3. Medical Emergencies: Pulmonary Flashcards
◦ Extrathoracic components are the ____, trachea.
◦ Intrathoracic components are the ____, primarily. Then the trachea, bronchi, bronchioles, and alveoli which are involved in gas exchange.
mouth
lungs
Airway Physiology
● Airways become ____ as you move toward the periphery but the total cross-sectional area ____
smaller
increases
Airway Physiology
Primary thing here is: the trachea has ____. They’ll maintain support of the area. Because they’re ____-shaped, it allows for some distensibility of that airway as well. The ____ portion is NOT cartilage, so it can change in terms of diameter. But the cartilage helps support the airway and keeps them open.
As we go further down into the bronchi, there will be ____ bronchi that go to the lobes of the right lung, and only ____ bronchi that go to the lobes of the left lung.
cartilaginous rings
C
posterior
3
2
Airway Physiology
We’ll see the ____ here at the end. Finally, the alveolar sacs and alveoli. These are normal-looking alveoli. You can see the tremendous amount of cross-sectional area, and that is where CO2 and O2 are going to be exchanged.
terminal bronchioles
Airway Physiology
● Airways are held open by ____ support and by ____ differences
structural
pressure
Physiology of Breathing
● Central and peripheral respiratory and the sensory receptors
● The central chemoreceptors respond to ____ and the
peripheral chemoreceptors respond to ____
● The normal respiratory rate (RR) is ____ breaths per minute
carbon dioxide (CO2)
oxygen (O2)
14-16
Exhalation and Inspiration
Here’s a chest xray of someone that’s taking a breath in (right). You can see the tremendous increase in lung volume. The diaphragm contracts.
And then somebody that’s exhaling (left). Diaphragm is ____, so there is less lung volume.
We also see these little vascular markings. These white markings are ____. There’s not as much air in the lungs, so you can see those prominent markings. In patients with ____, those will be very prominent. That’s one of the reads we’ll see on a chest x-ray, prominent vascular markings suggestive of CHF. You’ll also see an enlargement of the ____ (its silouhette will be larger).
On the right lung, you can’t see those vascular markings quite as much as you could during ____.
up vascular markings CHF heart exhalation
Pulmonary Symptoms
● ____
● ____
● ____
dyspnea
wheezing
cough
Dyspnea
● The sensation of difficulty with ____
● ____ or chronic
● Can be triggered by any stimulus that increases the need for ____
breathing
acute
oxygen
Differential Diagnosis of Dyspnea
● Chronic obstructive pulmonary disease ● Asthma ● \_\_\_\_ obstruction ● \_\_\_\_ ● \_\_\_\_ ● \_\_\_\_ ● \_\_\_\_
● Congestive heart failure ● \_\_\_\_ infarction ● \_\_\_\_ disorders ● \_\_\_\_
upper airway aspiration pulmonary embolism pneumothorax laryngospasm
myocardial
neuromuscular
anxiety
Pulmonary Diseases
● COPD
- ____
- ____
● Asthma
bronchitis
emphysema
COPD
● Affects 14 million people
● ____ leading cause of death
fifth
“Causes of pure emphysema or pure chronic bronchitis are uncommon; patients usually have elements of both diseases. The disease that ____ receives the diagnostic label.”
predominates
● Chronic bronchitis “Blue bloaters” Frequency \_\_\_\_ Chronic productive \_\_\_\_ Copious, \_\_\_\_ sputum \_\_\_\_ dyspnea Frequent \_\_\_\_ infections
● Emphysema “Pink puffers” \_\_\_\_ chested \_\_\_\_ not prominent \_\_\_\_ sputum \_\_\_\_ dyspnea Few \_\_\_\_ infections
overweight cough mucopurulent mild respiratory
barrel cough scant severe respiratory
Chronic Bronchitis
“Excessive tracheobronchial mucous production sufficient to cause cough with expectoration for at least ____ months of the year for ____ consecutive years”
3
2
Chronic Bronchitis
This is what it looks like pathologically
You’ll see ____ cells in the lining of the airway that produce mucus
Also bronchial glands: only found in the ____ glands
You’ll see thick sputum in the middle of the airway and these big mucus ____ (you have to clear the plugs in order to breathe)
goblet
larger
plugs
Emphysema
“Distension of the air space ____ to the terminal bronchioles with destruction of ____”
distal
alveolar septa
Emphysema and chronic bronchitis are clinically managed in an ____ fashion.
Both patients with emphysema and chronic bronchitis will be managed exactly the same way clinically.
Patients with COPD will get more ____, but patients with emphysema are also treated with antibiotics (not as frequently tho). They will be on some kind of either B-2 agonist or parasympathetic blocker.
In essence, there’s a blur between the 2 categories and patients have features of both. Ultimately, they’re not managed identically, but pretty close!
identical
antibiotics
