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Respiratory Failure

What is respiratory failure?

Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Sometimes you can have both problems.

When you breathe, your lungs take in oxygen. The oxygen passes into your blood, which carries it to your organs. Your organs, such as your heart and brain, need this oxygen-rich blood to work well.

Another part of breathing is removing the carbon dioxide from the blood and breathing it out. Having too much carbon dioxide in your blood can harm your organs.

What causes respiratory failure?

Conditions that affect your breathing can cause respiratory failure. These conditions may affect the muscles, nerves, bones, or tissues that support breathing. Or they may affect the lungs directly. These conditions include:

  • Diseases that affect the lungs, such as COPD (chronic obstructive pulmonary disease), cystic fibrosis, pneumonia, pulmonary embolism, and COVID-19
  • Conditions that affect the nerves and muscles that control breathing, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal cord injuries, and stroke
  • Problems with the spine, such as scoliosis (a curve in the spine). They can affect the bones and muscles used for breathing.
  • Damage to the tissues and ribs around the lungs. An injury to the chest can cause this damage.
  • Drug or alcohol overdose
  • Inhalation injuries, such as from inhaling smoke (from fires) or harmful fumes
What are the symptoms of respiratory failure?

The symptoms of respiratory failure depend on the cause and the levels of oxygen and carbon dioxide in your blood.

A low oxygen level in the blood can cause shortness of breath and air hunger (the feeling that you can't breathe in enough air). Your skin, lips, and fingernails may also have a bluish color. A high carbon dioxide level can cause rapid breathing and confusion.

Some people who have respiratory failure may become very sleepy or lose consciousness. They also may have arrhythmia (irregular heartbeat). You may have these symptoms if your brain and heart are not getting enough oxygen.

How is respiratory failure diagnosed?

Your health care provider will diagnose respiratory failure based on:

  • Your medical history
  • A physical exam, which often includes
    • Listening to your lungs to check for abnormal sounds
    • Listening to your heart to check for arrhythmia
    • Looking for a bluish color on your skin, lips, and fingernails
  • Diagnostic tests, such as
    • Pulse oximetry, a small sensor that uses a light to measure how much oxygen is in your blood. The sensor goes on the end of your finger or on your ear.
    • Arterial blood gas test, a test that measures the oxygen and carbon dioxide levels in your blood. The blood sample is taken from an artery, usually in your wrist.

Once you are diagnosed with respiratory failure, your provider will look for what is causing it. Tests for this often include a chest x-ray. If your provider thinks you may have arrhythmia because of the respiratory failure, you may have an EKG (electrocardiogram). This is simple, painless test that detects and records your heart's electrical activity.

What are the treatments for respiratory failure?

Treatment for respiratory failure depends on:

  • Whether it is acute (short-term) or chronic (ongoing)
  • How severe it is
  • What is causing it

Acute respiratory failure can be a medical emergency. You may need treatment in intensive care unit at a hospital. Chronic respiratory failure can often be treated at home. But if your chronic respiratory failure is severe, you might need treatment in a long-term care center.

One of the main goals of treatment is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the cause of the condition. Treatments may include:

  • Oxygen therapy, through a nasal cannula (two small plastic tubes that go in your nostrils) or through a mask that fits over your nose and mouth
  • Tracheostomy, a surgically-made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy, or trach tube, is placed in the hole to help you breathe.
  • Ventilator, a breathing machine that blows air into your lungs. It also carries carbon dioxide out of your lungs.
  • Other breathing treatments, such as noninvasive positive pressure ventilation (NPPV), which uses mild air pressure to keep your airways open while you sleep. Another treatment is a special bed that rocks back and forth, to help you breathe in and out.
  • Fluids, often through an intravenous (IV), to improve blood flow throughout your body. They also provide nutrition.
  • Medicines for discomfort
  • Treatments for the cause of the respiratory failure. These treatments may include medicines and procedures.

If you have respiratory failure, see your health care provider for ongoing medical care. Your provider may suggest pulmonary rehabilitation.

If your respiratory failure is chronic, make sure that you know when and where to get help for your symptoms. You need emergency care if you have severe symptoms, such as trouble catching your breath or talking. You should call your provider if you notice that your symptoms are worsening or if you have new signs and symptoms.

Living with respiratory failure may cause fear, anxiety, depression, and stress. Talk therapy, medicines, and support groups can help you feel better.

NIH: National Heart, Lung, and Blood Institute

Respiratory Syncytial Virus Infections

What is respiratory syncytial virus (RSV)?

Respiratory syncytial virus, or RSV, is a common respiratory virus. It usually causes mild, cold-like symptoms. But it can cause serious lung infections, especially in infants, older adults, and people with serious medical problems.

How is respiratory syncytial virus (RSV) spread?

