Pathophysiology of Respiratory Disorders Flashcards
1
Q
Obstructive disease
A
can’t get air out
Occurs when the positive pressure of exhalation causes the small airways to pinch shut trapping gas in the alveoli
2
Q
Signs of obstructive disease
A
Pursed lip breathing
Increased inspiratory to expiratory ratio
Abdominal muscle use
Jugular venous distention
3
Q
Asthma Name from Greek work meaning
A
panting
4
Q
Asthma is characterized by
A
an inflammation in the bronchiole airways due to a variety of stimuli.
Is a common chronic inflammatory disease of the airways.
5
Q
Hallmark of Asthma is
A
Airway Diameter Reduction
6
Q
key points of asthma
A
Reversible
Must be triggered
7
Q
normal levels of C02 in blood
A
35-45mmhg
8
Q
CPAP rule
A
must have neb running
9
Q
Hypoxia
Hypoxemia
A
Hypoxia: area of the body that is short of oxygen
Hypoxemia: entire body is short of oxygen
10
Q
Only way to fix Hypoxemia aka low spo2
A
02 and PEEP
11
Q
Bronchospasm/ Bronchoconstriction
A
Caused by the construction of smooth muscle that surrounds the larger bronchi in the lungs
When air is forced through the constricted tubes it causes them to vibrate which creates wheezing
12
Q
The primary treatment of bronchospasm
A
is the administration of bronchodilator medication ex: Ventolin
13
Q
3 main symptoms of asthma
A
bronchoconstriction
mucous production
inflammation
14
Q
Signs and Symptoms of asthma
A
SOB
Increase Work of Breathing
Accessory Muscle use
SPO2 abnormalities
Adventitious lung sound, especially wheezing
Decreased air entry
Pallor or cyanosis
ETCO2 reveals signs of bronchoconstriction
15
Q
treatment for asthma
A
Ventolin(Salbutimol)
Atrovent(Ipratropium Bromide)
epinephrine
16
Q
Potentially Fatal Asthma
A
Severely compromised ventilation all of the time
Be alert for silent chest syndrome
17
Q
Potentially Fatal Asthma
Ask if pt:
A
Previous intubation for respiratory failure or respiratory arrest
2 or more admissions to hospital despite oral corticosteroid use
2 or more episodes of pneumothorax
18
Q
Status asthmaticus
A
severe prolonged asthmatic attack that cannot be broken with conventional treatment
Patient physically tired: accessory muscle use, cyanosis, chest hyperinflatedA despite treatment already given
19
Q
when is epinephrine used for asthma
A
silent lungs
20
Q
Mild asthma
A
Can form sentences
Lungs: clear
-Expiratory wheezes
- 5-5.0mg Ventolin
- Contra: tachy arrythmia
250-500mcg Atrovent *won’t do anything after 2 doses (1000mcg)
21
Q
moderate asthma
A
Can speak few words at a time, tripod position
Inspiratory and expiratory wheezes through all 4 lobes
O2 immediately
22
Q
Severe asthma
A
Stridor
—Upper airways already 50% closed
wheezing upper lobes, silent lower lobes
02
5.0/500 Combivent- Atrovent and Ventolin
CPAP: must have neb running
- 5mg EPI when you hear Silent chest
- –Call ALS
23
Q
Anaphylaxis
A
Serious allergic reaction that is rapid in onset and may cause death
24
Q
Risk factors: Anaphylaxis
A
Predisposition
Substance
Route and dosage
Time between exposure
25
Allergen
Antibody (immunoglobulin)
Antigen
Hypersensitivity
Allergen: antigen
Antibody (immunoglobulin): attach to surface of mast cell and
Antigen: proteins found on surface of cells
Hypersensitivity: results from immune response to antigens
26
Allergic Reaction vs Anaphylaxis
Allergic Reaction
1 body system
Anaphylaxis
2 body systems
EPI!!
27
Sensitization
over production of IgE (antibodies)
First exposure
Antibodies attach to MAST cells and basophils
--Mast cell: part of immune system and fights off stuff
Release of chemical mediators
28
Anaphylaxis Common causes
Drugs
Foods and Additives
Hymenoptera Stings
29
Chemical Mediators cause and result in
Causes inflimation, bronchonstriction and mucous
These substances result in bronchoconstriction, peripheral vasodilation and increased capillary permeability.
