Respiratory Conditions

Question 1

What is respiratory compromise

Answer 1

Occurs when the blood contained in the capillaries of both lungs stops or interrupts its normal process of oxygen absorption.
Blood isn’t oxygenated.

This leads to lack of oxygen in the blood stream - vital organs and body tissues receive inadequate supply - hypoxia. They will ultimately fail and cease to function.
Doesn’t happen straight away. But danger of brain damage within 2-3 mins

Question 2

Respiratory compromise affects the…

Answer 2

Respiratory tract (nose to lungs)
Respiratory mechanism (ribs, Intercostal muscles and diaphragm)
Respiratory centre (in the brain).

Question 3

What are the 5 Causes of respiratory compromise?

Answer 3

Obstruction of air passages
Chest or lung trauma (injury as opposed to medical cause)
Paralysis of respiratory nerves (don’t get to where they are supposed to be or don’t get sent)
Non oxygen atmosphere
Lung disease and illness

Question 4

Obstruction of air passages - how and what happens

Answer 4

Obstruction by…
Tongue during unconsciousness
Maxillo facial injuries (injuries to front of face)
Blood and vomit
Inhaled foreign bodies e.g food and false teeth
Suffocation
External pressure to the neck (hanging or strangulation )
Drowning
Internal swelling of the throat tissues (burns, scalds, stings, anaphylactic reaction, disease)

Question 5

What can Chest or lung trauma result from?

Answer 5

External compression - sand, masonry, damaged vehicle and crowd pressure
Blast injury

Question 6

Paralysis of respiratory nerves and muscles may arise from…

Answer 6

Electrocution
Head or spinal injuries 
Poisons such as cyanide, week killers and toxic fumes
Drugs such as barbiturates and morphine
Disease such as tetanus and polio

Question 7

Non oxygen atmospheres can result from…

Answer 7

Gases e.g carbon monoxide are absorbed by the bloodstream and progressively replace oxygen.
Chemical fumes
Smoke
Altitude

Question 8

Lung disease and illness can lead to chronic respiratory failure…

Answer 8

Emphysema 
Pulmonary oedema 
Acute pneumonia 
Asthma/bronchitis
Continuous fits

Question 9

How do we recognise what is going on? Obstruction

Answer 9

Difficult and noisy breathing (disponea)
Cyanosis (skin colour starts to go blue)
Dilated pupils (getting bigger)
Congestion of the veins in the head and neck 
Fits
Gradual loss of consciousness 
Petechial haemorrhage

Question 10

Signs (when there is a paralytic origin)

Answer 10

Progressive deterioration in rate and depth of breathing (quiet unless obstructed by tongue).
Increasing cyanosis
Dilated pupils
Gradual loss of consciousness

Question 11

Management

Answer 11

Ensuring an open airway (using appropriate position techniques)
Commencing cardiopulmonary rescuitation if neccessary
Administer high flow oxygen /(target SP02 94-98%)
Placing the patient in the recovery position if unconscious or semi recumbent if conscious
Reassure the patient

Question 12

Respiratory diseases cause hypoxia how?

Answer 12

Block airway

Or impaired perfusion of the alveoli. (Messes up external respiration)

Question 13

Obstructive airway conditions

Answer 13

COPD (chronic obstructive pulmonary disease)
ASTHMA

These conditions cause obstruction in the pulmonary tissues reducing free flow of air into the lungs.

Question 14

What is COPD?

Answer 14

Airway obstruction mainly in smoker or ex smokers
E.g
Chronic Bronchitis
Emphysema

Approx 3.7 million people with COPD in UK but only 90,000 diagnosed.
Fifth biggest killer kills about 30,000 a year.

Chronic = over time, a,ways there?
Acute =

Question 15

Sign vs symptom

Answer 15

Symptom - something the patient reports

Sign - something you can see

Question 16

COPD sign and symptoms

Answer 16

Not all patients may have these and don’t have all of them

Easily fatigued
Frequent respiratory infections 
Use of accessory muscles to breathe
Orthopneic (difficulty when lying down)
Thin in appearance 
Wheezing 
Dyspnea 
Chronic cough (long term)
Digital clubbing -

Question 17

What is bronchitis?

Answer 17

Inflammation of the mucous membranes in the bronchial tubules, caused by bacterial or viral infections.
Have more goblet cells than a normal person.
Acute bronchitis can be common in very young and the elderly and normally short lived.

Question 18

What is acute bronchitis

Answer 18

In previously healthy individuals it is often viral.
Bacterial infections with organisms such as strep. Pneumonia and H influenza is a common sequel to viral infections in smokers and those with COPD.

Damage caused by irritation of the airways leading to inflammation and neutrophils (WBC) infiltrating the lung tissue.
Mucosal hylersection is promoted by a substance released by neutrophils.
Further obstruction to airways caused by goblet cells.

