Asthma

Chronic inflammatory airways. Exacerbation is intermittent and reversible.

Trigger -> inflammation and airway hyperresponsiveness -> bronchoconstriction and airway obstruction

Signs and Symptoms

• dyspnea
• wheezing
• chest tightness
• coughing
• tachypnea
• accessory muscle use
• prolonged expiration
• gasping
• inability to speak
• reduced LOC
• cyanosis
• neck vein distension

Diagnosis

• PEFR (highest of 3x attempts)
• ABG (decreased O2)

Treatment

• Bronchodilators — preventer (control) and reliever e.g. salbutamol
• Anticholinergic — relax airways e.g. ipratropium
• Steroids — reduce inflammation.g. prednisone, budesonide
• Oxygen
• Airvo

Heart Failure

Heart unable to fill with and pump blood effectively (cardiomyopathy, MI, HTN, AF, valve disease, infection).

Right-Sided

• Blood backs up into the body (systemic congestion) -> peripheral oedema, ascites, jugular vein distension, hepatomegaly

Left-sided

• Blood backs up into the lungs (pulmonary congestion) -> dyspnea, crackles, pink frothy sputum

BNP

BNP is a hormone released when cardiac muscle is stretched — hence elevated in HF.

Echocardiogram

Measures the ejection fraction (percentage of blood that is ejected from the ventricles during contraction). Normal LVEF: 55-70%. Indicative of HF: <55%.

Medications

• Diuretics — eliminate excess fluid to decrease workload
• Digoxin — improves efficiency of heart, stronger and slower contractions
• Antihyperensives

Care

• Weight
• FBC and fluid restriction
• Sit upright
• O2 or airvo

Respiratory Failure

Inadequate gas exchange impairing oxygen and carbon dioxide levels.

Hypoxemia — drop in oxygen

Hypercapnia — drop in carbon dioxide

Type 1

Hypoxeamia with normal or low carbon dioxide. T1RF is caused by conditions that affect oxygenation.

• Low ambient oxygen e.g. high altitude
• Ventilation-perfusion mismatch e.g. pulmonary embolism, ARDS, COPD, HF
• Alveolar hypoventilation e.g. neuromuscular disease
• Diffusion problem (oxygen cannot enter capillaries) e.g. pneumonia or ARDS
• Right-left shunt (oxygenated blood mixing with non-oxygenated blood) e.g. AVM, complete atelectasis, severe pneumonia, severe pulmonary oedema

Type 2

Hypoxemia with hypercapnia and pH <7.35. T2RF is caused by conditions that affect alveolar ventilation. There is a buildup of carbon dioxide generated by the body that cannot be eliminated.

• Increased resistance e.g. COPD, asthma, suffocation
• Decreased ventilation e.g. drug effects, brain stem lesion
• Decreased area of lung available for gas exchange e.g. chronic bronchitis
• Neuromuscular problems e.g. GBS, MND
• Deformed (kyphoscoliosis), rigid (ankylosing spondylitis), or flail chest