Block 1.3, KFU, Al-Ahsa, Saudi Arabia Case 2.1

1. Case 2.1
Abdullatiff Sami Al-Rashed
Group: 3
Tutor: Dr.Ossama Zakarya

2. Objectives
Respiratory Depression &
Effect of Alcohol in Respiratory system
(ABG) analysis & the effect of abnormal values
Rib fracture & its effect “pneumothorax”

3. Respiratory Depression
• Respiratory depression occurs when ventilation is
inadequate to perform needed gas exchange.
• It can be caused by medical conditions, such as:
• Head injury
• Anaesthesia
• Opiate overdose
• Bronchiectasis
• Respiratory failure
• Pneumoconiosis
• Brain tumours
• Lung carcinoma
• Obstruction

4. Effect of Alcohol in Respiratory System
• Alcohol affects the respiratory system in many ways such as
slower breathing and sleep apnea in many individuals.
• These can be considered as shorter term effects, but over
time, many individuals can potentially experience more long
term effects such as those experienced as a result of lack of
oxygen to the brain due to sleep apnea related issues.
• Heavy drinkers, over time, are also at risk of developing diseases
and conditions affecting the respiratory system such as
pneumonia due to a weaker immune system that can be
experienced due to consumption of alcohol.

6. Effect of Alcohol in Respiratory System
• There are affects of alcohol in
respiratory system:
1. Pneumonia:
• Alcohol has been observed to be
a common comorbidity in MICU
patients with pneumonia.
• There is a 60% increase in the use
of the MICU when an alcoholic
has pneumonia compared with a
nonalcoholic patient.

7. Cont..
2. Acute Respiratory Distress
Syndrome (ARDS):
• A history of chronic alcohol
abuse significantly increases
the risk of developing acute
respiratory distress syndrome
(ARDS) in critically ill patients.
• Characterized by inflammation
of the lung parenchyma leading
to impaired gas exchange

8. Blood Gases Analysis
• Blood gas analysis, also called
arterial blood gas (ABG)
analysis, is a procedure to
measure the partial pressure of
oxygen (O2) and carbon dioxide
(CO2) gases and the pH
(hydrogen ion concentration) in
arterial blood.

9. Effects of Abnormal Values
The effect
is either:
Acidosis Alkalosis

10. Cont..
• If pH <7.35 indicates acidosis, either metabolic (non-
respiratory) or respiratory
• pH >7.45 indicates alkalosis.

11. Cont..
• Metabolic or non-respiratory
acidosis is characterized by pH
<7.35 (i.e. increased [H+]) and
decreased [HCO3-].
• Common causes of metabolic
acidosis are diabetes
mellitus, alcoholism, lactic
acidosis (associated with
hypoxia), acid poisoning, renal
failure, renal tubular acidosis (an
inherited defect of the renal
tubules), and diarrhea.

12. Cont..
• Respiratory acidosis is caused by deficient ventilation that
results in retention of carbon dioxide. The pH is <7.35, and
PCO2 is increased.

13. Cont..
• Metabolic alkalosis is caused by
excess blood bicarbonate and
usually involves a renal factor.
• Metabolic alkalosis is
characterized by pH >7.45 and
elevated [HCO3-].

14. Cont..
• Respiratory alkalosis is caused by hyperventilation. The pH is
>7.45 and the PCO2: is low.

15. Rib Fracture
• A rib fracture is a crack or break in
one of the bones of the rib cage.
• The most common cause of a
fractured rib is a direct blow to the
chest, often from a car accident or a
fall.
• Coughing hard can also fracture a rib.
This is more likely to happen if you
have a disease that has made your
bones weak, such as osteoporosis or
cancer.

16. Sign & Symptoms
 A fractured rib may cause:
1. Mild to severe pain in the injured
area.
2. Pain when you breathe.
3. Pain around the fracture when
someone pushes on your
breastbone.

17.  Specific signs of ventilatory
insufficiency include:
1. Cyanosis
2. Tachypnea
3. Retractions, and use of
accessory muscles for
ventilation.
4. Less specific signs include
anxiety and agitation.
Sign & Symptoms

18. How is a fractured rib diagnosed?
• The doctor first take the history and do physical
examination, then he may order one or more of the following
imaging tests:
1. X-ray: X-rays often have problems revealing fresh rib
fractures, especially if the bone is merely cracked.
2. CT Scan: can often uncover rib fractures that X-rays might
miss. Injuries to soft tissues and blood vessels are also easier
to see on CT scans.

19. Cont..
3. (MRI) : MRI scans can be used to look at the soft tissues and
organs around the ribs to determine if there is any damage
to these structures.
4. Bone scan: This technique is good for viewing stress
fractures, where a bone is cracked after repetitive trauma —
such as long bouts of coughing.

21. Complication
• Complications of rib fracture may include:
1. Pneumothorax
2. Haemothorax
3. Pulmonary contusion
4. Respiratory failure
5. Pneumonia: Pneumonia is one of the most common
complications associated with rib fractures.
6. Intra-abdominal organ injury

22. Treatment
• Most broken ribs heal on their own within six weeks.
• It's important to obtain adequate pain relief because if it hurts
too much to breathe deeply, you may develop pneumonia.
Such as:
• Pain relief such as: Acetaminophen (Tylenol, others) and
nonsteroidal anti-inflammatory drugs (NSAIDs)

23. Pneumothorax
• Pneumothorax is defined as the
presence of air or gas in the
pleural cavity (ie, the potential
space between the visceral and
parietal pleura of the lung) , that
causes part or all of a lung to
collapse.

24. Types of Pneumothorax :
1. Spontaneous :
• Having an unknown cause or occurring as a consequence of nature
course of a disease process , such as COPD , tuberculosis.
2. Traumatic :
• Following any penetrating or non-penetrating chest trauma , with
or without bronchial rupture.
3. Iatrogenic :
• Occurring as a result of diagnostic or therapeutic medical procedure
. intentional or a complication .

26. Causes of Pneumothorax :
• Pneumothorax can be caused by a
chest injury or underlying lung
disease, such as
Emphysema, Pneumonia…
• Pneumothorax also can occur for
no obvious reason.

27. Signs and Symptoms of Pneumothorax
• The Symptoms of a pneumothorax include:
• chest pain that usually has a sudden onset.
• Tightness in the chest.
• Shortness of breath.
• Tachycardia.
• Tachypnea.
• Cough, and fatigue.
• The skin may develop a bluish color (termed cyanosis) due to
decreases in blood oxygen levels.

29. Treatment
• The treatment of pneumothorax depends on a number of
factors, and may vary from discharge with early follow-up to
immediate needle decompression or insertion of a chest tube.
• Treatment is determined by the severity of symptoms and
indicators of acute illness, the presence of underlying lung
disease, the estimated size of the pneumothorax on X-ray, and
- in some instances - on the personal preference of the person
involved

30. Treatment
• Aspirating (removing) the trapped air is sometimes needed
• It is essential to remove the air quickly in a tension
pneumothorax. The common method of removing the air is to
insert a very thin tube through the chest wall with the aid of a
needle.
• Pleurodesis: Caregivers use chemicals, such as iodine or talc
powder, to irritate the walls of pleural space. This causes the
walls of pleural space to close together so air can no longer be
trapped there.

31. References
• http://www.rightdiagnosis.com/r/respiratory_depression/intr
o.htm
• http://www.webmd.com
• http://www.mayoclinic.com
• http://emedicine.medscape.com