Question 19

Things to look for in acute bronchitis

Answer 19

Initially irritating, unproductive cough together with discomfort behind sternum.
Tightness of the chest with associated respiratory wheeze and shortness of breath.
Cough becomes productive, the sputum being yellow suggestive of live neutrophils or green suggesting dead neutrophils.
Mild fever
Crackles heard upon auscultation (in bronchi region about T5)

Question 20

What is chronic bronchitis

Answer 20

Productive cough on most days for at least 3 months of the year for more than one year.

Inflammation of the bronchus and bronchioles leading to enlargement of mucous secretion glands which can block airways and only cleared by patient coughing the obstruction up.

Blue and bloated
May not appear breathless but will be even after minimal effort.
May have pitting Odema.
If hypoxia is severe then levels of consciousness may be decreased.

Question 21

What is ACVPU?

Measure levels of conscious

Answer 21

A - alert
C - new confusion
V - verbal (you as a paramedic talking to your patient e.g. hello can you hear me
P - pain. Only allowed to illicit pain - give pain response to two areas. Trapezius muscle you can pinch this or the ear lobe.
U - unconscious

Question 22

Typical bronchitic patient

Answer 22

Airway flow problem due to mucous and inflammation
Cyanosis (blue colour)
Recurrent cough and sputum production
Hypoxia
Respiratory acidosis. 
Increased haemoglobin level - as body is trying to increase oxygen carry. Even though no oxygen to carry but doesn’t realise.
Exertional dyspnea. 
Ask history of smoking 
Digital clubbing 
Increase respiration rate 
Cardiac enlargement
Use of accessory muscles to breathe
Can lead to right sided heart failure and then bilateral pedal edema.

Question 23

What is emphysema?

Answer 23

Distension of the alveoli and destructive changes in their membranes. (Get larger and break open, so lose their large surface area which they need for gas exchange).

Question 24

Emphysema stimulus to breathe

Answer 24

Not normally cyanotic
Hypoxia is still the driving factor of the respiratory system.

Our stimulus to breath is high levels of c02. Emphysema patients have to recognise low levels of 02 instead to start breathing. So only give 28% oxygen (normally) as if we were too give them too high oxygen the body wouldn’t recognise that they need to breathe as not detecting low levels of 02.

Question 25

Emphysema signs

Answer 25

Breathe out through pursed lips Thin Normally maintain colour as still diffusion still happening unlike bronchitis. Tachycardia (fast HR above 100) Tachpnoea (fast respiration rate e.g. more than 20 per min Dyspnoea Blood pressure elevated Use of accessory muscles with difficulty healing Maybe cyanosis in acute attack Confusion Abnormally large chest Oedema Cardiac dysrhythmias may be evident on ECG. Elderly Hyper resonance on chest percussion

Question 26

Treatment/management of COPD

Answer 26

SCENE/SMART - scene safety, mechanism of injury, airway?, triage Ensure open airway, use suction if neccessary. Follow JRCALC UK ambulance services clinical practie guidelines oxygen administration. Aim for oxygen saturation 88-92% Consider salbutamol for wheeze or exacerbation Consider ipratropium bromide Place or allow patient to be in most comfortable position to aid breathing. Be prepared to assist ventilations or full CPR. calm patient to maintain and reduce effort of breathing Document everything that you do Hypoxia presents a greater risk than hypercapnia. Do not withold high conc 02 from a COPD patient who needs it.

Question 27

What is the hypoxic drive theory

Answer 27

In some patients the respiratory centre may be relatively insensitive to c02 and respiration is driven by hypoxaemia.

Question 28

What is asthma?

Answer 28

One of the most common medical conditions Acute episodes (short lived reversible) can be brought on by many factors such as infection, environmental factors and hyperactive airways responding to inhaled irritants. Most calls occur when patients own attempts haven’t worked.

Question 29

What happens with asthma

Answer 29

Chronic airway inflammation and increased hyper responsiveness Inhalation of allergen leads to spasm and bronchi constriction Increased bronchial mucus production (goblet cells) Swelling of the mucosal cells that line the bronchioles

Question 30

Asthma signs can be divided into

Answer 30

Moderate asthma exacerbation Acute or severe asthma attack Life threatening asthma attack

Question 31

Moderate asthma

Answer 31

Increasing symptoms Peak flow >50-75% of best/predicted No features of severe asthma attack

Question 32

Acute/severe asthma

Answer 32

Unable to complete sentences in one breath Respiratory rate >25% in adult and pulse rate above 110BPM Peak flow 33% -50% of best/predicted

