Respiratory Flashcards
What does the supine position suggest?
That they are too exhausted to stay upright.
What should a respiratory assessment include?
Listen for audible noises Skin colour Breathing rate Regularity See if chest movements are deep or shallow. Limited rise and fall may suggest inadequate tidal volume. Asymmetrical breathing Use of accessory muscles and indrawing Pursing of lips, head bobbing or nasal flaring Coughing Saturations
What are some physical indicators of respiratory distress?
Skin discolouration Retractions in the muscles of the neck Jugular venous distension (sometimes the jugular veins will stand our and pulse) Indrawing Altered level of consciousness Abnormal lung soundsq
What is the normal respiration rate in an infant?
25-50 breaths per minute
Whats the normal respiration rate for a child?
18-30 breaths
Whats the normal respiration rate for an adult?
12-20 breaths
What are normal lungs sounds called?
Vesicular
What are crackles?
Bubbling or crackling noises heard on inspiration. Characterised by discrete discontinuous sounds each lasting just a few milliseconds. Which may be fine, high pitched or coarse. These are associated with fluid in the airways. Usually hear these sounds at the base of the lobes in patients sitting upright.
What does the tripod position indicate?
It indicates that they are trying to open their chest by leaning forward. it shows that they are mildly distressed.
What is a wheeze?
A high pitched musical or whistling sound. Heard mainly on expiration. Associated with the narrowing of bronchioles (bronchospasm). Commonly heard in the asthma patient.
What is stridor?
High pitched sound heard during inspiration and expiration (but more prevalent during inspiration). It is associated with obstruction of the upper airway.
What are the three characteristics of asthma?
Bronchospasm
Oedema
Increased mucous production
How does increased mucous production affect asthma?
Leads to blockages of the smaller airways
How does oedema affect asthma?
Leads to swelling of the linings of the bronchioles and therefore narrowing
How does bronchospasm affect asthma?
Causes increased resistance due to decreased bronchiole diameter.
Is exhalation an active or passive process in asthmatics?
Active, as they have to overcome greater resistance in order to breath out. This involves using accessory muscles. The air that is forced through these constricted airways creates the wheezing noise.
What does the absence of a wheeze in an asthmatic patient suggest?
It does not always mean they are getting better. If it is still coupled with poor perfusion, altered level of consciousness etc it may mean they are no longer moving a sufficient amount of air to make a noise. This indicates their condition is deteriorating as they are exhausted.
What other factors do we take into consideration when determining the seriousness of an asthmatic patient?
The length of time from onset of the episode
Recent admissions to hospital, particularly ICU
Ongoing medications such as steroids
Recent affliction with chest infections or colds
What is status asthmaticus?
A prolonged asthma attack that does not respond to medication
What are the symptoms of mild-moderate asthma?
SOB Air movement Ability to speak sentences No significant chest/neck indrawing Wheeze
What are the symptoms of severe-life threatening asthma?
Extreme SOB Not much air movement Few words per breath Marked indrawing unless exhausted Probably not moving enough air to create a wheeze
What are the three diseases classified as CORD?
Chronic bronchitis
Emphysema
Chronic asthma
What is chronic bronchitis?
Inflammation of the bronchial tubes
Considered chronic when a patient has a productive cough for three months of the year for two years.
Smoking is a major causative factor
What are the characteristics of chronic bronchitis?
Oedema and thickening of the lining of the bronchioles - results in air trapping of the alveoli.
Excessive mucus production in bronchioles or bronchi - results in air trapping of the alveoli.
Restricted air movement
Compromised gas exchange
Wheezing produced by air being forced through constricted airways.
Why is chronic bronchitis often called the blue bloater?
Because a chronic bronchitis patient will often have:
Cyanosis of the face/lips
Excess weight
Vigorous productive cough
Crackles and wheeze on auscultation
A History of frequent persistent pulmonary infections.
What is the pathophysiology of emphysema?
Usually caused by smoking or toxic environments which lead to destructive lung changes.
