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https://www.physio-pedia.com/Capnography

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- Oxygen therapy, can be via face mask, mask with a reservoir bag or a nasal tube (can be dangerous due to toxicity and underlying disease which are based on 02 levels)
- we can also use respiratory support (mechenical ventilation)
Intermittenent Positive pressure ventilator
Controlled mechanical ventilator (patients' breathing is basically stopped and ventilator works)
Invase ventilation
Non-invasive ventilation

Benefits of mechanical ventilation
-  relieve from exhaustion (muscles can relax)
- Increase oxygen use
- Improved C02 elimination

ECHMO
- Put a catheter in and give 02

Make sure the ABCDE is correct
Thus, proper ventilation and breathing
Is the patient conscious?
Patient needs to know how to breath again after!!

pH is very important
alkalosis (treated with a ''paper'' bag) or acidosis
Needs to be constant for enxymes and overall balance
Breathing is best way of regulating pH

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- tachycardia
- tachypnea
- sweating
- aggitation
- less conscious

Maesure:
- Blood gasses (PO2 and PCO2), needs to be fast to have accurate measurement
- Normal values (add later)

- Respiratory rate
- Tidal volume

Monitering

- pulse oximetry (does not sense changes). Normal range is: 95 - 100%
- blood gasses
- pAO2 ratio (calculated by arterial O2 and FI02)
FI02 is fraction of fresh oxygen that the patient is recieving
Capnography is used to meausure expired CO2

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- There is insufficient gas exchange
- hyopxemia, with or without hypercapna
Two types:
- Hypoxemia,  without hypercapnia results from a V/Q mismatch
Cause: Pneumonia, edemna, embolism or alveolar hemorrage
-Hyopxemia, with hypercapnia, results from less ventilation
Cause: neuromuscular, or obstructive (COPD or asthma) or simply an obstruction
Respiratory fatigue (positive feedback loop)

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Defined as gas in the pleural space, results in a V mismatch

Four types:
Primary spontaneous ptx
Secondary spontaneous Ptx occurs in the setting of lung disease
Traumatic Ptx (penetrating or blunt)
Penetrating could be a wound
Blunt/closed be a broken rib
Tension Ptx (life treathening, due to moving of mediastinum and decreased venous pressure)

- For tension Ptx, you increase tension and basically have a 1 way valve.
Needle will be a solution to release pressure

Iatrogenic (see picture below)

Normal lung pyshiology (add picture)

Air in pleara due to

- some kind of due, negative pressure drops and lungs will recoil
- size may differ (see picture)

Effects
- decreased ventilation
- Chest pain, unilateral
- Dypnea
- Loss of ventilation may lead to hypercapnia (patient can become confused and even coma) VERY EXTREME

Spontaneous
-  Most common in young males
- Caused by rupture of pleural bleb (small collection of air between lung and visceral pleura) due to congestive in connective tissue
- Or caused by anatomical mistakes
- Often tall and thin patients

COPD can cause pneumothorax
-  emphysema
Cystic fibrosis
- could be due to cysts

Diagnostic evaluation
- Chest X ray, but sometimes CT scan when there is an emphysema
- On chest X ray, you do no see the vessel anymore
- Breath sounds are different as well

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When a thrombus (usually formed in the systemic veins or sometimes in right heart), dislodged and symbolizes into the pulmonary system
Prevelance is 100.000 to 180.000 in the US

Most clots come from pelvic and abdominal veins
Here because of less circulation when you have a sedentary job or state (think about the Virchow's triad)
If formed here, moves up to inferior vena cava, heart and pulmonary artery where they get stuck

Effects of pulmonary embolism:
- Results in lung tissue that is ventilated but not perfused which produces an intrapulmonary dead space and impaired gas exchange
- increased pulmonary resistance
- haemodynamic consequences

Classification:
Three types

Small/medium thrombosis
Massive pulmonary embolism

Or
Acute vs non acute

Or
Stable vs unstable (source: Dtsch Arztebl Int. 2010 Aug; 107(34-35): 589–595.
Published online 2010 Aug 30. doi: 10.3238/arztebl.2010.0589)
Hemodynamically unstable patients are considered to have high-risk PE, whereas hemodynamically stable patients are considered to have non-high-risk PE. After classification into one of these two risk groups, patients undergo further diagnostic evaluation for PE according to the appropriate risk-adapted algorithm. Patients who are in cardiogenic shock or have persistent arterial hypotension (high-risk PE) should undergo multidetector computed tomography (MDCT) or echocardiography at once, so that a PE, if present, can be treated immediately by thrombolysis. For hemodynamically stable patients with non-high-risk PE the proper diagnostic strategy is determined by the clinical probability of PE, which can be calculated with the aid of validated scoring systems and is based on both MDCT and D-dimer levels. For further risk stratification in hemodynamically stable patients, tests are performed to detect right ventricular dysfunction or myocardial injury, either of which indicates intermediate-risk PE. In addition to specific therapy, patients with high-risk PE, patients at high risk for hemorrhage and these with severe renal insufficiency should be anticoagulated with unfractionated heparin. All other patients should be treated with low-molecular-weight heparin or fondaparinux. Thereafter, long-term oral anticoagulation with vitamin K antagonists is recommended.

Risk factors of pulmonary embolism
- Clinical signs and symptoms (such as swelling, heartrate, immobilsation)
- Already having had PE
- Haemoptysis
- Check the algorythm
- take into account pregancy
- D dimer

Investigations

Radionuclide ventilation/perfusion scanning V/Q (pregant women can recieve it but recieve a lower dose and at a certain point)
It is performed in a special clinic
CTA scan is done (contrast is given and look where the blood stops)

Acute management is to solve the problem
- could be antigoaculant