Acute Respiratory Failure - Prof Tamsil

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CURRICULUM VITAE

N a m a : Prof.Dr.TAMSIL SYAFIUDDIN Sp.P (K) Alamat : Jln.Karsa No F 1 Kompleks Eks KOWILHAN I

Sei.Agul Medan 20117

Jabatan : Guru Besar Tetap FK- UISU / Luar Biasa FK- USU

Penasehat Perhimpunan Dokter Paru Indonesia PusatKetua Perhimpunan Dokter Paru Indonesia Cabang Sumut

Dewan Pembina Yayasan Asma Indonesia Wilayah Sumut

Ketua Departemen Pulmonologi dan Kedokteran Respirasi FK-UISU

Anggota Dewan Asma Nasional

Anggota Kolegium Perhimpunan Dokter Paru Indonesia Pusat

Anggota Pokja Asma Perhimpunan Dokter Paru Indonesia Pusat

Anggota Pokja PPOK Perhimpunan Dokter Paru Indonesia PusatAnggota Tim Akreditasi Pendidikan Spesialis Paru Nasional

Riwayat Pendidikan:

-Dokter Umum, FK-USU Medan,1979

-Dokter Spesialis I Paru, FK-UI Jakarta, 1990

-Dokter Spesialis II Paru, Konsultan Asma/PPOK, 1995

Pendidikan tambahan:- Pelatihan Kanker Paru, TSUKAGUCHI Hospital, Kobe- Japan 1989- Pelatihan PPOK, AMAGASAKI Hospital, Kobe- Japan 1990- Pelatihan Respiratory Physiologi, ”JAPAN RESPIRATORY PHYSIOLOGIST

CLUB”, Kyoto- Japan 1990- Spirometry Training Course, Department of Respiratory Medicine,

National University Hospital Singapore, Singapore 1997



- Workshop of Bronchoscopy and Autofluorecent Bronchoscopy, RS Persahabatan

Jakarta, Jakarta September 2005

-Training of the new interventional technique of bronchosfiberscopy”(Optical Coherence

Tommograhy) , Department of Thoracic Surgery, Tokyo Medical University Hospital,

Tokyo - Japan 2007

- Workshop of the new technique of bronchoscopy, Postgradute Medical Institute,

Singapore General Hospital, Singapore 2008

- Respiratory Masterclass Asthma and COPD, Singapore 2011

- Workshop on Medical Thoracoscopy, The American College of Chest Physicians-TheIndonesian Association of Pulmonologist, RS Persahabatan Jakarta, Jakarta November

1997

- Workshop on Reformation of Higer Education System,HEDS-JICA, Jakarta 1998

- Pulmonary Infections Course, Postgraduate Medical Institute, Singapore General Hospital,

Singapore 2001- Bronchoscopy &Thoracoscopy Workshop, Postgraduate Medical Institute, Singapore

General Hospital, Singapore 2005

- Workshop on Transbronchial Lung Biopsy and Trasbronchial Needle Aspiration PDPI

Cabang Jakarta, RS Persahabatan Jakarta ,Jakarta 1997

- Workshop on Respiratory Physiology and Its Clinical Application, RS Pusat Angkatan

Darat Gatot Subroto Jakarta, Jakarta Juni 1997



ACUTE RESPIRATORY FAILURE

DIAGNOSTIC

AND

MANAGEMENT

TAMSIL SYAFIUDDIN

DEPARTMENT OF PULMONARY AND RESPIRATORY MEDICINE

FAKULTAS KEDOKTERAN UISU

MEDAN 2013



Initial Assessment

• Airway – open,no noises

• Breathing – 12-20 times per minute

•

Circulation –

warm, pink, dry, strongpulses

• Disability – mental status clear

•

Vital Signs



Respiratory Assessment

• Airway

– Open and Clear

– Needs Intervention

• Breathing

– Inspection

– Palpation

– Percussion

–Pulse Oximetry

– Auscultation

• Circulation & Vital Signs

•

History



Respiratory failure

•Impairment in O2 uptake•

Impairment in CO2 elimination•Both

Abnormal arterial blood gases



ACUTE RESPIRATORY FAILURESPECTRUM OF CAUSES OF ARTERIAL HYPOXEMIA)

LUNG

OTHERS



Causes of Respiratory Emergencies

• Failure of: – Ventilation : air in/ air out

– Diffusion : movement of gases

– Perfusion : movement of blood

• Compounded by:• Inflammation/mucus production



Hypoxia – low oxygen to cells

Causes of hypoxia

• Hypoxic hypoxia – not enough oxygen

• Anemic hypoxia – not enough hemoglobin

• Stagnant hypoxia – not enough perfusion

– shock

• Histotoxic hypoxia – unable to download – Cyanide poisoning



Cyanosis – blue discoloration

suggests hypoxia




HYPOXIA

•ALTITUDE

•HYPOVENTILATION

•DIFFUSION ABNORMALITTY

•RIGHT to LEFT SHUNT

•VENTILATION-PERFUSION ABNORMALITY



ALTITUDE

INCREASE IN ALTITUDE

DECREASE IN BAROMETRIC PRESSURE

LOWERRING OF THE PO2 IN THE INSPIRED AIR



HYPOVENTILATION

DRUG OVERDOSE AND NEUROMUCULAR WEAKNESS)

ACCUMULATION OF CARBON DIOXIDE

IN THE ALVEOLI

DISPLACING ALVEOLAR OXYGEN

PO2 AND PCO2



DIFFUSION ABNORMALITY

PNEUMONIE

PO2 and PCO2



RIGHT TO LEFT SHUNT

ALVEOLUS IS PERFUSED

BUT NOT VENTILATED

Extreme imbalance V/Q)

PO2 and PCO2

CARDIAC and NONCARDIAC

PULMONARY EDEMA



Ventilation-Perfusion AbnormalityV/Q, 4/5 or 0.8 )

•

ASTHMA•COPD

•EMBOLI

PO2 and PCO2



Acute Respiratory Failure

Airway obstruction •

COPD•Asthma

•Heart failure

Restrictive defects

•Pleural effusion

•Pneumothorax

•Infiltrative diseases

•Atelectasis

•Obesity

•Abdominal distention of all types

•Intertitial fibrosis of all types



Acute Respiratory Failure continue )

Central nervous system depressions •Drugs

•Head injury

•Central nervous system infection

Chest wall abnormalities•Congenital and acquired deformities

•

Trauma flail chest)•Neuromuscular disease or blockade



DIAGNOSTIC

•SUBJECTIVE

•OBJECTIVE




SUBJECTIVE

•Dyspnea

•Headache

•Confusion

•Unconsciousness

•Restlessness




Objective

•ABGAhypoxemia and respiratory acidosis )

•Underlying disease

CX examination )

•Tachycardia

•Hypotention



BODY CELLS OF HEALTHY

AT REST REQUIRE

250 ml/minute Oxygen

NORMAL CELLULAR AEROBIC RESPIRATION

OXYGEN CONSUMTION)



ManagementAcute respiratory failure

•General management

Improving the PaO2 )

•Specific management

Underlying disease )



24

Management of The Airway

• Basic techniques:

1. Head tilt [ respiratory tract in one straight line ].

2. Chin left.

3. Jaw thrust [take tongue with its base & the only technique

done in suspected cervical spine injury patient ].



THANK YOU

Syafiuddin San : You are the Inspiring woman

Imah San : You are the Wind beneath my wings

Arigato gozaimasu


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