Respiratory Disorders Flashcards
What’s a pulmonologist?
Physician that deals with diseases involving respiratory tract
What’s a respiratory therapist?
Health care discipline that promotes optimum cardiopulmonary function and health and wellness.
What’s in respiratory therapist scope of practice?
Application and monitoring of
medical gases, mechanical ventilator support, artificial airway care, bronchopulmonary hygiene, pharamacological agents related to respiratory care procedures,
CArdiopulmonary rehab
Hemodynamic cardiovascular support
What’s intubation
Can be nasal or oral tracheal
Called endotracheal tube regardless
When are patients intubated
Typically done when patient unable to protect or maintain their own airway.
Need to have a ventilator to assist with breathin
What’s a tracheostomy
surgical procedure to create an opening through the neck into the trachea.
Tube placed through this opening to provide an airway and remove secretions from lungs
What are reasons for tracheostomy
To bypass an obstructed upper airway and go straight to lower airway.
If lungs need to be continually cleared of secretions
If patient needs lots of oxygen all the time
What health problems may require trach?
Tumors Laryngenctomy (if portion of larynx removed) VF folds paralyzed in close position Congenital abnormalities Severe neck or mouth injuries chronic pulmonary disease diaphragm dysfunction anaphylaxis (severe allergic reaction) neuromuscular disease
Where trach insertion
Cut hole into tracheal ring and placed below the level of the vocal folds
What are materials for trach construction?
Metals=silver and stainless steel
Plastic=polyvinyl chloride, silicone
How do we determine trach size according to International Standards Organization?
The inner and outer diameter. Outer diameter tells us if we can fit a passy-murer valve.
Inner diameter is tube size identifier.
Trach must be size 6 for PM valve.
What happens if ID is too small?
Increase airway resistance, makes suctioning more difficult, increased pressure required to seal trache cuff
What happes if OD too large?
Affects the ability to use upper airway with cuff deflation
Difficult to pass through the stoma
What are the advantages of cuffs?
If on ventilator MUST have cuff. Makes for easier positive pressure in ventilation.
Some protection from aspiration as it will catch secretion.
What are challenges of cuff
Can cause tracheal wall damage.
Occupies a larger percentage of the airway
Pressure monitoring mandatory (fenestrated might help with this)
What’s a fenestrated trach tube
The tissue agains mucosal wall of trach can grow in fenestration.
Provide more airflow to VFS.
Decreased work of breathing.
Issues with fenestrated trach
Plug easily and granulation potential too
How to liberate (wean) from tracheotomy
Cautious sequential approach to assess work of breathing. The more work
First simple finger occlusion>One way speaking valve>Plug
What’s the key issue with liberation?
WE want to assess work of breathing. How hard do they work to breathe when we wean? The larger a tube the less WOB but more difficult liberation
What does a Passy Muir valve do
Redirects outward airflow through vf folds.
What causes increased aspiration risk in trach individuals?
Decreased laryngeal elevation, esophageal compression, loss of upper airway sensitivity, loss of normal laryngeal closure during swallow.
Some research to suggest there’s not a causal relationship between trachs and aspiration.
What conditions put people on ventialtion?
You have Apnea, acute ventilatory failure, impending failure (have ALS). Refractory hypoxemia (COPD)
What’s purpose oventilation?
Life support, it does the work of breathing for you. Ventilator is a pump.
What are non-invasive positive pressure ventiltation devices?
adminster ventilatory support without using an invasisve artificial aiirway.
Candidates for non-invasive positive pressure
People who Can breathe on own, but need little bit of support at times. Decrease work of breathing without artificial airway
What are types of Non-inva
CPAP
CPAP
provides constant stram of air pressure to keep upper airway open
Waht’s BiPa
PRovides different lvels of air pressure. Increased pressure during inhalation, lower during exhalation.
What conditions use non-invasives?
Obstructive sleep apnea, COPD exacerbation, Neuromuscular disorders (ALS), acute congestive heart failure. Acute lung injury