30
Mediators that are stored include
*histamine, heparin and chemotactic factors.
| Other mediators are formed during degranulation such as prostaglandins, leukotriene's, bradykinins and interleukins.
31
Histamine Receptors
| H1
Bronchospasm
increased peristalsis
Vessel dilation
Post capillary venule permeability
Increases heart rate
32
Histamine Receptors
| H2
Gastric acid secretion
33
Anaphylaxis Presentation initial response
which occurs within the first 30 minutes after exposure and resolves within one hour consists of vasodilation, vascular leakage, and smooth muscle spasm
34
Anaphylaxis Presentation delayed response
which can occur hours later and last for days consisting of more intense infiltration of tissues with inflammatory cells and more severe symptoms
35
Anaphylaxis Presentation
| skin
Urticaria (Hives)
Pruritus(itching)
Angioedema (Swelling)
36
Criteria for anaphylaxiss exist when one of the following are met:
1. Acute onset symptoms involving hives, flushing, swelling of the mouth and throat, with at least one of the following:
Respiratory concerns or distress, including difficulty breathing or speaking or decrease peak expiratory flow
Declining blood pressure
Symptoms of end organ disfunction
2. Rapid occurrence of two or more of the following after exposure to likely Allergan:
Skin and mucosal tissue symptoms including hives itchy and flushed skin and or swelling of the face and body
respiratory concerns or distress including difficulty breathing or speaking or decreased peak expiratory flow
Declining blood pressure
Symptoms of an organ disfunction
Severe gastrointestinal symptoms
3. Exposure of known allergin causing a decline in blood pressure
37
COPD
General term (umbrella term): contains emphysema and chronic bronchitis
38
copd spo2
Spo2 always lower than normal
Goal is 94 but COPD pts goal is 90-92
Do not get COPD pt into 98
Too much O2 will lower respiratory rate
39
copd CO2
CO2 is always higher 50-60 mmhg
40
Common Pathologies of COPD
Airflow obstruction
Bronchospasm/bronchoconstriction
Increased mucous production
Impaired elasticity of airways
41
Emphysema
is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli.
Emphysema patients have damage to lung tissue in alveoli, which causes thickening and delays, or block entirely, the oxygen/carbon dioxide exchange.
42
Pulmonary Emphysema (Pink Puffers)
Abnormal, permanent enlarged air spaces distal to terminal bronchiole
Usually a non-productive cough
Increased Anterior/Posterior diameter (barrel chest) due to hyperinflation and increased lung volume
43
Emphysema Pathologies
Destruction of alveoli walls
Weakening and destruction of bronchioles
Decreased alveoli surface area
Decreased gas exchange
44
Emphysema – Signs and Symptoms
“pink puffer”- respiratory distress: exhalation
Pink color
Pursed lip breathing
Leaning forward
Use of accessory muscles
Tachypnea
Distended neck veins
Barrel chest
Tachypneic
Thin because they burn calories trying to breath
45
Chronic Bronchitis
Inflammation, swelling and excessive mucous production in the bronchial tree.
Minimal alveoli involvement
Decreased ventilation of alveoli due to airflow obstruction
46
Chronic Bronchitis - Signs and Symptoms
“blue bloater”- respiratory distress: inhalation
Cyanotic
Sweating
Leaning forward
Use of accessory muscles
Tachypnea
Distended neck veins
47
COPD with right heart failure
Very difficult to push the patients thick blood through lungs destroyed by emphysema and through capillaries squashed by hyperinflated alveoli
48
COPD with right heart failure Signs and symptoms
Peripheral edema
JVD
End inspiratory crackles
49
Hypoxic Drive
Rare phenomenon that affects only a very small percentage
Pts whose respiratory drive can be decreased by high levels of oxygen
50
Bagging someone with COPD
Pts who have severe asthma or copd should be ventilated 4-6 breaths per pin to avoid bagging them to death
51
Management of COPD
Primary goal is to reverse airflow obstruction through bronchodilation
This is accomplished through use of sympathomimetics and
anticholinergics.
