Lecture 2 Flashcards
What is a normal breathing rate?
12-20 min
What is tachnypnea?
20 breaths/minute
What is considered bradypnea?
less than 12 breaths per minute
What is “diminished” or “absent” breaths?
reduced sound of breathing due to obstruction, obesity, shallow breathing
Description of “Wheezes”
High pitched sounds on inspiration/expiration, continuous sometimes audible at open mouth, usually expiratory, heard with asthma and COPD
Description of “Ronchi”
Low-pitched continuous, musical, best heard on chest wall, snoring quality of sound
Description of “Crackles”
Short, high pitched, random, explosive in nature, usually on inspiration, passage of air through secretions, heard with emphysema, chronic bronchitis, COPD, can be described as coarse or fine
If a patient has shortness of breath, what can be related reasons to the cause?
pregnancy, ascites from liver failure (accumulation of fluid in the abdomen), toxins (local anesthesia toxicity), CNS trauma, morbid obesity
what kind of data would you like to see in order to determine what can be the cause of shortness of breath?
- respiratory rate according to the patient’s age and health
- use of stethoscope
- look for edema
- pulse oximetry
- review diagnostic reports from consultations like x-rays, electrocardiograms, etc.
What kind of questions should you ask fi a patient has shortness of breath?
- Can the patient tolerate the procedure with minimal risks?
- Can the patient have good treatment prognosis with the current medical condition
- Does this medical condition need to be addressed first?
What are the characteristics of COPD?
- Irreversible pulmonary damage
- progressive airflow limitations due to obstruction or abnormal inflammatory response
- permanent alveolar damage (collapse and hyperinflation)
- continuous thick mucous production, lack of gas exchange
- detectable hypoxemia and cyanosis in peripheral tissues
What can cause COPD?
Smoking, chronic exposure to inhaled irritants, genetic component
What is the treatment for cOPID?
There is no cure, but you can manage with:
- bronchodilators
- steroids
- methylxanthines
- supplemental oxygen
Should we give oxygen to a patient with COPD?
It depends
Patients do increase arterial CO2 concentration over time because of Haldane effect and hypoxic pulmonary vasoconstriction
What is haldane effect?
Decrease in carbon dioxide affinity of hemoglobin in response to increased blood pH resulting from increased oxygen concentration in the blood
Where does the haldane effect occur?
lungs
What causes the haldane effect?
uptake of oxygen in the lungs
What is the bohr effect?
(Think O in bohr), decrease in oxygen affinity of a respiratory pigment such as hemoglobin in response to decreased blood pH resulting from increased carbon dioxide concentration in the blood
Where does the bohr effect occur?
metabolizing tissue
What causes the bohr effect?
caused by the uptake of carbon dioxide at the metabolizing tissue
What is normal hypoxic pulmonary vasoconstriction?
a low functioning alveolus will have reduced blood flow from the heart to ensure deoxygenated blood is directed towards better functioning alveoli
What happens to hypoxic pulmonary vasoconstriction for patients with COPD?
More oxygen leads to more blood being circulated to poorly functioning alveoli, increasing the shunting and the ventilation/perfusion mismatch. More blood will be directed to areas which will not liberate carbon dioxide and pick up oxygen
TLDR: Increase in carbon dioxide over time
Should we use nitrous oxide for patients with COPD?
- Access whether or not pt can tolerate the surgery and local anesthesia
- administer slowly and observe for oversedation or restlessness
- keep aptient within 3-5% of baseline oxygen saturation
What is the other name for emphysema?pink puffer
pink puffer
What is emphysema?
abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles, destruction of alveolar walls with and without resulting fibrosis, loss of elastic recoil, loss of surface area for gas exchange
What causes emphysema?
smoking, probable vaping
what is the treatment?
no cure, just manage:
- supplemental oxygen therapy
- bronchodilators, rarely steroids
- antibiotics to treat sporadic pulmonary infection
Why do patients with emphysema purse their lips?
need to continuously maintain alveolar inflation so they create a self positive end expiratory pressure to maintain the residual pressure in their lungs to prevent the alveoli from collapsing
What is chronic bronchitis?
chronic inflammation leading to increased mucous production, presents with chronic productive cough
What is acute bronchitis?
self-terminating respiratory infection (viral “cold” or other infection)
What is chronic bronchitis?
Prolonged exposure to irritants, continuous, episodic and develops into emphysema (eventual COPD)
What is the treatment for chronic bronchitis?
Bronchodilators, steroids, methylxanthines, and supplemental oxygen
Why does peripheral edema develop?
rV of the heart has increased pressure due to pulmonary resistance. RV can become hypertrophic and become dilated. fluid buildup in extremities due to inefficient and delayed venous drainage
What is asthma?
immune response to allergens, hyper-responsiveness, “reactive airway disease,” increased inflammation and increased mucous production (mucocilliary response)
What is the treatment for asthma?
beta agonist, steroids, leukotriene inhibitors, mast cell stabilizers, monoclonal antibody therapy
What are types of medications that can be used for asthmatic rescue or maintenance
- albuterol
- levalbuterol
- epinephrine
What is the purpose of monoclonal antibody therapy for those with asthma?
help block cytokine mediated activation of mast cells and eosinophils (eosinophilic asthma)
Why is it important for us to know that our patient has obstructive sleep apnea?
Affects our usage in sedation and anesthesia
