Airway & Breathing

Question 1

What makes people breathless?

Answer 1

Pain, exercise, obesity, exercise, genetics, smoking

Question 2

Name 5 common respiratory conditions?

Answer 2

Chest Infection
Pneumonia
Emphysema
Dyspnoea
Respiratory failure
Asthma
COPD
PE
TB
Bhronchiectasis
Bhronchitis
CF

Question 3

What is Kussmaul breathing?

Answer 3

Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure

Question 4

What is dyspnoea

Answer 4

Difficulty in breathing

Question 5

What is orthopnoea

Answer 5

Difficulty in breathing when lying down

Question 6

Signs of dyspnoea

Answer 6

Orthopnoea – DIB Lying down
Use of accessory muscles
Nasal Flaring
Head bobbing (Children)

Question 7

What is cheyne-stokes breathing?

Answer 7

an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea. The pattern repeats, with each cycle usually taking 30 seconds to 2 minutes

Question 8

What is Stridor?

Answer 8

High pitched noise on inspiration or expiration, indicates a disturbance to the airflow in the upper respiratory tract

Question 9

What is stertor?

Answer 9

Snoring during sleep or altered consciousness

Question 10

What is a wheeze?

Answer 10

Whistling heard on expiration, indicates resistance to airflow in lower respiratory tract

Question 11

What is a rattle?

Answer 11

Heard on inspiration and expiration, associated with secretions in the lower respiratory tract (death rattle!)

Question 12

How would you position the breathless patient?

Answer 12

Upright position chair/bed

Leaning over pillow placed on hospital table (orthopneic position)

Question 13

What is asthma?

Answer 13

Chronic inflammatory disease of the airways
Causes hyper-responsiveness, mucosal oedema and mucous production
Allergy is the strongest predisposing factor
Inflammation leads to cough, chest tightness, wheezing and dyspnoea

Question 14

What is Status Asthmaticus?

Answer 14

medical emergency where symptoms do not respond to bronchodilators (aggressive treatment/ventilation/ICU)

Question 15

What is Type I respiratory failure?

Answer 15

Type I respiratory failure involves low O2, and normal or low CO2
Occurs because of damage to lung tissue. Lung damage prevents adequate oxygenation of the blood (hypoxaemia); however, the remaining normal lung is still sufficient to excrete the CO2 being produced by tissue metabolism. This is possible because less functioning lung tissue is required for CO2 excretion than is needed for oxygenation of the blood.

Question 16

What is Type II respiratory failure?

Answer 16

Type II respiratory failure involves low O2, with high CO2
‘Ventilatory failure’ - occurs when alveolar ventilation is insufficient to excrete the CO2 being produced. Inadequate ventilation is due to reduced ventilatory effort, or inability to overcome increased resistance to ventilation – it affects the lung as a whole, and thus CO2 accumulates. Complications: damage to vital organs due to hypoxaemia, CNS depression due to increased CO2 levels, respiratory acidosis (CO2 retention). This is ultimately fatal unless treated.

Question 17

List causes of Type I respiratory failure?

Answer 17

disease that damage lung tissue, including pulmonary oedema, pneumonia, acute respiratory distress syndrome, and chronic pulmonary fibrosing alveoloitis

Question 18

List causes of Type II respiratory failure?

Answer 18

COPD, chest-wall deformities, respiratory muscle weakness (e.g. Guillain-Barre syndrome) and central depression of the respiratory centre (e.g. heroin overdose).

Question 19

What is subjective data in respiratory assessment?

Answer 19

Subjective is that the patient (the subject) tells us. So these are the things we cant see/verify with our own eyes.
Pain
Shortness of breath
Feelings
What the pt says “I can’t breathe” “I’m exhausted”
Past health Hx
Family health Hx

Question 20

What is objective data in respiratory assessments?

Answer 20

Objective = measurable, can see with our own eyes
 Age/gender
 RR  HR SpO2  IPPA  BP
Diaphoresis/Pale
ECG (e.g. showing sinus tachycardia)
Accessory muscle use, nasal flaring etc
Pursed lip breathing/tripod position

Question 21

What are the normal ABG values?

Answer 21

pH 7.35-7.45
paCO2 35-45mmHg
paO2 80-100mmHg
HCO3 22-26mmol/l
BE +/- 2mmol

Question 22

What causes respiratory acidosis?

Answer 22

Alveolar hypoventilation
Inadequate perfusion
Mechanical ventilation

Question 23

What diseases cause alveolar hypoventilation?

Answer 23

COPD
Obesity hypoventilation syndrome
Chest wall deformities
Neuromuscular disorders
Central alveolar hypotension

Question 24

What diseases cause inadequate perfusion?

Answer 24

Shock - cardiogenic, hypovoleamia

Question 25

What are the compensatory mechanisms to restore ABG to normal limits?

Answer 25

Initial response: increased RR and depth
Increase in minute ventilation
Increased HR
Possible vasoconstriction
Peripheral chemoreceptors detect hypoxia and initiate compensatory mechanisms

Question 26

What is Non Invasive Ventilation?

Answer 26

Non Invasive Positive Pressure Ventilation (NIPPV) delivers positive pressure breaths to a spontaneously breathing patient.
Delivered by a mask with an airtight seal
Reduces the occurrence of patients being intubated

Question 27

What does CPAP stand for?

Answer 27

Continuous Positive Airway Pressure

Question 28

What patients is CPAP used for?

Answer 28

Commonly used in patients with
Pulmonary oedema
COPD
Asthma

Question 29

Why use CPAP?

Answer 29

Support for spontaneously breathing patients and ventilated patients
The raised positive pressure assists in reducing the work of breathing on inspiration
Increases gas exchange and reduces hypoxia

Question 30

What does BiPAP stand for?

Answer 30

Bilevel Positive Airway Pressure

Question 31

How does BIPAP work?

Answer 31

Involves-
IPAP (Inspiratory positive airway pressure)
A higher pressure is delivered on inspiration
EPAP (Expiratory positive airway pressure)
Lower pressure (but still positive) on expiration

Question 32

What patients benefit from BiPAP?

Answer 32

Commonly used in-
high dependency patients
Neurological disorders (Guillain Barre syndrome)
OSA (Obstructive sleep apneoa)
COPD
Asthma
Post extubation weaning issues

Question 33

What do we call mechanical ventilation?

Answer 33

Invasive Positive Pressure Ventilation (IPPV)

Question 34

Indications for IPPV?

Answer 34

Inability to protect own airway (gag response diminshed (GCS reduced)
Inadequate breathing pattern rate and/or depth
inability to sustain O2 demands of the body
hypercapnia