Oxygenation Pt.1 Flashcards
Partial vs Complete Airway Obstruction?
Partial: breathe and cough spontaneously; encourage pt to cough forcefully habang kaya pa!; if not removed = hypoxia, hypercarbia, respi + cardiac arrest
Complete: weak, ineffective cough + high pitch noise w inhalation; can’t dislodge object w cough na; hypoxia; permanent brain injury / death within 3 TO 5 MINUTES
Causes of airway obstruction?
- Aspiration of foreign bodies
- Anaphylaxis (allergic reax; observe 30m-1h after exposure)
- Viral / bacterial infection (d/t abscess or secretions)
- Trauma (smoke, chemicals)
- Inhalation / chemical burns
- Asphyxiation by food
Most common reasons for aspiration in:
Children
Adults
Unconscious pts
C: Small toys or coins
A: boules of meat
U: may nagbigay ng oral fluids
In aspiration, objects commonly go to which bronchus?
RIght, which is more direct compared to left
Assessment findings in airway obstruction?
- Clutching neck between thumb + finger = UNIVERSAL SIGN
- Weak, ineffective cough, high pitch noises = total obstruction na
- Respi distress
- Unable to speak, breathe, cough
- Collapse
- No breath sounds
Pulse Oximeter - monitor O2; severe = low
Serum ABG - changes in pH, CO2
Management of Airway Obstruction includes:
Establish patent airway:
- Abdominal thrust / Heimlich maneuver
- Head tilt, chin lift if no SCI; else, use jaw-thrust
- Oropharyngeal airway insertion / ETT
- Cricothyroidotomy (insert needle sa may thyroid area so air would go in)
Provide artificial means of ventilation
What is near drowning?
Survival for at least 24h after submersion (Water causes obstruction)
Most common consequence of near drowning?
Hypoxemia; could lead to death by suffocation from submersion
Fresh water drowning vs salt water drowning
Fresh water
- hypotonic; fully water kaya nagsswell ang cells
- lungs r filled w water kaya no space for air
- leads to cardiac and respi arrest
Salt water
- hypertonic; may nakahalong salt = more concentrated = shrinked, wrinkly cell
- salt attracts water to the lungs which leaves blood with no O2
- pulmo edema, cardiac arrest, hemoconcentration, drowning in ur own blood
Management for near drowning?
First Aid: CPR for both types, stabilize spine
Management:
- ET with PEEP
- Rewarming
- ECG for monitoring
- Foley cath
- NGT
Prevention of near drowning?
- Test water depth
- No ETOH (alak)
- Ensure availability of rescue equipment
Decompression sickness is AKA?
The bends, Caisson’s Disease, chokes, staggers
What happens in DCS?
- Person starts ascending too fast and di makakeep up ang body para irelease ang absorbed Nitrogen
- Happens at tissue level, which will eventually form gas bubbles and create a blockage
- Can lead to platelet aggregation > blood clots > emboli
Manifestations of DCS?
- “Bends” : joint, extremity pain, loss of ROM
- Cardiopulmonary arrest d/t hypoxia
- Chokes: abnormal gas exchange + hemodynamic compromise
- Air embolism: stroke, paralysis, death - neuro symptoms that mimic stroke/SCI
Management of DCS?
100% O2, CXR, IV line w LRS or NSS, warm pt, transfer to closest hyperbaric chamber, resuscitate if unconscious, fluids, antibx
HOB SHOULD BE LOWERED to save brain from clots
Describe Carbon Monoxide Poisoning
Basically: you inhale CO > CO likes RBCs more than O2 > Less O2 for the body
Instead of oxyHgb > CarboxyHgb
Nagkakadefect in transport of gases
Manifestations of CO Poisoning
- Cerebral hypoxia, coma (remember: 3 mins = injured, damaged brain; 5-6 mins = brain dead)
- Headache, lightheadedness, collapse
- EARLIEST SIGN: restlessness or irritation
What is the earliest sign of CO poisoning?
Restlessness or irritation
Mgmt of CO poisoning?
REMEMBER: Pulse ox is NOT a valid indicator kasi it reflects Hgb sat
Expose to fresh air, loosen tight clothing, CPR PRN, 100% O2, prevent chills, keep patient quiet, Hyberbaric O2 Chamber (HBO)
NO: SMOKING OR ETOH
Half-life off CO?
4-6 hours
Goal of CO poisoning mgmt :
Reverse cerebral and myocardial hypoxia via CO elimination
Types of immunity?
- Active: body participates in producing protection Laban sa foreign body
- Natural: nainfect ka na dati kaya nakaproduce na ng antibodies yung body mo
- Artificial: from vaccine
- Passive: galing sa mom via placenta
- Adaptive: nainfect ka, kaya body finds a way to adapt
Anaphylaxis is AKA?
Hypersensitivity allergic reaction
What are the different types of hypersensitivity?
- Type I: immediate, involved IgE
- Type II: involved IgG
- Type III:
- Type IV: delayed type of hypersensitivity
FOCUS: type I, kasi IgE is responsible for allergic processes
___________ is when the body reacts to a foreign object TOO SEVERELY
Acute systemic hypersensitivity reaction
Antibody IgE is produced by the ?
B cells
What happens in anaphylaxis?
A second exposure to the same antigen results in a more severe and rapid response
Anaphylaxis Mgmt:
- Rush to ER
- Cricothyroidotomy. - to provide patent airway kasi glottal edema occurs
- Meds: EPINEPHRINE SQ/IM INJECTION followed by anti-H2 drug to reverse bronchoconstriction and vasodilation
(SQ = severe; IM = worse; max of 0.5 mL to be given in single dose) - Can be repeated 2-3x depende sa response ng pt at 10-15mins interval
Pharma mgmt of Anaphylaxis?
- Cetrizine
- Benadryl (Dipenhydramine)
- Epinephrine
- Antamuine
