respiratory insufficiency?
What location does acute respiratory failure and chronic respiratory failure need treatment?
Who is at risk for respiratory failure?
What are the signs and symptoms of respiratory failure?
How is respiratory failure diagnosed?
Is there a difference between pediatric respiratory failure and adult respiratory failure?
What are the differences between pediatric respiratory failure and adult respiratory failure?
When does a person get combination of acute and chronic respiratory failure?
How have computers and Internet enhanced human heath care around the planet earth?
How do you differentiate between an acute and chronic medical condition?
What is the best location for critical care in the state or outside the state?
What are examples of chronic respiratory insufficiency?
How is respiratory failure treated?
What do you have to do living with respiratory failure?
What were clinical trials findings in recent months or a year?
What useful links are there relevant to this issue?
What is the difference between types 1 and type 2 respiratory failure?

Acute Respiratory Failure

What is acute respiratory failure?
What are the causes of acute hypoxemic respiratory failure?
What are the symptoms of acute respiratory failure?
What is the treatment for acute respiratory failure?
What are the individuations of mechanical ventilation in acute hypoxemic respiratory failure?
What should an internist know about mechanical ventilation?
What are the types of mechanical ventilation?

Chronic Respiratory Failure

What is chronic respiratory failure?
What are the causes of chronic respiratory failure?
What are the symptoms of chronic respiratory failure?
How is chronic respiratory failure diagnosed?
What is the treatment for chronic respiratory failure?

Pediatric respiratory failure

Is there a difference between pediatric respiratory failure and adult respiratory failure?
Yes.

What are the differences between pediatric respiratory failure and adult respiratory failure?
Many causes of pediatric respiratory failure, especially in neonates, are entirely different than causes of adult respiratory failure that may be acute or chronic.

Acid Base Balance in the Human Body

How should you answer these questions?
This depends on the type of question.
Answer should be a number, one word, or a list of words or terms.
Answers like this have accuracy.
After a number, one word or a list of words or terms, you can elaborate further.
Here are various examples.

What should you not do in chronic respiratory failure?
Do not go ahead with any ventilation machine/mechanical ventilation. Mechanical ventilation in chronic respiratory failure will make issues complicated.
Do not go ahead with excessive chest X-ray or CT (computerized tomography) scan to obtain a better view of your lungs.

What should be the focus of treatment for chronic respiratory failure?
Focus on restoring oxygen saturation above 95% through oxygen therapy. Co2 normal concentration through respiratory exercises.
Bronchodilators when required.

Guidelines for intensive care unit design, dimensions, resources, staff.

Why build a new intensive care unit or renovate an old one in the state or outside the state?
Nowadays, doctors, for example Doctor Asif Qureshi, impart training to intensivists that is a physician intensive care unit from his home office through computer and Internet.

All states must have intensive care units with computers and Internet so that physician intensive care units and the rest of the staff are updated regularly relevant to intensive care unit issues in the state or outside the state.

Here are further guidelines.
http://www.qureshiuniversity.com/criticalcareworld.html

Home Care Services for Seniors

How should you care for elders at home?
Create a pleasant environment without any stress.
Make sure a person is around to take care of basic needs.
Progress of elders at home can be monitored, enhanced from other location including, ICU.

Follow-up
What questions do we need to follow up on?

Follow-up assessment of health
Questions you need to answer.

Follow-up of patient with respiratory issues.

Questions you need to answer.

What is your answer relevant to assessment of her health?
How much is oxygen saturation by pulse oximetry?
What type of pulse oximeter is there?
When was the pulse oximeter analysis last done?
What is her normal day activity like, including walk?
How is her sleep during the night?
How did you monitor that she is consuming enough food every day to remain healthy?
Does she have any problem or issue at this point?
How did you verify if she has any stress?

Follow-up of respiratory case.

What do you have to do?
Answer these questions.

What is the name, date of birth, location of patient?

____________________

____________________

____________________

What was the day, date, time, and location these readings were taken?

____________________

____________________

Who took these readings and verified these readings?

