Chapter 17 Respiratory Emergencies Flashcards
The adequate rate for artificial ventilation is
10-12/min breath for adult
15-30/min for children
25-50/min infants
Inadequate breathing may be?
- Above or below normal Respiratory Rates
- Irregular Rhythm
- Inadequate or unequal chest expansion
- Diminished, Abnormal, unequal, or absent Breath sounds
- Labored (increased respiratory effort), use of accessory muscles
- shallow Depth
inspirations (inhalation)
an active process in which the intercostal muscles and the diaphragm contract, expanding the size of the chest cavity and causing air to flow into the lungs
expiration (exhalation)
a passive process in which the intercostal muscles and the diaphragm relax, causing the chest cavity to decrease in size and forcing air from the lungs
What three things are looked at when determining a patients breathing?
Rate, Rhythm, Quality
Physical Exam on Respiratory system
- Observing
- AMS, restlessness, anxiety
- unusual anatomy (barrel chest) - Patient Position
- Tripod position
- sniffing position - Work of breathing
- Retractions - use of accessory muscles to breathe
- flared nostrils - pursed lips
- one word dyspnea, two word dyspnea - Skin color
- Cyanosis = low O2 in body, pale, flushed - Pedal edema
- sacral edema
- Noisy breathing
- SpO2 less than 94%
Auscultating
- Lung sounds - Vitals
Wheezes
- high pitched sounds
- indicates narrowing of passages
- Common in Asthma, COPD, emphysema, and chronic bronchitis
- mostly heard on exhalation
Crackles
fine crackling or bubbling sounds heard on inhalation
- caused by fluid in alveoli
Rhonchi
lower pitched sound resembles snoring or rattling
- caused by secretions in larger airways
- seen with pneumonia, or bronchitis
- generally louder then crackles
Stridor
high pitched sound heard on inhalation
- indicates upper airway obstruction
- in trachea or larynx
- may be severe closing of airway
CPAP
Continuous Positive Airway Pressure
- blows O2 or air into the mask at relatively low pressures
- prevents alveoli from collapsing at the end of exhalation
- pushes fluid out of alveoli and lungs
- Common uses include: pulmonary edema, drownings
Patient must be breathing on his own to use CPAP
CPAP Contraindications
Two classes:
anatomic physiologic
- include mental status so depressed patient cannot protect airway
- spontaneous RR
- inability to sit up
- hypotension
- Constant positive pressure causes less blood to return to the heart, so CO decreases and also BP
Pathologic contraindications:
- nausea and vomiting
- penetrating chest trauma
- may cause Pneumothorax by causing weak area in lung to rupture
- shock
- upper GI Bleed
- Recent gastric surgery
COPD
Chronic Obstructive Pulmonary Disease
- Emphysema, chronic bronchitis and black lung are some COPD diseases
- COPD patients often develop hypoxic drive to trigger respirations
- Patients need for oxygen outweighs any risk involved in administration
- if patient has Heart attack, stroke, develops shock or respiratory distress A HIGHER CONCENTRATION OF O2 WILL BE ADMINISTERED
- If patient stops breathing use artificial ventilation and contact medical direction
Chronic Bronchitis
the Bronchiole lining becomes inflamed and excess mucus is formed
- the Cilia (short-microscopic-hairlike-vibrating structure in respiratory system) has been damaged or destroyed cilium
Emphysema
In this disease walls of alveoli break down, greatly reducing the surface area for respiratory exchange
- allows CO2 to be trapped in lungs