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8/14/2019 Respiratory Insufficiency & Other Clinical Conditions
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Dr. Niranjan Murthy H LAsst Professor of Physiology
SSMC, Tumkur
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RESPIRATORY INSUFFICIENCY
Narcosis, other pharmacologic influences,
hypoxia, andpathologic processes
reduce excitability of respiratory neurons respiratory failure
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Narcotic drugs & respiratory depression:
Leads to reduced PaO2 & increased PaCO2.
Carries best prognosis & amenable to Rx.Narcotic drugs also diminish metabolism.
Complications of narcotic poisoning-
(vi) Asphyxia(vii)Microbial infections
(viii)Circulatory depression
(ix) Renal functional derangements(x) Hypo or hyperthermia
(xi) Consequences of therapeutic measures
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Asphyxia- depression of PaO2 and
elevation of PaCO2; assisted ventilation.
Circulatory depression- due to central
vasomotor depression, hypoxemia, and
direct narcotic effects on blood vessels;
blood supply of brain is maintained due tohypercapnia induced cerebral
vasodilatation; support of circulation.
Hypothermia- due to reduced metabolism& deranged heat regulating mechanisms;
hyperthermia in case of infections
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Renal impairment- due to hypotension
Respiratory insufficiency due to
pulmonary pathologies:
(i) Pulmonary Emphysema
(ii) Pneumonia(iii) Atelectasis
(iv) Asthma
(v) Tuberculosis
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Pulmonary Emphysema
Excessive air in lungs
Causes- chronic infections, chronic smoking.
Physiologic abnormalities-
(i) Increased airway resistance
(ii) Destruction of alveolar walls reduced
diffusing capacity increased PaCO2 &
reduced PaO2
(iii) Reduced alveolar capillaries pulmonary
hypertension right heart failure
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Asthma
Airway hyper-responsiveness
Allergic hypersensitivity- pollen
Older people- pollution
Histamine, SRS-A, ecf, bradykinin are released
from mast cells
Localized edema in walls of airways and spasm
of bronchiolar smooth muscles Reduced PEFR and FEV1
Increase in FRC and RV
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Tuberculosis
Mycobacterium tuberculosis
Tubercle- due to walling off of infection
Cavitation- in untreated cases
Fibrosis- in late stages
Reduced VC
Reduced surface area and increasedthickness of respiratory membrane
Abnormal VA/Q
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Apnea
Cessation of breathing (generally
temporary)
(ii) Reduction in stimulus to respiratory
centre
(iii) Active inhibition of respiratory neurons-
prolongation of Hering-Breuer reflex
(iv) Decreased ability of respiratory neurons
to react to stimuli- narcotics
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Dyspnea
Labored, distressful breathing with
conscious effort
Factors leading to dyspnea -
(iii) Abnormality of respiratory gases in body
fluids
(iv) Amount work to be performed byrespiratory muscles
(v) State of mind
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Disorders of rhythm
Cheyne-Stokes respiration:
Periodic breathing
Seen in congestive heart failure, uremia,brain disease and sleep.
Prolongation of circulation time
Increased sensitivity to CO2
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