____________________

____________________

What are the readings of these vitals?
Respiratory rate:
Pulse rate:
Consciousness:
Blood pressure:
Temperature:
Emotional response:
Behavior:
Oxygen saturation by pulse oximetry:
Mobility: How many minutes does the individual walk every day?
Not at all.
Walk up to washroom and back.
5 minutes walk every day.
15 minutes walk every day.
More than 30 minutes walk every day.

Pulse oximeter
What is normal human value of oxygen saturation Spo2 by pulse oximeter?
95% or more.

What do manufacturers of pulse oximeters have to do?
Up to January 1, 2020, pulse oximeter technology used to measure the oxygen level in your blood and your heart rate.

Manufacturers of pulse oximeters must enhance this technology so that arterial blood carbon dioxide and other arterial blood gas analysis are done through the pulse oximeter.

Human blood chemistry analysis, blood urea, creatinine, glucose, and other ingredients also should be possible through a pulse oximeter as soon as possible.

What is a pulse oximeter?
A pulse oximeter is a small, lightweight device used to monitor the amount of oxygen carried in the body. This noninvasive tool attaches painlessly to your fingertip, sending two wavelengths of light through the finger to measure your pulse rate and how much oxygen is in your system. Once the oximeter finishes its assessment, its screen will display the percent of oxygen in your blood coming from your heart?as well as your current pulse rate.

How to use a pulse oximeter?
Turn on the device. Open the clamp like device and place the right hand middle finger inside the device. A display is attached to the top of the device which shows the results for each reading. Wait for 5-10 seconds till the readings are stable. We recommend taking out the batteries when the product is not in use to ensure that there is no battery drain.

What does a pulse oximeter reading mean?
The normal oxygen saturation readings should show between 95% ? 100% (SpO2). If the readings display below 92% (SpO2), you should immediately consult a doctor. What is the cost of a pulse oximeter?
The cost of the pulse oximeter can vary depending on its model and functionality. There are various types of Pulse Oximeters.

What is the Perfusion Index (PI) in a pulse oximeter?
In BPL Pulse Oximeters, there is an index called PI. Perfusion Index is a measure for physicians to check if a sensor site has good pulse strength. There?s not much for you to do, But for your information, PI is expressed as a percent ranging from 0.02% to 20%. Normal PI may vary from person to person depending on various factors. Consult a medical professional to understand what this level means for you.

How accurate is a pulse oximeter?
Pulse Oxygen levels can vary under different circumstances. BPL Pulse Oximeter is equipped with a four-direction display that shows results with a ±2% accuracy.

Which finger to use in a pulse oximeter?
As per the studies, your right hand?s middle finger shows the best results. Make sure to take off any nail polish and avoid using on cold fingers as the readings may not show correctly.

Why keep a pulse oximeter at home?
Using a pulse oximeter can help you keep a check on the levels of oxygen saturation in your blood. Thus we all should keep the device at home and monitor regularly. If your readings are below the recommended level, seek immediate medical help.

What is pulse oximetry?
Pulse oximetry is a test used to measure the oxygen level (oxygen saturation) of the blood. It is an easy, painless measure of how well oxygen is being sent to parts of your body furthest from your heart, such as the arms and legs.

A clip-like device called a probe is placed on a body part, such as a finger or ear lobe. The probe uses light to measure how much oxygen is in the blood. This information helps the healthcare provider decide if a person needs extra oxygen.

Why might you need pulse oximetry?
Pulse oximetry may be used to see if there is enough oxygen in the blood. This information is needed in many kinds of situations. It may be used:
During or after surgery or procedures that use sedation
To see how well lung medicines are working
To check a person?s ability to handle increased activity levels
To see if a ventilator is needed to help with breathing, or to see how well it?s working
To check a person has moments when breathing stops during sleep (sleep apnea)

Pulse oximetry is also used to check the health of a person with any condition that affects blood oxygen levels, such as:

Heart attack
Heart failure
Chronic obstructive pulmonary disease (COPD)
Anemia
Lung cancer
Asthma
Pneumonia

Your healthcare provider may have other reasons to advise pulse oximetry.