CPAP, if indicated, helps with medication administration
PEEP: Positive End Expiratory Pressure
52
Pleural effusion
is when fluid collects between the visceral and parietal pleura.
53
Effusions can be caused by
infections, tumors, CHF, trauma
54
what do pleural Effusions cause
can contain several litres of fluid, which can decrease lung
capacity and cause dyspnea.
They impair breathing by limiting lungs expansion and can cause partial or complete lung collapse.
55
where do P effusions happen
Happens in pleural space
56
what will you hear with a pleural effusion
what will the spo2 be
When you listen you won’t hear anything
SPO2 will be low (hypoxemic)
57
P effusions Treatment
Prehospital treatment should consist of proper positioning, high fowlers most often, aggressive supplemental oxygen if required.
58
Bronchitis
Is an inflammation of the mucous membranes of the bronchi
59
bronchitis Is characterized by
development of cough or small sensation in the back of the throat, with or without production of sputum
60
bronchitis Divided into two categories:
Acute
Chronic
61
bronchitis treatment
treat symptomatically
62
Laryngitis
inflammation of voice box due to overuse, irritation or infection
63
Croup
is the inflammation of the larynx and airwaves just below it
it primarily affects children five years or younger
it comes on strongest in the night time in the last 3 to 7 days
64
symptoms and cause of croup
symptoms include loud harsh barking cough, fever, noisy inhalations, hoarse voice and dyspnea
caused by a virus
65
Pneumonia
Is an inflammatory condition of the lung, affecting primarily the alveoli
66
Viral Pneumonia
In adults, viruses account for approximately a third and in children for about 15% of pneumonia cases
Commonly implicated agents include rhinoviruses, coronaviruses, influenza viruses, respiratory syncytial virus (RSV)
67
Pneumonia signs and symptoms
```
systemic:
skin:
lungs;
muscular:
central
vascular
heart
gastric
joints
```
Systemic:
- High fever
- Chills
Skin:
- Clamminess
- Blueness
Lungs:
- Cough with sputum or phlegm
- SOB
- Pleuritic chest pain
- Hemoptysis
Muscular:
- Fatigue
- Aches
Central:
- Headaches
- Loss of appetite
- Mood swings
Vascular:
-Low bp
Heart:
-High hr
Gastric:
- Nausea
- Vomiting
Joints:
-Pain
68
Pneumonia treatment
treat symptomatically
69
V:Q normals and normal ratio
Ventilation 4l/min
Perfusion 5l/min
0.8 is normal VQ ratio
70
Pulmonary Embolism
is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism).
71
P embolism most commonly results from
deep vein thrombosis (a blood clot in the deep veins of the legs or pelvis) that breaks off and migrates to the lung, a process termed venous thromboembolism (VTE)
72
Pulmonary embolism Risk Factors
Estrogen-containing hormonal contraception
Cancer (due to secretion of pro-coagulants)
Alterations in blood flow: immobilization after surgery, injury, pregnancy, obesity (also procoagulant), cancer (also procoagulant)
Smoking
Travel
73
Signs and Symptoms of pulmonary embolism
Dyspnea
Short of breath but clear and equal lung sounds think pulmonary embolism
Pleuritic chest pain on inspiration
Pin point chest pain
Low oxygen saturation
Cyanosis
Tachypnea
Hemoptysis
Usually clear sounding lung sounds
About 15% of all cases of sudden death are attributable to PE
Severity of symptoms depend on the vessel size and location
74
pulmonary embolism treatment
symptomatically
high O2
75
Normal co2 levels
35-45 mmhg
76
Acute Respiratory Failure
Respiratory failure is inadequate gas exchange by the respiratory system, with the result that levels of arterial oxygen, carbon dioxide, or both cannot be maintained within there normal ranges.
