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Ok. Hi, I'm I am Eb. Hi, I'm Barnie. I am 1/4 year medical student. I'll be doing a talk on rest failure. Just give me one second to get ready and also get the chat working on my other device. I need to check tt 10 200. Ok. Yes. All right. Bye. Check. Yep. I'm checking on my other device and it all works good. Let me great. Ok. I will start this talk if the, if the, if you have any questions, put them in the chart, let me see if there's anyone here, if you have any questions put in the chat and also for the interactive bit, you can pause the recording or the video and then have a think as well. This would be quite a short talking as and so slightly a not complicated lecture and I'm gonna try and simplify it for you guys. So let's start. Here are the main title, but what's important for you guys are the key landing point. So firstly, we go over phase on resp this is mainly going on compliant elastance spirometry. Then we're gonna look at type one, type two, type three, type four respiratory failure. After that, we're gonna able to focus on acute resp failure. That's when a patient suddenly comes into A&E with like low oxygen, high CO2 like difficulty breathing and finally looking at treatments and how your content reed on the slides. So phase one a recap, then looking at resp failure, then looking at acute respiratory failure, then looking at treatment and if you have any questions probably put in the chat or you can email me that. So our first S pa we have a 55 year old man. They attend your respiratory clinic, he undergoes ty testing and you find there is a total lung capacity of 5500 mL ML with the ins capacity of 3000 mL and a re residual volume of 1000 mL. However, the rest of the findings are missing. Can you calculate expiratory reserve value? And here's your four options. So I'll give you guys 30 seconds, have a drink, take a sip of water again if you don't know that's fine. But by the end of this first section, you should know the answer. Ok. Let's go over L capacities, volume and ventilation. So this is your capacity graphy. This is a spirometry reading. So tide volume is what they normally breathe in and breathe out er at rest at general at rest or at baseline. The infant will reserve volume is when they take a deep breath in, then you have to take a deep breath out. You get your expiry reserve volume as well from the tidal volume. Then you've got in capacity that's basically inspiratory reserve volume plus your tidal volume or functional residual capacity. That's the air typically in, in the lung while doing tidal volume is expert reserve volume and residual volume vitality is all the air you can blow out except for your residual volume and how to come lung capacities. All of these are together. One thing I'll mention is um volumes don't overlap. Our capacities are two or more volumes added together. Again, volumes will not overlap while capacities are some volume. And then just to recap, you have two formulas saying mini ventilation is basically your tidal volume, time breathing rate. But alveolar ventilation is tidal volume minus 10 space and dead space is the value that will give you and that's the um parts of the lung which does not um interact in gas exchanges. So from this side, why I want you to know is that the volumes will not overlap while capacities are some volume, the form for minute ventilation and alveolar ventilation. Good. Now, we're going over compliance and elastance. So compliance is how the lung changes shape under air pressure. So if you like blow a balloon, how the balloon will expand. Well, elastance is when you get rid of the air, how the lung returns back to a or how in a balloon when you get rid of the air, the balloon returns to its original state was swollen. So, can anyone tell me the four years for compliance are lessons? Mhm. All right. I'll just let you guys know we can pause the recording here. But compliance is volume over pressure or elastance is the opposite pressure over volume and inva, that's it from the side. What I want to know is the definitions of compliance, elastance and their formulas. Now on to ventilation and perfusion. This is just a slide I taken from your lecture from my lecture. This was like a recap of phase 18. And this is just telling you um the difference between ventilation and perfusion. That's it because you just learn this slide now onto the first S pa the answer was 1500 mL ml. Sorry, the reason why it was that is you had your total lung capacity, you have inver capacity, residual volume and um in included tidal volume. So you just needed the last value you just needed the um last value. So you had registered, you had in tidal volume and then you had the last one. And if you go back to these slidess here, yeah, your inspir reserve volume here, tidal residual. You just need this value here, which is this one, this one, this one added it together and you to you do add these three and your total lung volume, total lung capacity minus these three