What are the risks of pulse oximetry?
All procedures have some risks. The risks of this procedure may include:
Incorrect reading if the probe falls off the earlobe, toe, or finger
Skin irritation from adhesive on the probe

Your risks may vary depending on your general health and other factors. Ask your healthcare provider which risks apply most to you. Talk with him or her about any concerns you have.

How do you get ready for pulse oximetry?
Your healthcare provider will explain the procedure to you. Make sure to ask any questions you have about the procedure. If a finger probe is to be used, you may be asked to remove fingernail polish.

Your healthcare provider may have other instructions for getting ready.

What happens during pulse oximetry?
You may have your procedure as an outpatient. This means you go home the same day. Or it may be done as part of a longer stay in the hospital. The way the procedure is done may vary. It depends on your condition and your healthcare provider's methods. In most cases, pulse oximetry will follow this process:
1. A clip-like device called a probe will be placed on your finger or earlobe. Or, a probe with sticky adhesive may be placed on your forehead or finger.
2. The probe may be left on for ongoing monitoring.
3. Or it may be used to take a single reading. The probe will be removed after the test.

What happens after pulse oximetry?
You can go home after the test, unless you are in the hospital for another reason. You may go back to your normal diet and activities as instructed by your healthcare provider. Your healthcare provider may give you other instructions after the procedure.

Reference ranges for blood tests
What is the range of normal human biochemistry laboratory values?
Food and Drug Administration (FDA)




Type 1 and Type 2 respiratory failure: Prevent, Detect, Intervene

SUCCESSFUL MANAGEMENT OF MIXED RESPIRATORY FAILURE
What is respiratory failure?
Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Sometimes you can have both problems.

When you breathe, your lungs take in oxygen. The oxygen passes into your blood, which carries it to your organs. Your organs, such as your heart and brain, need this oxygen-rich blood to work well.

Another part of breathing is removing the carbon dioxide from the blood and breathing it out. Having too much carbon dioxide in your blood can harm your organs.

What causes respiratory failure?
Conditions that affect your breathing can cause respiratory failure. These conditions may affect the muscles, nerves, bones, or tissues that support breathing. Or they may affect the lungs directly. These conditions include
?Diseases that affect the lungs, such as COPD (chronic obstructive pulmonary disease), cystic fibrosis, pneumonia, pulmonary embolism, and Viral Pandemic 2019-2020
?Conditions that affect the nerves and muscles that control breathing, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal cord injuries, and stroke
?Problems with the spine, such as scoliosis (a curve in the spine). They can affect the bones and muscles used for breathing.
?Damage to the tissues and ribs around the lungs. An injury to the chest can cause this damage.
?Drug or alcohol overdose
?Inhalation injuries, such as from inhaling smoke (from fires) or harmful fumes

What are the symptoms of respiratory failure?
The symptoms of respiratory failure depend on the cause and the levels of oxygen and carbon dioxide in your blood.

A low oxygen level in the blood can cause shortness of breath and air hunger (the feeling that you can't breathe in enough air). Your skin, lips, and fingernails may also have a bluish color. A high carbon dioxide level can cause rapid breathing and confusion.

Some people who have respiratory failure may become very sleepy or lose consciousness. They also may have arrhythmia (irregular heartbeat). You may have these symptoms if your brain and heart are not getting enough oxygen.

How is respiratory failure diagnosed?
Your health care provider will diagnose respiratory failure based on
?Your medical history
?A physical exam, which often includes
?Listening to your lungs to check for abnormal sounds
?Listening to your heart to check for arrhythmia
?Looking for a bluish color on your skin, lips, and fingernails
?Diagnostic tests, such as
?Pulse oximetry, a small sensor that uses a light to measure how much oxygen is in your blood. The sensor goes on the end of your finger or on your ear.
?Arterial blood gas test, a test that measures the oxygen and carbon dioxide levels in your blood. The blood sample is taken from an artery, usually in your wrist.

