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Acute respiratory failure


Respiratory failure is a condition in which the respiratory system is not able to provide oxygen and the removal of carbon dioxide, necessary to maintain the normal functioning of the body.
Acute respiratory failure is characterized by rapid progression: after a few hours, and sometimes minutes, the patient may die.
The main causes of acute respiratory failure:
─ airway obstruction during tongue retraction, obstruction of the larynx or trachea by a foreign body, laryngeal edema, severe laryngospasm, hematoma or tumor, bronchospasm, chronic obstructive pulmonary disease and bronchial asthma;
─ respiratory distress syndrome or “shock lung”, pneumonia, pneumosclerosis, emphysema, atelectasis, pulmonary embolism, fat embolism, amniotic fluid embolism, sepsis and anaphylactic shock;
─ some exogenous and endogenous intoxications (opiates, barbiturates), injuries and diseases of the brain and spinal cord, convulsive syndrome of any origin, myasthenia gravis, Guillain-Barré syndrome, etc .;
─ injuries of the chest and abdomen.
DIAGNOSTICS
The main clinical signs of acute respiratory failure: shortness of breath, circulatory disorders and psychomotor agitation.
According to the severity, acute respiratory failure is divided into three stages.
I stage. The first symptoms are a change in the psyche. Patients are excited, tense, often complain of headache, insomnia. Respiratory rate up to 25-30 per minute.
The skin is cold, pale, moist, cyanosis of the mucous membranes, nail beds. Blood pressure, especially diastolic, is elevated, tachycardia is noted.
II stage. Consciousness is confused, motor excitement. Respiratory rate up to 35-40 per minute. Pronounced cyanosis of the skin, auxiliary muscles take part in breathing. Persistent arterial hypertension (except for cases of pulmonary embolism), tachycardia. Involuntary urination and defecation. With a rapid increase in hypoxia, there may be convulsions.
III stage. Hypoxemic coma. Consciousness is absent. Breathing can be rare and superficial. Cramps. The pupils are dilated. The skin is cyanotic. Blood pressure is critically reduced, arrhythmias are observed.
URGENT CARE
1. Ensuring airway patency:
= Triple reception of Safar (if there is a suspicion of an injury in the cervical spine, do not extend your head);
= rehabilitation of the tracheobronchial tree;

= in the presence of a foreign body - its removal under the control of laryngoscopy;
= use of air ducts;
= tracheal intubation or conicotomy.
2. Oxygen therapy. Oxygen inhalation through the nasal cannula, face mask or endotracheal tube (with clinical death - 100% oxygen).
3. For chest injuries, pleurisy - anesthesia. Elimination of pneumo- and hemothorax.
4. If these measures are ineffective, transfer the patient to mechanical ventilation.
5. Hospitalization - according to the indications of the underlying disease (see relevant recommendations).
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Acute respiratory failure

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