Respiratory Failure Hot Case
GENERAL APPROACH
Respiratory failure in general
- Brain
- Cough
- Nerves
- NMJ
- Respiratory Muscles
- Pleura
- Airways (large and small)
- Parenchymal
- Chest wall
- Ventilator asynchrony
- Cardiac failure
- Abdominal distension/failure
Respiratory Failure in the Haematology/Oncology patient
- determine phase of illness (new diagnosis, post chemo, post BMT – acute, early, late)
- determine level of immunosuppression (neutropaenia, pancytopaenia)
Causes in the Haematology/Oncology patient
- infection
– bacterial: multiple causes
– viral: CMV, HSV, VSV
– fungal: PJP, aspergillus, candida
– protozoa: toxoplasmosis - engraftment
- BOOP
- diffuse alveolar haemorrhage
- idiopathic pulmonary syndrome
- cardiac failure
INTRODUCTION
CUBICLE
- inhalers
- ventilators
- sputum
- isolation (MDRO)
INFUSIONS
- bronchodilators
- antibiotics (MDRO)
- heavy sedation + paralysis
- IVIG (GB, MG, vasculitis)
VENTILATOR
- type of ventilation (NIV, invasive, spontaneous breaths, controlled, oscillation, ECMO)
- assess ventilation strategy (ARDS, bronchospasm, selective ventilation)
- level of support
- level of oxygenation
- disease specific questions (ARDS: plateau pressure, bronchospasm: dynamic hyperinflation, intrinsic PEEP)
MONITOR
- temperature
- ETCO2 (waveform, value, remember to compare to PaCO2 for dead space assessment)
- CVP (number, waveform)
- arterial trace (pressure, swing, pulsus paradoxus)
EQUIPMENT
- intercostals drains (number, bubbling, drainage)
- PAC (ask for recent numbers)
- PICCO (ask for recent numbers)
- iNO
- inhaled prostacyclin
- IABP
QUESTION SPECIFIC EXAMINATION
- hands/arms -> head -> chest -> abdo -> legs/feet -> back
-> cardiovascular
-> respiratory
-> abdominal (distension)
neurological
-> paralysed
-> quick examination
-> unconscious
-> conscious
RELEVANT INVESTIGATIONS
Bedside
- ABG
Laboratory
- microbiology: sputum, blood cultures
Imaging
- CT chest
OPENING STATEMENT
- = “Multi-factorial” and list headings of causes -> clinical signs associated with list
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