Once you are diagnosed with respiratory failure, your provider will look for what is causing it. Tests for this often include a chest x-ray. If your provider thinks you may have arrhythmia because of the respiratory failure, you may have an EKG (electrocardiogram). This is simple, painless test that detects and records your heart's electrical activity.

What are the treatments for respiratory failure?
Treatment for respiratory failure depends on
?Whether it is acute (short-term) or chronic (ongoing)
?How severe it is
?What is causing it

Acute respiratory failure can be a medical emergency. You may need treatment in intensive care unit at a hospital. Chronic respiratory failure can often be treated at home. But if your chronic respiratory failure is severe, you might need treatment in a long-term care center.

One of the main goals of treatment is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the cause of the condition. Treatments may include
?Oxygen therapy, through a nasal cannula (two small plastic tubes that go in your nostrils) or through a mask that fits over your nose and mouth
?Tracheostomy, a surgically-made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy, or trach tube, is placed in the hole to help you breathe.
?Ventilator, a breathing machine that blows air into your lungs. It also carries carbon dioxide out of your lungs.
?Other breathing treatments, such as noninvasive positive pressure ventilation (NPPV), which uses mild air pressure to keep your airways open while you sleep. Another treatment is a special bed that rocks back and forth, to help you breathe in and out.
?Fluids, often through an intravenous (IV), to improve blood flow throughout your body. They also provide nutrition.
?Medicines for discomfort
?Treatments for the cause of the respiratory failure. These treatments may include medicines and procedures.

If you have respiratory failure, see your health care provider for ongoing medical care. Your provider may suggest pulmonary rehabilitation.

If your respiratory failure is chronic, make sure that you know when and where to get help for your symptoms. You need emergency care if you have severe symptoms, such as trouble catching your breath or talking. You should call your provider if you notice that your symptoms are worsening or if you have new signs and symptoms.

Living with respiratory failure may cause fear, anxiety, depression, and stress. Talk therapy, medicines, and support groups can help you feel better.

What are the types of respiratory failure?
The majority of cases of respiratory failure fall under one of the following two categories: Type I (hypoxemic) respiratory failure, also known as ?oxygen failure?, is categorized by a low level of oxygen in the blood without an increased level of carbon dioxide in the blood. Type I respiratory failure is typically caused when the volume of air flowing in and out of the lungs is uneven with the flow of blood to the lungs. Type II (hypercapnic) respiratory failure, also known as ?ventilatory failure,? takes place when alveolar ventilation is unable to efficiently remove carbon dioxide from the blood, causing it to build-up in the body.

Acute respiratory failure is a short-term condition that is treated as a medical emergency, while chronic respiratory failure develops over time and requires long-term treatment.

Other Types of Respiratory Failure

Perioperative respiratory failure is usually caused by atelectasis (collapse of lung tissue with loss of volume). (See also Overview of Mechanical Ventilation.)

Effective means of preventing or treating atelectasis include
? Incentive spirometry
? Ensuring adequate analgesia for chest and abdominal incisions
? Upright positioning
? Early mobilization

Atelectasis caused by abdominal distention should be alleviated according to the cause (eg, nasogastric suction for excessive intraluminal air, paracentesis to evacuate tense ascites).

Hypoperfusion, regardless of cause, may result in respiratory failure through inadequate delivery of oxygen to respiratory muscles coupled with excess respiratory muscle load (eg, acidosis, sepsis). Mechanical ventilation is useful for diverting blood flow from overworked respiratory muscles to critical organs such as the brain, kidney, and gut.

Type 1 and type 2 respiratory failure is a serious medical condition with potentially fatal outcomes. It affects 360,000 people per year in the United States, of which 36% die during hospitalisation.