RSV spreads from person to person through:

  • The air by coughing and sneezing
  • Direct contact, such as kissing the face of a child who has RSV
  • Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands

People who have an RSV infection are usually contagious for 3 to 8 days. But sometimes infants and people with weakened immune systems can continue to spread the virus for as long as 4 weeks.

Who is at risk for respiratory syncytial virus (RSV) infections?

RSV can affect people of all ages. But it is very common in small children; nearly all children become infected with RSV by age 2. In the United States, RSV infections usually occur during fall, winter, or spring.

Certain people are at higher risk of having a severe RSV infection:

  • Infants
  • Older adults, especially those age 65 and older
  • People with chronic medical conditions such as heart or lung disease
  • People with weakened immune systems
What are the symptoms of respiratory syncytial virus (RSV) infections?

The symptoms of RSV infection usually start about 4 to 6 days after infection. They include:

  • Runny nose
  • Decrease in appetite
  • Cough
  • Sneezing
  • Fever
  • Wheezing

These symptoms usually appear in stages instead of all at once. In very young infants, the only symptoms may be irritability, decreased activity, and trouble breathing.

RSV can also cause more severe infections, especially in people at high risk. These infections include bronchiolitis, an inflammation of the small airways in the lung, and pneumonia, an infection of the lungs.

How are respiratory syncytial virus (RSV) infections diagnosed?

Your health care provider may use many tools to make a diagnosis:

  • A medical history, including asking about symptoms.
  • A physical exam.
  • A lab test of nasal fluid or another respiratory specimen to check for RSV. This is usually done for people with severe infection.
  • Tests to check for complications in people with severe infection. The tests may include a chest x-ray and blood and urine tests.
What are the treatments for respiratory syncytial virus (RSV) infections?

There is no specific treatment for RSV infection. Most infections go away on their own in a week or two. Over-the-counter pain relievers can help with the fever and pain. However, do not give aspirin to children. And do not give cough medicine to children under four. It is also important to get enough fluids to prevent dehydration.

Some people with severe infection may need to be hospitalized. There, they might get oxygen, a breathing tube, or a ventilator.

Can respiratory syncytial virus (RSV) infections be prevented?

There are currently no vaccines for RSV. But you may be able to reduce your risk of getting or spreading an RSV infection by:

  • Washing your hands often with soap and water for at least 20 seconds
  • Avoiding touching your face, nose, or mouth with unwashed hands
  • Avoiding close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others if you are sick or they are sick
  • Cleaning and disinfecting surfaces that you frequently touch
  • Covering coughs and sneezes with a tissue. Then throw away the tissue and wash your hands
  • Staying home when sick

There is a medicine to help prevent severe RSV illness in certain infants and children who are at high risk for severe illness. For example, they might be at high risk because they:

  • Were born prematurely
  • Have congenital heart disease
  • Have chronic lung disease

The medicine is given in monthly injections (shots) during RSV season. It may help prevent severe RSV illness, but it can't cure or treat children who already have it. And it cannot prevent an RSV infection.

Centers for Disease Control and Prevention

Shingles

What is shingles?

Shingles is an outbreak of rash or blisters on the skin. It is caused by the varicella-zoster virus - the same virus that causes chickenpox. After you have chickenpox, the virus stays in your body. It may not cause problems for many years. But as you get older, the virus may reappear as shingles.

Is shingles contagious?

Shingles is not contagious. But you can catch chickenpox from someone with shingles. If you've never had chickenpox or the chickenpox vaccine, try to stay away from anyone who has shingles.

If you have shingles, try to stay away from anyone who has not had chickenpox or the chickenpox vaccine, or anyone who might have a weak immune system.

Who is at risk for shingles?

Anyone who has had chickenpox is at risk for getting shingles. But this risk goes up as you get older; shingles is most common in people over age 50.

People with weakened immune systems are at higher risk of getting shingles. This includes those who:

  • Have immune system diseases such as HIV/AIDS
  • Have certain cancers
  • Take immunosuppressive drugs after an organ transplant

Your immune system may be weaker when you have an infection or are stressed. This can raise your risk of shingles.

It is rare, but possible, to get shingles more than once.

What are the symptoms of shingles?

Early signs of shingles include burning or shooting pain and tingling or itching. It is usually on one side of the body or face. The pain can be mild to severe.

One to 14 days later, you will get a rash. It consists of blisters that typically scab over in 7 to 10 days. The rash is usually a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash.

Some people may also have other symptoms:

  • Fever
  • Headache
  • Chills
  • Upset stomach
What other problems can shingles cause?