Question 33

Life threatening attack

Answer 33

``` Exhaustion Bradycardia Hypotension Peak flow <33% SPO2 less than 92% Cyanosis Confusion Silent chest ```

Question 34

Asthmatic patients are often prescribed two types of medication

Answer 34

Prevent - Anti inflammatory drugs includimg steroids. Include beclomethoasone and fluticasone. Work on smooth muscle and with regular work can eradicate symptoms. Relievers - drugs such as salbutamol, terbutaline, titropium and ipatropium bromide. These work rapidly on bronchi and bronchioles to relax smooth muscle.

Question 35

Asthma management

Answer 35

Scene/smart Open airway Position patient upright 02 as per JRCALC adrenaline 1:1000 in life threatening asthma as per JRCALC nebulised salbutamol as per JRCALC nebulised ipratropium bromide as per JRCALC Try to achieve SP02 levels >94% Calm patient Remove possible intrinsic/extrinsic causes Be prepared to assist ventilations or full CPR Document all interventions and basic observations Rapid transportation.

Question 36

Asthma standards

Answer 36

Need to record respiratory rate - no exceptions to this Need to record peak flow (not doing this at the moment) Need to record SP02 (before treatment) Salbutamol administered Oxygen administered

Question 37

Signs and symptoms of airway obstruction

Answer 37

Productive cough (green/yellow sputum) Cyanotic Disponea Etc.

Question 38

Impaired perfusion if alveoli

Answer 38

Many conditions cause gas exchange between alveolus and pulmonary blood capillary to become restricted.

Question 39

Pneumonia

Answer 39

Inflammatory condition if e lung, especially of the alveoli,. Usually cause by a range of bacteria Either localised, such as when whole or one love is affected or diffuse when they primarily affect the lobules of both lungs, often in association with the bronchi and bronchioles

Question 40

Pneumonia clinical features

Answer 40

Varies according to the immune state of 5e patient and the infecting agent Often a preceding history of a viral infection with the patient rapidly becoming ill with a high temp up to 39.5 degrees cel, pleuritic pain and a dry cough which develops a day or two later into rusty coloured sputum. The patient breathes rapidly and shallowly >30 BPM. The affected side of the chest moved left and signs of consolidation may be present with hypo-resonance.

Question 41

Pleurisy

Answer 41

Inflammation of the pleural lining which leads to the drying up of serous fluid found between the pleura. Often occurs in conjunction with pneumonia Symptoms includ sharp chest pain, worse on breathing and movement and a dry cough. May be relieved through shallow breathing. But this means wont be able to remove bacteria on chest Pleuritic rub may be heard upon auscultation over the affected area.

Question 42

What is pulmonary embolism?

Answer 42

Blood clot that sits in the pulmonary artery. Prevents blood from going to get oxygenated. Blockage of artery in the lungs by a substance that has travelled from elsewhere in the body via the blood stream (embolism). Symptoms include pain, shortness of breath, sometimes coughing up blood.

Question 43

Risk factors

Answer 43

``` Extended travel Prolonged bed rest Obesity Oral contraceptives Varicose veins - blood sits and gets stale and clots Surgery of throat, abdomen, pelvis and legs Fractures of pelvis and legs Diabetes Trauma Pregnancy ```

Question 44

Pulmonary embolism

Answer 44

Lungs ventilated but not perfused Right heart failure as trying to bump blood heard

Question 45

Things to look for in PE

Answer 45

``` Dyspnoea Pleuritic chest pain Tachypnoea Pleural rub Hyporesonance upon percussion ``` In big PE Severe chest pain, evidence of shock, pale, sweaty, tachycardia and tachypnoea, absent breath sounds, syncope,

Question 46

Management of a PE

Answer 46

``` Scene/smart Open airway Administer oxygen at high flow rate Cardiac monitor Prepare to ventilate or perform CPR monitor Document ```

Question 47

What is tuberculosis?

Answer 47

Is the worlds leading cause of death from a sunken infection disease, resulting from Inadequate programs for infection control Multiple drug resistance Co-infection with HIV rapid rise in young adult population Often symptomless Lymph node enlargement can suppress the bronchi leading to collapse of segments or lobes of the lungs

Question 48

Features of TB

Answer 48

Patients may complain of aching chest Pleural effusion or pneumonia Finger clubbing

Question 49

Industrial lung diseases

Answer 49

``` Disease as a result of work E.g. Coal dust (pneumoconiosis) Silicosis (quarry dust) Asbestosis Byssinosis (cotton, flax and hemp fibres) ``` Symptoms: Cough, sputum (quality, colour, any solid material in there, taste or smell)

Question 50

What Is hyperventilation syndrome

Answer 50

A rate of breathing that exceeds metabolic needs and higher than that required to maintain normal c02 levels in the blood. It can occur in a number of life threatening sistuations including PE, asthma, diabetic ketoacidosis Also anxiety and stress

Question 51

Signs of hyperventilation syndrome

Answer 51

``` Acute anxiety Tetany (cramps including sharp bending of wrists and ankle joints) Numbness and tingling of mouth and lips Aching*of chest muscles Light headed ```