Respiratory Compromise Types

Respiratory failure occurs when the respiratory system fails to maintain gas exchange, resulting in hypoxia or hypercapnia. It is classified according to blood gases values: ?Type 1 Respiratory Failure (hypoxemic): is associated with damage to lung tissue which prevents adequate oxygenation of the blood. However, the remaining normal lung is still sufficient to excrete carbon dioxide. This results in low oxygen, and normal or low carbon dioxide levels.5 Arterial oxygen pressure (PaO2) is <8 kPa (60 mm Hg) with normal or low arterial carbon dioxide pressure (PaCO2).6,7 ?Type 2 Respiratory Failure (hypercapnic): occurs when alveolar ventilation is insufficient to excrete the carbon dioxide being produced. Inadequate ventilation is due to reduced ventilatory effort or inability to overcome increased resistance to ventilation. It affects the lung as a whole, and therefore carbon dioxide accumulates, presenting with PaO2 of <8 kPa (60 mm Hg) or normal, with hypercapnia PaCO2 >6.0kPa (> 50 mm Hg).5,7

Preventing Type 1 and Type 2 Respiratory Failure

Preventing respiratory failure starts with being aware of possible risk factors and causes

Causes of type 1 respiratory failure include: pulmonary oedema, pneumonia, COPD, asthma, acute respiratory distress syndrome, chronic pulmonary fibrosis, pneumothorax, pulmonary embolism, pulmonary hypertension.

Type 2 respiratory failure is commonly caused by COPD but may also be caused by chest-wall deformities, respiratory muscle weakness and Central nervous system depression (CNS depression.)5 CNS depression is associated with reduced respiratory drive and is often a side effect of sedatives and strong opioids. It may also be caused by severe asthma, myasthenia gravis, muscle disorders, obesity , hypothyroidism and adult respiratory syndrome.

Once aware of individual risk factors, healthcare professionals are able to plan interventions that minimize risk and reduce the likelihood of increased morbidity and mortality.

Detecting Type 1 and Type 2 Respiratory Failure

?Blood gas analysis: helps professionals identify the type of respiratory failure, which is crucial to indicate what respiratory support may be needed.8 Type 1 respiratory failure may require only supplementary oxygen, but type 2 failure may require additional support such as continuous positive airway pressure (CPAP) or biphasic positive airway pressure (BiPAP) to increase exchange of both gases and, where possible, reverse any causes for low tidal volumes or low respiratory rates.8 Blood gas analysis will also be useful in monitoring the clinical condition throughout treatment and recovery. Capnography: provides a continuous reading of respiratory function and end tidal CO2.
Pulse oximetry: gives a continuous measure of blood oxygen saturation.
ECG: to monitor cardiac function as tachycardia and cardiac arrhythmias may result from hypoxaemia and acidosis.7

Interventions for Type 1 and Type 2 Respiratory Failure

Intervening in cases of respiratory failure includes not only supportive measures as well as treatment of the underlying cause.6 Depending on presentation, interventions aim to correct hypoxemia or hypercapnia and respiratory acidosis.

Correction of hypoxemia: aim to maintain adequate oxygenation, achieved with an arterial oxygen pressure (PaO2) of 60 mm Hg. The inspired oxygen concentration should be adjusted at the lowest level which is sufficient for tissue oxygenation.6 Oxygen can be delivered via nasal canula, simple face mask, nonrebreathing mask or high flow nasal canula. In severe cases, patient may require invasive ventilatory support.

Correction of hypercapnia and respiratory acidosis: this is achieved by treating the underlying cause or providing ventilatory support.6

Type 1 and type 2 respiratory failure is a serious medical condition. Mortality associated with respiratory failure depends on the underlying cause as well as the speed of diagnosis and efficacy of management.7 Being able to prevent, detect and intervene adequately is crucial for improved patient outcomes.

Acute Respiratory Failure

What is acute respiratory failure?
Acute respiratory failure occurs when fluid builds up in the air sacs in your lungs. When that happens, your lungs can?t release oxygen into your blood. In turn, your organs can?t get enough oxygen-rich blood to function. You can also develop acute respiratory failure if your lungs can?t remove carbon dioxide from your blood.

