Lecture 2 (Respiratory) Flashcards
What is a normal breathing rate?
12-20 breaths per minute
What is considered tachypnea?
More than 20 breaths per minute
What is considered bradypnea?
less than 12 breaths per minute
Description of “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 nature, usually on inspiration, passage of air through secretions, heard with emphysema, chronic bronchitis, COPD and can be described as coarse or fine
If a patient has shortness of breath, what can be related reasons to the cause?
pregnancy, ascites (fluid in abdomen), CNS trauma, toxins (local anesthesia toxicity), morbid obesity
What kind of data would you like to see in order to determine what can be the cause of shortness of breath?
- patient health/age
- 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 if 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 limitation due to obstruction or abnormal inflammatory response
- permanent alveolar damage
- 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 COPD?
There is no cure, but you can manage using
- bronchodilators
- steroids
- methylxanthines
- supplemental oxygen
Should we give oxygen to a patient with COPD?
It depends
-Patients with COPD have an increase of PCO2 concentration due to the Haldane effect and hypoxic pulmonary vasoconstriction
What is the haldane effect?
decrease in carbon dioxide affinity of hemoglobin in response to increased blood pH resulting from increased oxygen concentration in blood (if carbon dioxide cannot bind, its cause oxygen has taken over)
Where does the haldane effect occur?
lungs
what is the bohr effect?
(the O in bohr says that Oxygen is affected) decreased oxygen affinity of hemoglobin due to decrease blood pH due to increased carbon dioxide concentration
Where does the bohr effect occur?
Metabolizing tissue
What causes the bohr effect?
uptake of carbon dioxide at the metabolizing tissue (the blood uptakes carbon dioxide to relieve the buildup of carbon dioxide in the tissue)
What is normal hypoxic pulmonary vasoconstriction
For less effective alveolus, the pulmonary arteries will constrict themselves to prevent blood circulating to these lame alveolus, and ensure that blood is circulating to those that work well
What happens to hypoxic pulmonary vasoconstriction for patients with COPD?
There would be more blood being circulated to poor functioning alveoli, increasing the shunting and ventilation/perfusion mismatch. More blood will be directed to areas which cannot liberate the carbon dioxide
TLDR: Causes an increase in PCO2 concentration in blood
Should we use nitrous oxide for patients with COPD?
It depends
- determine whether or not the patient can tolerate the surgery and local anesthetic
- administer slowly and observe oversedation
- keep patient within 3-5% of baseline oxygen saturation
What is another name for emphysema?
pink puffer
What is emphysema?
The result of chronic bronchitis. It is the loss of elasticity in alveoli, abnormal and permanent damage to the airspaces distal to the terminal bronchioles, which causes the loss of surface area for gas exchange
What is the cause of emphysema?
smoking, probably vapin
What is the treatment for emphysema?
There is no treatment, it is only manageable.
Tx: bronchodilators, antibiotics
Why do patients with emphysema purse their lips?
To Auto PEEP: Positive End Expiratory Pressure
To help maintain the residual pressure in their lungs to prevent the alveoli from collapsing
What is chronic bronchitis?
chronic inflammation leading to increase mucous production, presents with chronic productive cough
What is acute bronchitis?
Self-terminating respiratory infection (viral “cold”)
What causes chronic bronchitis?
Prolonged exposure to irritants, continuous episodic and develops into emphysema (eventually COPD)
What is the treatment for chronic bronchitis?
Bronchodilators, steroids, methylxanthines, and supplemental oxygen
How does peripheral edema develop?
Due to increased pulmonary pressure, there is difficulty for the right ventricle to pump blood, leading it to become hypertrophic and dilated. This causes inefficient and delayed venous drainage
what is asthma?
It is an immune response to allergens, hyper-responsiveness. It causes an increased inflammatory response and increased mucous production (mucocilliary response)
What is the treatment for asthma?
bronchodilators, steroids, leukotriene inhibitors, mast cells stabilizers, monoclonal antibody therapy
What are types of medications that can be used for asthmatic rescue or maintenance?
Epinephrine, albuterol, levalbuterol
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
