Eng / Emergency situation
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Symptoms of hypercapnia (Pa CO2 is greater than 45 mm Hg):
The result of both increased activity of the sympathetic nervous system and the direct action of excess CO2 on tissues
Hemodynamic:
Tachycardia
Increased cardiac output
Systemic vasodilation
Stages of ARF
Depending on the partial voltage of O2 and CO2 in the blood, three stages of acute respiratory disorders are distinguished:
ARF stage I - pO2 decreases to 70 mm Hg pCO2 up to 35 mm Hg. Art.
ARF stage II - pO2 decreases to 60 mm Hg. Art., pCO2 increases to 50 mm Hg. Art.
ARF stage III - pO2 decreases to 50 mm Hg. Art. and below, pCO2 increases to 80-90 mm Hg. Art. and higher.
Stages of ARF
Depending on the partial voltage of O2 and CO2 in the blood, three stages of acute respiratory disorders are distinguished:
ARF |
pO2 |
pCO2 |
|
mm Hg |
mm Hg |
|
|
|
stage I |
70 |
35 |
|
|
|
stage II |
60 |
50 |
|
|
|
stage III |
50 |
80-90 |
|
|
|
CLINIC ARF
ARF I degree (compensated stage) is accompanied by a feeling of lack of air, anxiety of the patient, sometimes euphoria. The skin is pale, slightly moist; there is a slight cyanosis of the fingers, lips, tip of the nose. Objectively: tachypnea (RR 25-30 per minute), tachycardia (HR 100-110 per minute), moderate increase in blood pressure.
With ARF II degree (stage of incomplete compensation), psychomotor agitation develops, patients complain of severe suffocation. Possible confusion, hallucinations, delirium. The color of the skin is cyanotic (sometimes with hyperemia), profuse sweating is observed. At the II stage of acute respiratory failure, the respiratory rate continues to increase (up to 30-40 per 1 minute), pulse (up to 120-140 per minute); arterial hypertension
CLINIC ARF
ONE III degree (stage of decompensation) develops hypoxic coma and tonic-clonic convulsions. Pupils dilate and do not respond to light, patchy cyanosis of the skin appears. Respiratory rate - 40 or more per minute, respiratory movements are superficial. A formidable prognostic sign is the rapid transition of tachypnea to bradypnea (RR 8-10 per minute), which is a harbinger of cardiac arrest.
Arterial pressure drops critically, heart rate over 140 per minute. with arrhythmias. Acute respiratory failure of the III degree is the preagonal phase of the terminal state and without timely resuscitation leads to a rapid death.
Hypercapnic coma
occurs with a rapid increase in CO2 and is associated with an increase in cerebral blood flow, intracranial pressure and cerebral edema:
Convulsive breathing with apnea - Cheyne-Stokes
Accessory muscles involved in respiration
Sharp cyanosis
Marbling of the skin
Cold sweat
BP drop
Tachycardia is replaced by bradycardia
Motor restlessness, excitement is replaced by apathy
Loss of consciousness, coma, seizures
Involuntary urination and defecation
Respiratory arrest, circulatory arrest and death
Diagnostic search for ARF:
lung radiograph,
ECG,
central venous pressure,
blood analysis,
hematocrit,
Analysis of urine,
pCO2,
pO2
(Additional investigations depend on the suspected cause of ARF).
Treatment of ARF
With ARF 1 degree, it is sufficient to carry out oxygen therapy with humidified oxygen. Optimal 35-40% oxygen content in the inhaled mixture (3- 5l / min)
with an increase in signs of ARF - high-flow oxygen supply (50-60 l / min)
if it is ineffective, transfer the patient to a ventilator
Treatment of ARF
Antioxidants and antihypoxants
(cytoflavin, reamberin, mexidol)
Bronchoand mucolytics (eufillin - 12 - 20 ml per day, ambrobene 6 ml / day, ACC)
Anticoagulants and antiplatelet agents
Antibiotics and immunocorrectors (cycloferon)
Acute renal failure (ARF)
violation of the excretory function of the kidneys with a delay in the blood of nitrogenous metabolic products, potassium, magnesium and water with the development of metabolic acidosis.