Respiratory failure happens when the capillaries, or tiny blood vessels, surrounding your air sacs can?t properly exchange carbon dioxide for oxygen. The condition can be acute or chronic. With acute respiratory failure, you experience immediate symptoms from not having enough oxygen in your body. In most cases, this failure may lead to death if it?s not treated quickly.

Types

The two types of acute and chronic respiratory failure are hypoxemic and hypercapnic. Both conditions can trigger serious complications and the conditions often coexist.

Hypoxemic respiratory failure means that you don?t have enough oxygen in your blood, but your levels of carbon dioxide are close to normal.

Hypercapnic respiratory failure means that there?s too much carbon dioxide in your blood, and near normal or not enough oxygen in your blood.

What are the symptoms of acute respiratory failure?
The symptoms of acute respiratory failure depend on its underlying cause and the levels of carbon dioxide and oxygen in your blood.

People with a high carbon dioxide level may experience:
rapid breathing
confusion

People with low oxygen levels may experience:
an inability to breathe
bluish coloration in the skin, fingertips, or lips

People with acute failure of the lungs and low oxygen levels may
experience:
restlessness
anxiety
sleepiness
loss of consciousness
rapid and shallow breathing
racing heart
irregular heartbeats (arrhythmias)
profuse sweating

What causes acute respiratory failure?
Acute respiratory failure has several different causes:

Obstruction

When something lodges in your throat, you may have trouble getting enough oxygen into your lungs. Obstruction can also occur in people with chronic obstructive pulmonary disease (COPD) or asthma when an exacerbation causes the airways to become narrow.

Injury

An injury that impairs or compromises your respiratory system can adversely affect the amount of oxygen in your blood. For instance, an injury to the spinal cord or brain can immediately affect your breathing. The brain tells the lungs to breathe. If the brain can?t relay messages due to injury or damage, the lungs can?t continue to function properly.

An injury to the ribs or chest can also hamper the breathing process. These injuries can impair your ability to inhale enough oxygen into your lungs.

Acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a serious condition characterized by low oxygen in the blood. ARDS affects you if you already have an underlying health problem such as:
pneumonia
pancreatitis (inflammation of the pancreas)
severe trauma
sepsis
severe brain injuries
lung injuries caused by inhalation of smoke or chemical products

It can occur while you?re in the hospital being treated for your underlying condition.

Drug or alcohol abuse

If you overdose on drugs or drink too much alcohol, you can impair brain function and hinder your ability to breathe in or exhale.

Chemical inhalation
Inhaling toxic chemicals, smoke, or fumes can also cause acute respiratory failure. These chemicals may injure or damage the tissues of your lungs, including the air sacs and capillaries.

Stroke

A stroke occurs when your brain experiences tissue death or damage on one or both sides of the brain. Often, it affects only one side. Although stroke does present some warning signs, such as slurred speech or confusion, it typically occurs quickly. If you have a stroke, you may lose your ability to breathe properly.

Infection

Infections are a common cause of respiratory distress. Pneumonia in particular, may cause respiratory failure, even in the absence of ARDS. According to the Mayo Clinic, in some cases pneumonia affects all five lobes of the lungs.

Who is at risk for acute respiratory failure?
You may be at risk for acute respiratory failure if you: smoke tobacco products drink alcohol excessively have a family history of respiratory disease or conditions sustain an injury to the spine, brain, or chest have a compromised immune system have chronic (long-term) respiratory problems, such as cancer of the lungs, chronic obstructive pulmonary disease (COPD), or asthma

Diagnosing acute respiratory failure

Acute respiratory failure requires immediate medical attention. You may receive oxygen to help you breathe and to prevent tissue death in your organs and brain.