There is a narrowing of the lower airways and a loss of elasticity in the alveolar walls.
This leads to air trapping and distended alveolar walls which then break down.
This means that less surface area is in contact with the capillaries so there is less gas exchange. The result is lower oxygen and higher carbon dioxide levels.
What are the symptoms of emphysema?
Restricted air movement. Thin barrel shaped chest. Pink colouration Pursed lip breathing Prolonged expiration Dyspnoeic on exertion Wheezing Diminished breath sounds
What is the main difference in asthma and CORD?
Asthmatics are usually under 50 and symptom free between attackes.
CORD patients are usually over 50 and are not symptom free between attacks
How do we manage CORD?
Oxygen to keep saturations between 88-92%
Nebulised bronchodilators. Alternating between 5 min on and 5 min off if their sats are greater than 92% during the neb.
ICP back up if their condition is moderate-severe.
What is bronchitis?
An infection of the lower conducting airways, producing inflammation, pus and sometimes bronchospasm.
What is pneumonia?
An infection of the alveoli. May produce an intense inflammatory reaction that causes alveoli to fill with organisms, pus and leukocytes.
What are the symptoms of a chest infection?
Fever/chills
Cough
Dyspnoea
Sharp/localise chest pain that worsens with breathing
Wheezes or crackles (in a chest infection these are usually unilateral and localised, they may also only exist in the presence of a productive cough or elevated temperature)
What is hyperventilation syndrome?
Caused by increased ventilatory rate. Often associated with anxiety.
Respirations are rapid and deep which increases the rate at which carbon dioxide is breathed out.
What are the signs and symptoms of hyperventilation syndrome?
Rapid breathing Cool pale skin Carpopedal spasm Tachycardia LOC/seizures Numbness/parasthesia around hands/feet/mouth Cold hands/feet Dyspnoea Chest pain
Why do we give Nebulised adrenaline?
We give it to relieve airway or facial swelling.
It’s indicated to:
Upper airway obstruction secondary to swelling or infection
Anaphylaxis where there is upper airway oedema
Isolated oedema of the face or mouth in the absence of systemic symptoms of anaphylaxis
How much nebulised adrenaline do we give?
Adults and children both receive 5mg of nebulised adrenaline which can be repeated every 10minutes. This is made up using 5 1mg ampoules
What is stridor?
An audible harsh high pitched musical sound produced by turbulent airflow through a partially obstructed upper airway
How do we manage croup?
Give nebulised adrenaline if there is resting stridor, or moderate to severe respiratory distress
What is urticaria?
A rash of pale red raised itchy bumps
What is the presentation of anaphylaxis?
Urticaria
Oedema of the face and mouth
Hypotension
Bronchospasm
How does nebulised adrenaline work?
By stimulating alpha ad reneged receptors in the airway.
These cause vasoconstriction which then decreases capillary permeability of the vascular and endothelial components, which in turn increases airway radius and decreases obstruction to airflow
What are the side effects of nebulised adrenaline?
Anxiety Headache Hypertension Tachycardia Tremors Palpitations
What receptors does salbutamol target?
It’s selective for beta 2 receptors
The SNS recognises salbutamol as a neurotransmitter. Therefore the drug is called sympathomimetic.
What are the indications for salbutamol?
Patients in bronchospasm. Therefore most patients with a wheeze
What are common causes of bronchospasm that are indicated for salbutamol?
Asthma CORD Anaphylaxis Burns (airway) Smoke inhalation
How does ipratroprium work?
Blocks Ach receptors in the smooth muscle of the bronchioles. Ach usually cause smooth muscle to contract.
Why do we only need to give one dose of ipratroprium?
Ipratroprium binds competively binds to Ach receptors, preventing further Ach from binding to that site.
Are bronchodilators indicated for the relief of wheeze associated with anaphylaxis?
No not any more.
What are the side effects of ipratroprium?
Nausea Dry mouth Blurred vision Tachycardia Worsening of glaucoma
What are some of the triggers of asthma?