77
hypoxemia
A drop in blood oxygenation
78
hypercapnia
a rise in arterial carbon dioxide level
79
Type 1 Respiratory Failure
Oxygenation Failure
hypoxia without hypercapnia, and indeed the PaCO2 may be normal or low
80
ventilation/perfusion (V/Q) mismatch
; the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lungs
81
the 5 causes of Type 1 Respiratory Failure
1. V:Q mismatch
2. Low inp fiO2= 21%
3. Alveolar wall disease
4. Low resp rate
5. Shunt
82
Type 1 Respiratory Failure treatment
oxygen
83
conditions that affect oxygenation
Parenchymal disease (V/Q mismatch)
Diseases of vasculature and shunts: right-to-left shunt
Pulmonary embolism
Interstitial lung diseases: ARDS, pneumonia, emphysema
84
Type 2 Acute Respiratory Failure
Ventilation CO2
Failure to compensate: hypercapnia
They will be breathing like 35 times per minute but their end tidal will still be high
85
inadequate ventilation defined
the build up of carbon dioxide levels (PaCO2) that has been generated by the body
86
Type 2 Acute Respiratory Failure underlying causes include
Increased airway resistance( COPD, Asthma, Suffocation)
Reduced breathing effort (drug effects, brain stem lesion, extreme obesity)
A decrease in the area of the lung available for gas exchange (such as in chronic bronchitis).
Neuromuscular problems (GB syndrome., myasthenia gravis, motor neurone disease)
Deformed (kyphoscoliosis), rigid (ankylosing spondylitis), or flail chest.
87
Respiratory failure resulting from hypoventilation
Conditions and impair lung function
Conditions that impair mechanisms of breathing
Conditions are impaired the neuromuscular apparatus
Conditions that reduce respiratory drive
88
Acute Respiratory Distress Syndrome
Is a life-threatening reaction to injuries or acute infection to the lung.
nflammation of the lung parenchyma leads to impaired gas exchange with systemic release of inflammatory mediators, causing inflammation, hypoxemia and frequently multi organ failure
89
Acute Respiratory Distress Syndrome death rate
This condition has a 90% death rate in untreated patients
90
Acute Respiratory Distress Syndrome symptoms
People usually present with shortness of breath, tachypnea leading to hypoxia and providing less oxygen to the brain, occasionally causing confusion
91
Aspiration
Is the inhalation of either oropharyngeal or gastric contents into the lower airways
92
Aspiration Pneumonia
Migration of fluids and inflammatory cells into the area of irritation
Fever, productive cough, radiographic findings
Immunocompromised patients may not present the inflammatory response
93
most common area if aspiration occurs in the sitting position
Aspiration in supine position
Right lower lobe
may produce infection in any lobe
94
The severity of the symptoms of Aspiration Pneumonia is related to :
Volume of aspirant
Amount of bacterial contamination
Oropharyngeal contents with anaerobic bacteria
pH of material
pH less than 2.0 are associated with a much higher mortality rate
95
Aspiration Pneumonia Management
Acute symptomatic Aspiration
Remove airway obstruction
Monitor CO2/SpO2
Correct hypoxia
Ventilate as required
Bronchodilators
--Aspiration-induce bronchospasm
Bronchoscopy
96
Aspiration Pneumonia Treatment
Aggressively reduce the risk of aspiration by avoiding gastric distension when ventilating and by decompressing the stomach with an NG tube whenever appropriate
Aggressively monitor the patient’s ability to protect his or her own airway and seek to protect the patient’s airway with an advanced airway if this is impossible
Aggressively treat aspiration to suction and airway control if steps one and two fail
97
BVM: ROMAN
restriction
obesity
mask seal
age over 55 (loss of muscle tone/ increase risk for disease)
no teeth
98
SGA: RODS
restriction
obesity
deformed anatomy
stiff neck
99
nasal O2
1-6lpm
24-44%
100
simple o2
6-12lpm
24-50%
101
nrb o2
10-15lpm
90-100%
102
bvm 02
15lpm
100%
103
o2 consumption constant
D
E
H
```
D= 0.16
E= 0.28
H= 3.14
```
104
o2 consumption formula
psi in tank x constant
------------------------------
flow rate
105
fiO2
fraction of inspired oxygen
106
Hyperventilation
Hyperventilation Syndrome is a respiratory disorder, psychologically or physiologically based, involving breathing too deeply or too rapidly.
The hyperventilation is self-promulgating as rapid breathing causes carbon dioxide levels to fall below healthy levels, and respiratory alkalosis (high blood pH) develops.
107
Hyperventilation Signs and symptoms
```
Palpation
Chest pain
Paresthesia hand and muscle
Light headed
Weak
Dizzy
Carpo-pedal spasm
```
