Pulse oximetry

Pulse oximetry 328 When employed correctly, pulse oximetry is a rapid non-invasive method of assessing one of the key components of tissue oxygen delivery: the oxygen saturation of haemoglobin (SaO2). • Based on the laws of light absorbance and optical density (Lambert's law and Beer's law), i.e. the principle that deoxygenated and oxygenated hemoglobin absorb light at different wavelengths....

Arterial blood gases

Arterial blood gas (ABGs) analysis forms the cornerstone of emergency respiratory investigation. In many situations values obtained dictate management strategy and facilitate decision-making. It is an uncomfortable procedure for the patients and if repeated ABGs are required, consider whether less invasive measures, such as respiratory rate, pulse oximetry or capillary blood gas measurements could be used....

Chest drain insertion

Drain types 312 Indications for drain insertion 313 Insertion technique 314 Although chest drains are used frequently, it should be remembered that there is a significant morbidity and even mortality associated with chest drain insertion. Complications increase with inexperienced operators, and the procedure must be undertaken or supervised by clinicians with experience in drain insertion. Chest drains are sometimes unnecessarily inserted (e.g. primary spontaneous pneumothorax), and careful thought should be given to the indication in each case....

Pleural aspiration

Diagnostic aspiration 308 Therapeutic aspiration 309 Pneumothorax aspiration 309 Pleural aspiration for diagnostic and therapeutic purposes is a commonly required procedure. Adequate attention must be paid to sterility and technique to prevent potential complications (bleeding, introduction of infection, and damage to the lung resulting in pneumothorax)....

Tracheostomy

Indications 268 Procedure 268 Anatomy 268 Changes in physiology 269 Tracheostomy tubes and attachments 270 Complications 271 General considerations 271 Specific problems and emergencies 272 • Upper airway obstruction. • Prolonged ventilation. • Protection against pulmonary aspiration. • Tracheobronchial toilet. • Major head & neck surgery....

Sleep disordered breathing

Sleep disordered breathing 254 Sleep disordered breathing is a relatively new area of respiratory medicine. It encompasses two broad and sometimes overlapping groups: the first and largest is obstructive sleep apnoea (OSA), and the second is the nocturnal hypoventilatory disorders. Both require nocturnal respiratory support, usually via a nasal or face mask, although sometimes via a tracheostomy. The on-call acute physician will be consulted about patients who have sleep disordered breathing and hence should be aware of the diagnoses and the therapies....

Sickle cell disease

Sickle cell disease 250 This is one of the most common inherited conditions in the world and affects predominantly people from equatorial Africa but also those of Mediterranean, Indian, and Middle-Eastern descent. It is recessively inherited and in the homozygous form (HbSS) causes a multi-organ disorder....

Respiratory conditions associated with connective tissue disorders

Introduction 246 Specific respiratory conditions related to CTDs 246 Specific respiratory conditions related to drugs used for CTDs 247 Opportunistic pulmonary infection 248 Pulmonary complications are common in patients with connective tissue disorders (CTDs). They can be either specific respiratory conditions related to the CTD or side effects of medication used to treat the CTD, including opportunistic infection. When a rheumatological patient presents with acute respiratory symptoms, a number of disease-specific diagnoses should be considered...

Respiratory problems in neuromuscular disease

Introduction 238 Assessment 239 Treatment 240 A variety of neuromuscular disorders may affect the ventilatory pump at different sites (Table 37.1). Most of these disorders result in respiratory muscle weakness, which results in alveolar hypoventilation and impaired cough. Patients with known neuromuscular disease may present acutely with a presentation related to their underlying neuromuscular disease (such as infection) or occasionally in end-stage ventilatory failure....

Pneumothorax

Definitions 162 Primary spontaneous pneumothorax (PSP) 162 Secondary spontaneous pneumothorax (SSP) 162 Acute presentation 163 Tension pneumothorax 164 Investigations 165 Management 166 Complications 167 Pneumothorax is defined as air in the pleural space. It may occur as a result of trauma or spontaneously, in which case it is further subdivided into primary and secondary. The treatment, response to therapy, and prognosis in these two groups is quite different, and establishing the category is essential....