After your doctor stabilizes you, he or she will take certain steps to diagnose your condition, such as: perform a physical exam ask you questions about your family or personal health history check your body?s oxygen and carbon dioxide levels level with a pulse oximetry device and an arterial blood gas test order a chest X-ray to look for abnormalities in your lungs

Treating acute respiratory failure

Treatment usually addresses any underlying conditions you may have. Your doctor will then treat your respiratory failure with a variety of options. Your doctor may prescribe pain medications or other medicines to help you breathe better. If you can breathe adequately on your own and your hypoxemia is mild, you may receive oxygen from an oxygen tank to help you breathe better. Portable air tanks are available if your condition requires one. If you can?t breathe adequately on your own, your doctor may insert a breathing tube into your mouth or nose, and connect the tube to a ventilator to help you breathe. If you require prolonged ventilator support, an operation that creates an artificial airway in the windpipe called a tracheostomy may be necessary. You may receive oxygen via an oxygen tank or ventilator to help you breathe better.

What can I expect in the long-term?
You may see improvement in your lung function if you get appropriate treatment for your underlying condition. You may also require pulmonary rehabilitation, which includes exercise therapy, education, and counseling.

Acute respiratory failure can cause long-term damage to your lungs. It?s important to seek emergency medical care if you?re experiencing the symptoms of respiratory failure.

Chronic Respiratory Failure

What is chronic respiratory failure?
Respiratory failure can happen when your respiratory system is unable to remove enough carbon dioxide from the blood, causing it to build up in your body. The condition can also develop when your respiratory system can?t take in enough oxygen, leading to dangerously low levels of oxygen in your blood.

Respiratory failure may be acute or chronic. Acute respiratory failure is a short-term condition. It occurs suddenly and is typically treated as a medical emergency. Chronic respiratory failure, however, is an ongoing condition. It gradually develops over time and requires long-term treatment.

Chronic respiratory failure usually happens when the airways that carry air to your lungs become narrow and damaged. This limits air movement through the body, which means that less oxygen gets in and less carbon dioxide gets out.

Chronic respiratory failure can also be classified as hypoxemic or hypercapnic respiratory failure. Low blood oxygen levels cause hypoxemic respiratory failure. High carbon dioxide levels cause hypercapnic respiratory failure.

What are the symptoms of chronic respiratory failure?
Symptoms of chronic respiratory failure may not be noticeable at first. They usually occur slowly over an extended period of time. When symptoms do develop, they may include:
difficulty breathing or shortness of breath, especially when active
coughing up mucous
wheezing
bluish tint to the skin, lips, or fingernails
rapid breathing
fatigue
anxiety
confusion
daily headache

Chronic respiratory failure is a serious illness that gets worse over time. As the condition increases in severity, people may develop an abnormal heart rhythm, stop breathing, or slip into a coma.

What causes chronic respiratory failure?
Certain lung diseases can cause chronic respiratory failure. Conditions that affect the way in which the brain, muscles, bones, or surrounding tissues support breathing can also cause chronic respiratory failure.

Diseases and conditions that commonly lead to chronic respiratory failure include:
chronic obstructive pulmonary disease (COPD)
complicated pneumonia
cystic fibrosis
spinal cord injuries
stroke
muscular dystrophy
ALS (Lou Gehrig?s disease)
injury to the chest
drug or alcohol misuse
smoking

How is chronic respiratory failure diagnosed?
Your doctor will be able to diagnose chronic respiratory failure by performing a physical exam and by asking you about your symptoms and medical history. They may also run certain tests to confirm the diagnosis. Often an ongoing illness or significant injury has occurred prior to its development.

Medical history

Your doctor will ask you about lung diseases or conditions you currently have or have had in the past to learn more about your medical history.

Physical examination

During a physical exam, your doctor will use a medical device called a stethoscope to listen for abnormal sounds in your lungs and heart.

Pulse oximetry test

Pulse oximetry is a simple and painless test that evaluates how well oxygen is being sent to various parts of the body. Your doctor will place a small sensor on the tip of your finger or ear lobe to determine whether you are getting enough oxygen. In healthy people, normal oxygen saturation range will be between 96 to 100 percent. Any percentage under 90 indicates an abnormally low oxygen level.

Arterial blood gas test

An arterial blood gas test is a safe, easy procedure that measures the amount of oxygen and carbon dioxide in the blood. It also measures the pH, or acid content, of your blood. Your doctor will take blood from an artery at your wrist. They will then send the blood to a lab for analysis. The results of this test indicate oxygen and carbon dioxide levels in your blood, as well as the overall chemistry of your blood.