Allergens - such as dust Irritants such as cigarette smoke Medicines such as NSAIDs Viral upper respiratory infections such as colds Physical activity including exercise
What are common signs and symptoms of asthma?
Shortness of breath Chest tightness Anxiety Respiratory distress Tachypnea Use of accessory muscles in the neck and abdo Prolonged expiratory phase Wheeze Coughing Difficultly speakingTachycardia Cyanosis (if severe)
What are the two main diseases of CORD?
Chronic bronchitis and emphysema
What are the signs of chronic bronchitis?
Commonly cyanosed.
Their right heart failure leads them to be swollen or bloated.
What is emphysema?
A permanent abnormal enlargement of the alveoli accompanied by destruction to their walls. This reduces the surface area for gas exchange. It also reduces lung elasticity, which results in a loss of support for the airways meaning they are more likely to collapse.
What are the common signs and symptoms of CORD?
SOB Abnormal sputum Chronic cough Anxiety Tachyopnea Wheeze or crackles on auscultation Prolonged expiratory phase Chest enlargement (barrel chest) Accessory muscle use in the neck and abdo Pursed lips (particularly on expiration) Tachycardia Difficultly performing daily activities
How much adrenaline do we give IM?
0.5mg
What are the indications for IM adrenaline in asthmatics?
Asthmatics who are status 1 or 2 and who are deteriorating despite bronchodilators.
What is prednisone?
A synthetic glucocorticosteriod. Activated glucocorticosteriod receptors upregulate hte expression of anti-inflammatory proteins in the nucleus and repress pro-inflammatory proteins in the cytosol.
What is the pharmacology of prednisone?
It is rapidly converted in the liver to its active metabolite - prednisolone.
What are the effects of glucocorticosteroids?
Stimulation of gluconeogenesis
Mobilisation of amino acids
Stimulation of fat breakdown
Inhibition of glucose.
They also posses marked anti-inflammatory, immunosuppressive and anti-rheumatic properties. This is because they reduce the vascular and cellular components of inflammation.
What is gluconeogenesis?
A metabolic pathway that uses non-carbohydrate carbon substrates (pyruvate, lactate, glycerol, odd-chain fatty acids and glucogenic amino acids) to generate glucose, particularly in the liver.
Why are AAs mobilsed by prednisone?
Because thet act as substrates for gluconeogenesis.
Why does prednisone cause inhibition of the glucose uptake in muscle and adipose tissue?
Because it is a way in which to conserve glucose.
How is prednisone absorbed?
It is readily absorbed from the GI tract. It has a half-life of 60 min before hydroxylation.
How is prednisone distributed
Prednisolone has a plasma half-life of 2-3 hours and is extensively bound to plasma proteins.
How is prednisone metabolised?
It is primarily metabolised in the liver.
How is prednisone excreted?
In the urine.
What are the adverse effects of prednisone?
Galucoma/cataracts Depression Insomnia Dizziness Headaches Vertigo Hypertension Electrolyte imbalances Reflux Nausea Vomiting Ulceration Fatigue Skin irritations Increased appetite leading to weight gain Reduction in bone density
What is prednisone indicated for?
Asthma
CORD
minor allergic reactions where an itch is prominent and associated with a rash. (Is not given for anaphylaxis but may be given after to resolve an itchy rash)
How much prednisone do we give?
Adults - two 20mg tablets. This maybe swallowed whole or crushed.
If adults are already taking prednisone give 40mg if they are taking less than 40mg a day.
Do not administer if they are taking more than 40 mg a day. If children are already taking prednisone just administer an additional dose anyway.
What are the contraindications of prednisone?
Universals.
Shouldn’t be given to children under 5 as we can’t accurately split a 20mg tablet.
When is non-transport appropriate following prednisone administration in a minor allergic reaction?
There are no signs of systemic involvement
There are no signs of spreading inflammation
There is no facial or intraoral swelling
There are no signs of blistering or peeling
No adrenaline has been administered
Who can recommend that an asthma or CORD patient stay at home after being administered a bronchodilator (even their own)?
Paramedic or ICPs