Shingles can cause complications:

  • Postherpetic neuralgia (PHN) is most common complication of shingles. It causes severe pain in the areas where you had the shingles rash. It usually gets better in a few weeks or months. But some people can have pain from PHN for many years, and it can interfere with daily life.
  • Vision loss can happen if shingles affects your eye. It may be temporary or permanent.
  • Hearing or balance problems are possible if you have shingles within or near your ear. You may also have weakness of the muscles on that side of your face. These problems can be temporary or permanent.

Very rarely, shingles can also lead to pneumonia, brain inflammation (encephalitis), or death.

How is shingles diagnosed?

Usually your health care provider can diagnose shingles by taking your medical history and looking at your rash. In some cases, your provider may scrap off tissue from the rash or swab some fluid from the blisters and send the sample to a lab for testing.

What are the treatments for shingles?

There is no cure for shingles. Antiviral medicines may help to make the attack shorter and less severe. They may also help prevent PHN. The medicines are most effective if you can take them within 3 days after the rash appears. So if you think you might have shingles, contact your health care provider as soon as possible.

Pain relievers may also help with the pain. A cool washcloth, calamine lotion, and oatmeal baths may help relieve some of the itching.

Can shingles be prevented?

There are vaccines to prevent shingles or lessen its effects. The Centers for Disease Control and Prevention recommends that healthy adults 50 years and older get the Shingrix vaccine. You need two doses of the vaccine, given 2 to 6 months apart. Another vaccine, Zostavax, may be used in certain cases.

Smoking

What are the health effects of smoking?

There's no way around it; smoking is bad for your health. It harms nearly every organ of the body, some that you would not expect. Cigarette smoking causes nearly one in five deaths in the United States. It can also cause many other cancers and health problems. These include:

  • Cancers, including lung and oral cancers
  • Lung diseases, such as COPD (chronic obstructive pulmonary disease)
  • Damage to and thickening of blood vessels, which causes high blood pressure
  • Blood clots and stroke
  • Vision problems, such as cataracts and macular degeneration (AMD)

Women who smoke while pregnant have a greater chance of certain pregnancy problems. Their babies are also at higher risk of dying of sudden infant death syndrome (SIDS).

Smoking also causes addiction to nicotine, a stimulant drug that is in tobacco. Nicotine addiction makes it much harder for people to quit smoking.

What are the health risks of secondhand smoke?

Your smoke is also bad for other people - they breathe in your smoke secondhand and can get many of the same problems as smokers do. This includes heart disease and lung cancer. Children exposed to secondhand smoke have a higher risk of ear infections, colds, pneumonia, bronchitis, and more severe asthma. Mothers who breathe secondhand smoke while pregnant are more likely to have preterm labor and babies with low birth weight.

Are other forms of tobacco also dangerous?

Besides cigarettes, there are several other forms of tobacco. Some people smoke tobacco in cigars and water pipes (hookahs). These forms of tobacco also contain harmful chemicals and nicotine. Some cigars contain as much tobacco as an entire pack of cigarettes.

E-cigarettes often look like cigarettes, but they work differently. They are battery-operated smoking devices. Using an e-cigarette is called vaping. Not much is known about the health risks of using them. We do know they contain nicotine, the same addictive substance in tobacco cigarettes. E-cigarettes also expose non-smokers to secondhand aerosols (rather than secondhand smoke), which contain harmful chemicals.

Smokeless tobacco, such as chewing tobacco and snuff, is also bad for your health. Smokeless tobacco can cause certain cancers, including oral cancer. It also increases your risk of getting heart disease, gum disease, and oral lesions.

Why should I quit?

Remember, there is no safe level of tobacco use. Smoking even just one cigarette per day over a lifetime can cause smoking-related cancers and premature death. Quitting smoking can reduce your risk of health problems. The earlier you quit, the greater the benefit. Some immediate benefits of quitting include:

  • Lower heart rate and blood pressure
  • Less carbon monoxide in the blood (carbon monoxide reduces the blood's ability to carry oxygen)
  • Better circulation
  • Less coughing and wheezing

NIH National Cancer Institute

X-Rays

X-rays are a type of radiation called electromagnetic waves. X-ray imaging creates pictures of the inside of your body. The images show the parts of your body in different shades of black and white. This is because different tissues absorb different amounts of radiation. Calcium in bones absorbs x-rays the most, so bones look white. Fat and other soft tissues absorb less and look gray. Air absorbs the least, so lungs look black.

The most familiar use of x-rays is checking for fractures (broken bones), but x-rays are also used in other ways. For example, chest x-rays can spot pneumonia. Mammograms use x-rays to look for breast cancer.

When you have an x-ray, you may wear a lead apron to protect certain parts of your body. The amount of radiation you get from an x-ray is small. For example, a chest x-ray gives out a radiation dose similar to the amount of radiation you're naturally exposed to from the environment over 10 days.