Imaging tests

Your doctor can use a chest X-ray or CT scan to obtain a better view of your lungs. These tests may reveal possible causes of chronic respiratory failure.

Bronchoscopy

A bronchoscope is a thin, flexible lighted instrument that can be inserted into your airway and lungs. Doctors can use this test to get a closer look at the lung passages, as well as take samples of airway and lung tissue.

How is chronic respiratory failure treated?
Although acute respiratory failure is a medical emergency that must be treated in a hospital, chronic respiratory failure may be managed at home, depending on its cause. In severe cases, medical professionals can help you manage the condition in a long-term healthcare center.

Treatment options typically include:
treating the underlying cause of respiratory failure
removing excess carbon dioxide from the blood
increasing oxygen levels in the blood

Oxygen therapy

You may receive oxygen therapy if you don?t have enough oxygen in your blood. Oxygen therapy raises oxygen levels by increasing the amount of oxygen you inhale. Oxygen is distributed from a tank through a tube. The gas enters the lungs through a facemask, nasal tubes, or one larger tube directly inserted into the windpipe. There are small, portable oxygen machines available that can be carried in a shoulder bag.

Tracheostomy

In severe cases of chronic respiratory failure, a tracheostomy may be needed. During this procedure, your doctor places a tube in your windpipe so that you can breathe more easily. The tube is inserted through a cut in the front of your neck where your windpipe is located. This tube may be temporary or permanent.

Mechanical ventilation

If chronic respiratory failure doesn?t improve with other treatments, your doctor may put you on a ventilator, or breathing machine. This machine pumps oxygen through a tube that is placed into your mouth or nose and down into your windpipe. Since the ventilator blows air directly into your lungs, you don?t have to work as hard to breathe oxygen in on your own. Depending on the severity of your condition, the ventilator may just need to help you with breathing, or it may need to do all of the breathing for you.

Other forms of breathing assistance, known as noninvasive ventilation (NIV) include BiPAP and CPAP. These may be appropriate long-term options for certain conditions.

What are the potential complications of chronic respiratory failure?
There often isn?t any cure for chronic respiratory failure, but symptoms can be managed with treatment. If you have a long-term lung disease, such as COPD or emphysema, you may need continuous help with your breathing. Your specific outlook depends on the exact cause of your respiratory failure, your overall health, and how quickly you receive treatment. Speak with your doctor to learn more about the outlook for your particular case.

Respiratory acidosis
What is the average pH in human blood?
What is the pH ranges of human blood?
What are examples of various human acid-based disorders?
What is respiratory acidosis?
What is the paco2?
How does excess co2 lead to respiratory acidosis?
What are possible etiologies of chronic respiratory acidosis?
What other conditions may be present in patients with respiratory acidosis?
Why does hypoventilation cause acidosis?
What is compensation in acid base balance?
What are the treatment options for respiratory acidosis?

What is the average pH in human blood?
7.4

What is the pH ranges of human blood?
7.35 to 7.45.

What are examples of various human acid-based disorders?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Mixed acid-based disorders

What are the treatment options for respiratory acidosis?
Pharmacologic therapies are generally used as treatment for the underlying disease process. Oxygen therapy is employed to prevent the sequelae of long-standing hypoxemia.

Therapeutic measures that may be lifesaving in severe hypercapnia and respiratory acidosis include endotracheal intubation with mechanical ventilation and noninvasive positive pressure ventilation (NIPPV) techniques such as nasal continuous positive-pressure ventilation (NCPAP) and nasal bilevel ventilation. The latter techniques of NIPPV are preferred treatment for obesity hypoventilation syndrome (OHS) and neuromuscular disorders, because they help to improve partial pressure of arterial oxygen (PaO2) and decrease the partial pressure of arterial carbon dioxide (PaCO2).
Here are further guidelines.
Last Updated: October 30, 2020