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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
There is no treatment for respiratory failure; however, medication may be used to allow for easier intubation and to ease anxiety in the patient. Recently, studies have demonstrated a strong recommendation against the use of sedatives or analgesics. The use of these agents has been implicated in decreasing the success rates of ventilation mechanisms.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Naloxone:
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
**Naloxone is used as an antidote to opioid overdose - induced respiratory depression.
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Flumazenil:
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
**Flumazenil is used as an antidote in benzodiazepine overdose - induced respiratory depression.
===Disease Name===
*Sedatives, activated charcoal and gastric emptying are all not recommended except in the rare case of hypercapnic respiratory failure with progressive respiratory acidosis with:
**Anxiety
**Rapid shallow breathing
**Respiratory arrest 
**Moderate to severe expiratory airway resistance
**Dynamic hyperinflation


* '''1 Stage 1 - Name of stage'''
===Respiratory failure===
** 1.1 '''Specific Organ system involved 1'''
* '''1 Opiate overdose'''
** 1.1 '''Naloxone'''
*** 1.1.1 '''Adult'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''  
**** Preferred regimen (1): Naloxone  0.05 mg IV initially, then titrated in increasing amounts every 5 minutes with a respriatory rate of 12 or greater
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**: '''Note (1):''' Apneic patients with suspected opiate overdose should receive higher first doses of naloxone between 0.2 - 1 mg
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**: '''Note (2)''': Cardiorespiratory with suspected opiate overdose should receive a minimum of 2 mg of naloxone
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days  
* 2 '''Benzodiazepine overdose'''
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
** 2.1 '''Flumazenil'''
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.1 '''Adult'''
*** 1.1.2 '''Pediatric'''
***** Preferred regimen (1):Flumazenil 0.2 mg IV over 30 seconds
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
**: '''Note (1):''' Repeated doses of 0.2 mg up to 1 mg if desired effect not achieved
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
**: '''Note (2)''': Maximum dose of 3mg is given within any hour
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==
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[[Category: (name of the system)]]
[[Category:Surgery]]
[[Category:Up-To-Date]]
[[Category:Primary care]]
[[Category:Medicine]]
[[Category:Emergency medicine]]

Revision as of 21:19, 9 March 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

There is no treatment for respiratory failure; however, medication may be used to allow for easier intubation and to ease anxiety in the patient. Recently, studies have demonstrated a strong recommendation against the use of sedatives or analgesics. The use of these agents has been implicated in decreasing the success rates of ventilation mechanisms.

Medical Therapy

  • Naloxone:
    • Naloxone is used as an antidote to opioid overdose - induced respiratory depression.
  • Flumazenil:
    • Flumazenil is used as an antidote in benzodiazepine overdose - induced respiratory depression.
  • Sedatives, activated charcoal and gastric emptying are all not recommended except in the rare case of hypercapnic respiratory failure with progressive respiratory acidosis with:
    • Anxiety
    • Rapid shallow breathing
    • Respiratory arrest
    • Moderate to severe expiratory airway resistance
    • Dynamic hyperinflation

Respiratory failure

  • 1 Opiate overdose
    • 1.1 Naloxone
      • 1.1.1 Adult
        • Preferred regimen (1): Naloxone 0.05 mg IV initially, then titrated in increasing amounts every 5 minutes with a respriatory rate of 12 or greater
      Note (1): Apneic patients with suspected opiate overdose should receive higher first doses of naloxone between 0.2 - 1 mg
      Note (2): Cardiorespiratory with suspected opiate overdose should receive a minimum of 2 mg of naloxone
  • 2 Benzodiazepine overdose
    • 2.1 Flumazenil
      • 2.1.1 Adult
          • Preferred regimen (1):Flumazenil 0.2 mg IV over 30 seconds
      Note (1): Repeated doses of 0.2 mg up to 1 mg if desired effect not achieved
      Note (2): Maximum dose of 3mg is given within any hour


References

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