Case 2.1

Abdullatiff Sami Al-RashedGroup: 3Tutor: Dr.Ossama Zakarya

Objectives

Respiratory Depression &Effect of Alcohol in Respiratory system

(ABG) analysis & the effect of abnormal values

Rib fracture & its effect “pneumothorax”

Respiratory Depression

• Respiratory depression occurs when ventilation is inadequate to perform needed gas exchange.

• It can be caused by medical conditions, such as:• Head injury• Anaesthesia• Opiate overdose• Bronchiectasis• Respiratory failure• Pneumoconiosis• Brain tumours• Lung carcinoma• Obstruction

Effect of Alcohol in Respiratory System • Alcohol affects the respiratory system in many ways such as

slower breathing and sleep apnea in many individuals.

• These can be considered as shorter term effects, but over time, many individuals can potentially experience more long term effects such as those experienced as a result of lack of oxygen to the brain due to sleep apnea related issues.

• Heavy drinkers, over time, are also at risk of developing diseases and conditions affecting the respiratory system such as pneumonia due to a weaker immune system that can be experienced due to consumption of alcohol.

Effect of Alcohol in Respiratory System

• There are affects of alcohol in respiratory system:

1. Pneumonia:• Alcohol has been observed to be

a common comorbidity in MICU patients with pneumonia.

• There is a 60% increase in the use of the MICU when an alcoholic has pneumonia compared with a nonalcoholic patient.

Cont..

2. Acute Respiratory Distress Syndrome (ARDS):

• A history of chronic alcohol abuse significantly increases the risk of developing acute respiratory distress syndrome (ARDS) in critically ill patients.

• Characterized by inflammation of the lung parenchyma leading to impaired gas exchange

Blood Gases Analysis

• Blood gas analysis, also called arterial blood gas (ABG) analysis, is a procedure to measure the partial pressure of oxygen (O2) and carbon dioxide (CO2) gases and the pH (hydrogen ion concentration) in arterial blood.

Effects of Abnormal Values

The effect is either:

Acidosis Alkalosis

Cont..

• If pH <7.35 indicates acidosis, either metabolic (non-respiratory) or respiratory

• pH >7.45 indicates alkalosis.

Cont..

• Metabolic or non-respiratory acidosis is characterized by pH <7.35 (i.e. increased [H+]) and decreased [HCO3-].

• Common causes of metabolic acidosis are diabetes mellitus, alcoholism, lactic acidosis (associated with hypoxia), acid poisoning, renal failure, renal tubular acidosis (an inherited defect of the renal tubules), and diarrhea.

Cont..

• Respiratory acidosis is caused by deficient ventilation that results in retention of carbon dioxide. The pH is <7.35, and PCO2 is increased.

Cont..

• Metabolic alkalosis is caused by excess blood bicarbonate and usually involves a renal factor.

• Metabolic alkalosis is characterized by pH >7.45 and elevated [HCO3-].

Cont..

• Respiratory alkalosis is caused by hyperventilation. The pH is >7.45 and the PCO2: is low.

Rib Fracture

• A rib fracture is a crack or break in one of the bones of the rib cage.

• The most common cause of a fractured rib is a direct blow to the chest, often from a car accident or a fall.

• Coughing hard can also fracture a rib. This is more likely to happen if you have a disease that has made your bones weak, such as osteoporosis or cancer.

Sign & Symptoms

A fractured rib may cause:1. Mild to severe pain in the injured

area.2. Pain when you breathe.3. Pain around the fracture when

someone pushes on your breastbone.

Specific signs of ventilatory insufficiency include:

1. Cyanosis2. Tachypnea3. Retractions, and use of

accessory muscles for ventilation.

4. Less specific signs include anxiety and agitation.

Sign & Symptoms

How is a fractured rib diagnosed?

• The doctor first take the history and do physical examination, then he may order one or more of the following imaging tests:

1. X-ray: X-rays often have problems revealing fresh rib fractures, especially if the bone is merely cracked.

2. CT Scan: can often uncover rib fractures that X-rays might miss. Injuries to soft tissues and blood vessels are also easier to see on CT scans.

Cont..

3. (MRI) : MRI scans can be used to look at the soft tissues and organs around the ribs to determine if there is any damage to these structures.

4. Bone scan: This technique is good for viewing stress fractures, where a bone is cracked after repetitive trauma — such as long bouts of coughing.

Complication

• Complications of rib fracture may include:1. Pneumothorax

2. Haemothorax

3. Pulmonary contusion

4. Respiratory failure

5. Pneumonia: Pneumonia is one of the most common complications associated with rib fractures.

6. Intra-abdominal organ injury

Treatment

• Most broken ribs heal on their own within six weeks.

• It's important to obtain adequate pain relief because if it hurts too much to breathe deeply, you may develop pneumonia. Such as:

• Pain relief such as: Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs)

Pneumothorax

• Pneumothorax is defined as the presence of air or gas in the pleural cavity (ie, the potential space between the visceral and parietal pleura of the lung) , that causes part or all of a lung to collapse.

Types of Pneumothorax :

1. Spontaneous :• Having an unknown cause or occurring as a consequence of

nature course of a disease process , such as COPD , tuberculosis.

2. Traumatic :• Following any penetrating or non-penetrating chest trauma ,

with or without bronchial rupture.

3. Iatrogenic :• Occurring as a result of diagnostic or therapeutic medical

procedure . intentional or a complication .

Causes of Pneumothorax :

• Pneumothorax can be caused by a chest injury or underlying lung disease, such as Emphysema, Pneumonia…

• Pneumothorax also can occur for no obvious reason.

Signs and Symptoms of Pneumothorax

• The Symptoms of a pneumothorax include:• chest pain that usually has a sudden onset. • Tightness in the chest.• Shortness of breath.• Tachycardia.• Tachypnea.• Cough, and fatigue.

• The skin may develop a bluish color (termed cyanosis) due to decreases in blood oxygen levels.

Treatment

• The treatment of pneumothorax depends on a number of factors, and may vary from discharge with early follow-up to immediate needle decompression or insertion of a chest tube.

• Treatment is determined by the severity of symptoms and indicators of acute illness, the presence of underlying lung disease, the estimated size of the pneumothorax on X-ray, and - in some instances - on the personal preference of the person involved

Treatment

• Aspirating (removing) the trapped air is sometimes needed:• It is essential to remove the air quickly in a tension

pneumothorax. The common method of removing the air is to insert a very thin tube through the chest wall with the aid of a needle.

• Pleurodesis: Caregivers use chemicals, such as iodine or talc powder, to irritate the walls of pleural space. This causes the walls of pleural space to close together so air can no longer be trapped there.

References

• http://www.rightdiagnosis.com/r/respiratory_depression/intro.htm

• http://www.webmd.com

• http://www.mayoclinic.com

• http://emedicine.medscape.com