Question

What is Hyperventilation - respiratory acidosis, respiratory alkalosis, metabolic acidosis or metabolic alkalosis? Explain.

What is next step after atropine 3mg multiple failed? Explain

What is dopamine is given for - to block alpha receptor while stimulating beta receptor OR to slow heart rate? Explain

What is critical step in cardioversion - set j50, OR turn syn button, OR set pacing to 72? Explain

Answer 1

1 HYPERVENTILATION

• hyperventilation is the deeper or rapid breathing than normal
• It can cause a decrease in amount of carbon dioxide in blood which results in feeling of light headedness,rapid heart beat and shortness of breath and further leads to numbness of hands and feet ,anxiety,fainting.

CAUSES

anxiety,fever,medications,intense exercise,emotional stress,asthma,emphysema,after a head injury,lung diseases,panic disorder

SYMPTOMS

anxiety or nervousness,frequent yawning,racing heartbeat,light headedness or vertigo,numbness in the hands ,feets or mouth,chest tightness,headache,sweating,vision changes,fainting

TREATMENT

treatment for hyperventilation depend upon the cause

MEDICAL TREATMENT

stress reduction methods,reassurence,breathing excercises ,medicines

RESPIRATORY ACIDOSIS

• respiratory acidosis is a condition in which the hypoventilation increases the concentration of carbon dioxide and decreases the ph of blood

TYPES

acute respiratory acidosis:- It is the condition in which partial pressure of carbon dioxide[paco2] level is elevated above the normal range [35 -45mmhg]with an accompanying acidemia [ph <7.35>]

chronic respiratory acidosis:-It is the condition in which partial pressure of carbon dioxide[paco2] level is elevated above the normal range with normal blood ph[7.35-7.45]

CAUSES

defects in the normal lung function or changes in the normal respiratory pattern,condition that cause airway obstruction,asthma,atelectasis[excessive mucus collection with collapse of alveolar sac],brain trauma,bronchiectasis[dilatation of bronchi results in inflammation and destructive changes,bronchitis[inflammation of bronchi],cns deppresants [sedative opioids anesthetics],emphysema [loss of elasticity of alveolar sac],hypoventilation,pulmonary edema,pneumonia,pulmonary emboli

CLINICAL MANIFESTATIONS

neurological-

drawsiness,disorientation,dizziness,headache,coma

cardivascular

decreased bp,ventricular fibrillation,warm or flushed skin

neuromuscular

seizure

respiratory

hypoventilation with hypoxia

TREATMENT

monitor signs of respiratory distress,administer oxygen,semi fowlers position,encorrage cough and deep breathing exercises,encourage fluid intake,suction the airway,administer tranquilizers,sedative or opioids to reduce restlessness,monitor electrolyte levels [potasium level],administer antibiotic for respiratory infection,endotrachial intubation and mechanical ventilation if co2 levels above 50mmhg with respiratory distress

respiratory alkalosis

it is acid base disterbens due to alveolar hyper ventilation which results in decresed paco2

causes

fever,hyperventilation,hypoxia,hysteria,mechanical hyperventilation,pain,

symptoms

neurologiacal-lethargy,lightheadedness,confusion

cardiovascular-tachycardia,dysarrythmia

gastrointestinal-nausea,vomiting,epigastric pain

neuromuscularl-tetany,numbness,tingling,seizures

respiratory-hyperventilation

Treatment-Monitor signs and symptoms,emotional support and reassurance,breathing exercise,provide rebreathing mask,monitor electrolyte levels,administer calcium gluconite in tetany

Metabolic acidocis

it occurs when body produces excessive quantity of acid when the kidneys are not removing enough acid from the body

Symptoms

Neurological-drowsiness,confusion,headache,coma

Cardiovascular-decreased bp,dysrythmias,warm and flushed skin

Gastrointestinal-nausea,vomiting,diarrhea,abdominal pain

Respiratory-deep,rapid respiration

Treatment-Assess the level of consciousness,monitor input and output,administer iv solutions,seizure precausions,monitor serum potassium

Metabolic alkalosis

It is a primary acid base disorder that causes the plasma HCO3- to raise an abnormally high level

CAUSES

Diuretics,excessive vomiting,GI suctioning,hyperaldosteronism,ingesion or infusion of excessive sodium bicarbonate,massive transfusion of whole blood

symptoms

Neuroligical-drowsiness,dizziness,nervousness,confusion

Cardiovascular-tachycardia,dysarrhythmias

Gastrointestinal-anorexia,nausea,vomiting

Neuromuscular-tremors,hypertonic muscles,muscle cramps,tetany,seizures

Respiratory-hypoventilation

Treatment

-monitor potassium and calcium levels,administer medications,replace potassium chloride

2.If atropine is ineffective we have 3 options-transcutaneous pacing ,dopamine infusion 2-10 microgm/kg/mint(chronotropic/heart rate dose),epinephrine infusion-2-10microgm/kg/mint.

3.Dopamine improves the pumbing strength of heart and blood flow to the kidneys.It produces positive chronotropic and inotropic effects on the myocardium resulting in increased heart rate and cardiac contractility.it exert an agonist action on beta adrenoceptor and indirectly by causing release of norepinephrine.

4.important step in cardioversion is to press sync button because it deliver a low energy shock is delivered at a specific point in the QRS complex.