Respiratory Dieases

There are many Respiratory diseases that need the urgent care in emergency setup , but we will discuss some of them;

1. Pneumothorax.
2. Hemoptysis.
3. Respiratory Failure.
4. Asthma.
5. Chronic Obstructive lung disease (COPD).

1. Pneumothorax:

Definition:

Pneumothorax means air in pleural space.

Causes:

Causes of pneumothorax may be divided into two major groups;

• Spontaneous pneumothorax.
• Traumatic pneumothorax.

Spontaneous Pneumothorax:

2. Hemoptysis:

Definition:

The Expectoration of blood or blood stained sputum is known as hemoptysis.

Circulation of Lungs:
The lungs are supplied with dual circulation;
Pulmonary arteries arise from right ventricle and supplies to pulmonary paranchyma.
Bronchial arteries arise from aorta or intercostal arteries and supplies airway, blood vessels, hila and visceral pleura.

* The common source of bleeding is Bronchial blood flow and it increases in inflammation.

Causes:
From Airways in;

1- Bronchitis.
2- Bronchiectasis.
3- Bronchial Adenoma.
4- Bronchogenic carcinoma.

From Pulmonary Vasculature;

1- Mitral Stenosis.
2- Pulmonary Infarction.
3- Left ventricular failure.
4- A-V malformation.

From Pulmonary Paranchyma;

1- Pneumonia.
2- Bleeding disorders.
3- Autoimmune disease.

* Massive hemoptysis more than 200 to 600 ml of blood in 24 hours.
It usually occurs in Bronchiectasis, Tuberculosis and Pulmonary infarction.

Investigation:

CXR.
CBC.
Platelet count.
BT, PT, APTT, INR.
Bronchoscopy.
CT- Scan.

Management:

Treat the underlying cause first.
Initial assessment/ Resuscitation.
(Secure the ABC, maintain airway, breathing and circulation)
Perform bronchoscopy in uncontrolled bleeding and for surgical consultation.
Angiography to localize the site of bleeding and to embolize the source of bleeding (Bronchial artery).

Reassurance.
Sedate the patient.
Give antibiotics.
Clotting agent e.g; Tranexamic acid - caps 250 mg / 500 mg.

3. Respiratory Failure:

Definition:
When the normal pressure of oxygen and carbon dioxide in the arterial blood are no longer maintained, the condition is know as respiratory failure.
i.e. PaO2 is less than 60 mm Hg.
PaCO2 more than 50 mm Hg.

Types of Respiratory Failure:
There are two types of respiratory failure;
1- Type I Respiratory failure (ventilation mismatch pefusion).
2- Type II Respiratory failure.

1- Type I Respiratory failure:
Its also known as ventilation mismatch perfusion or acute hypoxemic failure, in which the PaCO2 is normal while PaO2 is less than 60 mm Hg.
i.e. there is only hypoxemia but not hypercapnia (CO2 retention).

Causes:

• Type I failure is occur with disease that damage lung tissue.
• Bronchial Asthma.
• Acute Exacerbation of COPD.
• Pneumonia.
• LV failure and other causes of pulmonary edema.
• Pulmonary embolism.
• ARDS (Acute respiratory distress syndrome/ Adult respiratory disease syndrome).
• Pneumothorax.
• Interstitial lung disease.
• Fibrosing alveolitis.

Types of Type I Respiratory failure:
Acute type I respiratory failure.
Chronic type I respiratory failure.

Investigation:

ABGs; PaO2 is very low i.e. < 60 mm Hg.
PaCO2 is normal or low i.e. 35 - 45 mm Hg.
PH is normal or low i.e. Acidic in nature.
HCO3 is normal i.e. 24 - 28 mmol/L.

Management:
Acute type I respiratory failure;
Treat the underlying cause, i.e. pneumonia, pulmonary edema and ARDS etc.
Oxygen in high concentration > 3.5 L (> 35%) by oronasal mask.
Intubation of ETT may be.
Pain killer may be given in LV failure, massive pulmonary embolism or pulmonary infarction and pneumonia.

* Never use opiates in asthma and COPD.
Chronic type I respiratory failure;
Treat the underlying cause, i.e. emphysema, Interstitial lung disease etc.
Oxygen in high flow i.e. about 40%.

2- Type II Respiratory failure:
In type II or Ventilatory failure PaCO2 is elevated and PaO2 is reduced i.e. there are two problems hypoxemia and hypercritical leading to severe acute respiratory acidosis.
Type II failure occurs in which alveolar ventilation is insufficient to excrete carbon dioxide.

Causes:
Acute Type II;
COPD.
Depression of Respiratory center.
Acute severe asthma.
Respiratory muscles paralysis (In Guillain //barre syndrome).
Rib Fracture (Flail Chest).
Inhaled foreign body.
Sleep apnea syndrome.

Chronic Type II;
COPD.
Ankylosing spondylitis.
Kyphoscoliosis.

Arterial Blood Gases:
PaO2 : Low.
PaCO2 : High.
pH : Low.
HCO3 : Normal.