FAMILY MED EOR BLUEPRINT
URGENT CARE (4%)
RESP FAILURE/ARREST
RESP DYSFUNCTION resulting in abnormalities of OXYGENATION or VENTILATION (CO2
... [Show More] elimination) severe enough to threaten
function of vital organs
pO2 <60 mmHg + PCO2 >50 mmHg
CAUSES (full list on p 316 in Current)
ASTHMA
OBST
PULM EDEMA 2T ARDS, INJURY, ↑ HYDROSTATIC PRESSURE, MITRAL REGURG
AIR EMBOLISM
RIB FX, FAIL CHEST, PNEUMO
FEVER, INFECTION, DRUGS
SSX
those of UNDERLYING DZ combined w HYPOXEMIA (low O2 in blood) + HYPERCAPNIA (excessive CO2 in bloodstream)
HYPOXEMIA = cyanosis, restlessness, confusion, anxiety, delirium
HYPERCAPNIA = HA + dyspnea cardinal signs
LABS
obtain ABG
TX
treat underlying disease
RESP SUPPORTIVE CARE for adequate gas exchange
GENERAL SUPPORTIVE CARE
NONVENT ASPECTS OF TREATMENT
INSPIRED O2 CONC should be LOWEST VALUE -> ARTERIAL HEMOGLOBIN SATURATION of 90%
VENTILATOR ASPECTS
FULL FACE MASK or NASAL MASK of BiPAP FIRST LINE COPD
pts w ARDS or SEVERE IMPAIRED OXYGENATION need to be INTUBATED
You can have NONINVASIVE, TRACHEAL INTUBATION, MECHANICAL VENT
comps w MECHANICAL VENT include: ET TUBE MIGRATION into MAIN BRONCHUS, loss alveolar integrity, ACUTE
RESP ALKALOSIS 2T OVERVENTILATION (common), or PNA
GENERAL SUPPORT
adequate NUTRITION = key
Watch out for overfeeding of carbs with conventional enteral feeding methods because it can cause increase CO2
production
Watch out for hypokalemia and hypophosphatemia may worsen hypoventilation
Support from family
DETERIORATING MENTAL STATUS
"CONFUSED" PT frequently comes to medical attn 2T judgment of someone
DELIRIUM = acute change in attn + mental fxn; disturbance of wake-sleep cycles and fluctuating confusion.
DEMENTIA = chronic confusional state with insidious onset.
The two conditions can and frequently do coexist.
ALLERGIC RXN/ANAPHYLAXSIS
Allergen exposure followed by acute onset of illness involving the skin or mucosal tissue and either resp compromise of
hypotension (systolic <90 mmHg)
1
Types of anaphylaxis
IgE dependent: acute syndrome initiated by new allergen exposure after prior silent exposure in which the pts body made
IgE antibodies (can NOT occur on first time exposure)
Idiopathic anaphylaxis: without known immunologic mechanism and can occur with first time exposure
SSX
Occur within 30 min usually
First have skin manifestation like urticaria then respiratory distress, GI symptoms, and hypotension
Labs: elevated serum levels of mast cell mediators such as tryptase and histamine
BURNS
The first 48hrs of burn care offer the greatest impact [Show Less]