values here to get your expiry, that's it. So I hope that was a nice recap of base learning. And now let's go into the main crux of this talk on respiratory failure. So we got our next SBA. So this is a 55 year old man who comes in confused Dyno. That means like low oxygen. They look quite blue. He is placed on 15 L minute for oxygen. That's the highest oxygen. That's what you give first, Very straight to patients when they come into A&E because you don't need to be fussing around. Looking at voria mark oxygen, you just give him this mark first. Once the oxygen is ok, or once they get a minute to the hospital, you change it. The ABG this is arterial blood test that this is basically just you put a needle into the artery here and then you look at the iron and oxygen carbon oxide levels shows hypoxemia that oxygen when normal levels are carbon oxide and bicarbonate, which is quite important for this question. They were past medical history of CO PD heart failure. And on chest X ray, there's bilateral pulmonary in it's not due to cardiac cause. This is showing that it's respiratory failure because if it was due to cardiac cause, a cardiac failure, cardiac failure causing these symptoms. Now my question is, what type of breast failure do you have? 123 or four? And I'll explain what these four are. So have a guess you have a 25% chance of getting this right. Yeah, they are confused. They are cyanotic. They have low oxygen, normal CO2 CO PD heart failure, but this time it's not due to cardiac cause. So basic facts of respiratory failure, r failure is when your rest system stops working, leading to a reduction in gas exchange and abnormal levels of oxygen and carbon dioxide and can lead to that. So rest failure is when your rest system fails and are leads to abnormal levels of oxygen and carbon dioxide. So, can anyone tell me the A I could fail to re again, I'll give you a couple of seconds. Ok. It could be the nervous system. So it could be brain failure could have a stroke. It could be neuromuscular, it could be like having methocal lungs, co PD asthma cystic fibrosis, infection, trauma, like someone stabbing heart heart failure muscles, you could be having motor neuron disease. You could be having MS you could be having trauma, that's it. So from this side, why you want to know is that RS failure could be due to the brain failure, lungs, heart and muscles. So firstly, you could classify resp failure based at time. So the three times are acute, which is sudden deterioration, chronic, long term and acute and chronic. So, acute and chronic means they had a backward history of like CO PD cystic fibrosis and didn't have a sudden deterioration. It's acute sinus failure. Can you want to have any causes. Well, I'll tell you infection, trauma, sepsis, um GBS, this would say this should be IND. No, this should be trauma, sepsis, infection G N MS. Would that be N uh no, it should be um mg sorry me gravis or, or this or this should actually be neuromuscular syndrome like uh syndrome affected the neuromuscular ju junction, which she would have led in your year one and year two. Then chronic breast failure is a long term progressive failure. Again, any of the causes CO PD cystic fibrosis, muscular dystrophy like du and heart failure, lobectomy and finding acute and chronic failure, which is sudden and failure on the back. Again. Any acute and chronic failure is effective of CO PD cystic fibrosis after operation at missing quus mite quus could be both actually because if they don't, if you don't know they have missing glasses and they have a crisis that could be acute. But if you know they've had missing glasses, they could be cure chronic. That's quite niche. Overall. This slide is just hanging in the different between in acute chronic, acute. Now, finally, the main crux type one, type two, type three, type four, respiratory. Let's start with type one versus type two. The main thing I want you to know is type one, you have low oxygen. While type two, you have low oxygen and high CO2. That's it. That's all you really need to know. Type one, low oxygen type two, low oxygen high C OT. That's it. I know this table of other stuff here. But that's all you need to know when you have a question. When they have low oxygen high C OT. That's it. That's all you need to know how to differentiate between type one and type two. Then if you look at causes type ones like pneumonia, fibrosis, pe quite sudden deterioration causes while type two is more like mostly dystrophy co PD asthma fibrosis dazzling into both pneumo coma, having like tracheal blockage. So between type one and type two causes is most of type one or pulmonary, most of type two of extra pulmonary and type one like infection, pe acute respiratory depression. More type two is like CO PD asthma, pneumothorax, trauma. T that's it type one, low oxygen. Normally, lung causes type two, low oxygen, high co2, more worried about the high CO2 and more external causes but still has some lung causes. Then going on to type three versus type four.