Respiratory Emergencies Flashcards
In which position should you place a patient for auscultation?
Sitting upright.
Can you or can you not auscultate over clothing?
You should NEVER, always auscultate over bare skin
Describe the sounds of wheezing
Weezing is a high pitched musical whistling sound that is best Heard initially on exhalation , but can also be heard during inhalation in more severe cases
What Is weezing an indication of?
It is an.
Indication of swelling and constriction of the inner lining of the lower airways primarily the bronchioles.
What should you administer if weezing is diffuse? (Heard over all the lung fields)
You should administer beta 2 agonist medication by meter dose inhaler, or by small volume nebulizer.
In which conditions is wheezing typically heard in
Asthma, emphysema, chronic bronchitis.It could also be heard in Pneumonia congestive heart failure or other conditions when they cause bronchoconstriction
What happens with severe obstruction of the lower airways in relation to wheezing
Severe obstruction of the lower airways can cause wheezing to become much more diminished or absent because the velocity of the air movement through the bronchioles is no longer sufficient to produce the wheezing sound.
Describe how rhonchi sounds like
Also referred to as coarse crackles on auscultatation. They are snoring or rattling sounds.
What does rhonchi indicate?
Obstruction of the larger conducting airways of the respiratory track by thick secretions of mucus.
In which conditions can you typically hear rhonchi
Chronic bronchitis , emphysema , aspiration and pneumonia.
What is a unique characteristic of rhonchi
The quality of sound changes if the person coughs. Or sometimes when the person changes position.
Describe how crackles sound
Also known as rails, they are bubbly Or.
Bubbly sounds Heard during inhalation.
What is crackles an indication of
Fluid that has surrounded or filled the Aveoli or small bronchioles
What?
Are the crackling sounds commonly associated with?
Alveoli and terminal bronchioles popping open with each inhalation
What condition can crackles indicate
Pneumonia or pulmonary edema.
What are the 3 most commonly encountered obstructive pulmonary diseases?
Emphysema, chronic bronchitis and Asthma.
What is emphysema characterized by
The destruction of the alveolar walls and the distention of the alveolar sacs and a gradual destruction of the pulmonary capillary beds with a severe reduction in the alveolar and capillary area in which gas exchange can occur.
Emphysema is more common in which age group and which gender?
Men and also people who are 60 to 70 years of age.
Patho of emphysema
The lung tissue loses its elasticity. The alveoli become distended with trapped air and the walls of the avioli are destroyed. Loss of aviola wall reduces the surface area in contact with pulmonary capullaries.Therefore, a drastic disruption and gas exchange occurs and the patient becomes progressively.Hypothesimic and begins to retain carbon dioxide. Loss of alveolar wall reduces the surface area in contact with pulmonary capillaries. Therefore, a drastic disruption and gas exchange occurs and the patient becomes progressively. Hypoximic and begins to retain carbon dioxide.
Why do some patients with emphysema purse their lips?
To create positive end expiratory pressure (basically just know it helps them keep the bronchioles open)
Emphysema patients hyperventilate in order to…
Keep the blood levels maintained at a relatively normal level
S/S of emphysema
Anxious, alert, and oriented
• Dyspneic
• Uses accessory muscles
• Thin, barrel-chest appearance from chronic air trap-
ping in the alveoli causing the anterior-posterior
diameter of the chest to increase
• Coughing, but with little sputum (the material that is
coughed up)
• Prolonged exhalation (due to loss of elasticity of lungs)
• _Diminished breath sounds (indicating poor air
Amovement)
• Wheezing and rhonchi on auscultation
• Pursed-lip breathing (physiologic PEEP)
• Extreme difficulty of breathing on minimal exertion
• Tachypnea-breathing rate usually greater than
20 per minute al rest
• Tachycardia (increased heart rate)
• Diaphoresis (weating; moist skin)
• SpO, of 94% or greater unless in respiratory failure
* Tripod position (review Figure 16-1
• May be on home oxygen
What is chronic bronchitis characterized by
A productive cough that persists for at least three consecutive months a year for at least Two consecutive years
Patho of chronic bronchitis
Inflammation, swelling and thickening of the lining of the bronchi and bronchioles and excessive mucus production.The aveoli remain unaffected by the disease.However, however, the inflamed and swollen bronchioles and thick mucus.Restrict air flow to the aveoli , so they do not expand fully.
S/S of chronic bronchitis
Cough (hallmark sign) is prominent: vigorous cougl
ing produces spulum
• Typically, overwcight, with prominent peripheril edema
and chronic jugular vein distention
• Chronically cyanotic complexion (As already noted
chronic bronchitis patients were often called “blue
bloaters,” but this is outdated because many COPD
patients don`t conform to the description,)
• Minimal difficulty in breathing and anxiety, unless in
respiratory ilure
• Spo, reading of <94%, indicating chronic hypoxemia
• Scattered rales (cracklest and coarse rhonchi usually
heard upon ausculttionof the lungs
• Wheezes and, possibly, crackles a the bases ol the lungs
• Asterixis (lapping of the extended wrists) may be
seen in respiratory failure
Emergency medical care for emphysema and chronic bronchitis (COPD)
Ensuring an open airway and adequate breathing position of comfort administration of supplemental oxygen if necessary.
Perhaps even an metered dose inhaler or small volume nebulizer.
What drive can COPD patients develop
Hypoxic drive, which means. Since the body normally responds to increasing levels of carbon dioxide to stimulate breathing, but in this drive, the hypoxic drive, the body responds to low levels of oxygen in the body to stimulate breathing.
The best O2 range for COPD patient is what?
88%-92% (use nasal cannula staring at 2 lpm but rising up to 6lpm)
You should use CPAP in an COPD patient if…
There is moderate to severe dyspena with the use of accessory muscles and paradoxal abdominal movement, or the respiratory rate is greater than 25 per minute.
CPAP should be delivered at a rate of….
5 to 10 cm H²0 but if the patient’s condition continues to deteriorate, remove CPAP and begin BVM (Bag value mask) ventilation
Patho of asthma
Characterized by an increased sensitivity of the airways to irritants and allergens, causing bronchospasm which is a diffuse reversible narrowing of the bronchi and bronchioles as well as inflammation to the lining of the lower airways.
List of three factors at increase resistance to airflow difficulty in breathing according to asthma
Bronchial spasm , which is the construction of the smooth muscles in the bronchioles And edema which is swelling of the inner lining in the airways and increased secretion of mucus that causes plugging of the airways
Is what is acute severe asthma or status astbmaticus?
A prolonged life, threatening attack that produces inadequate, breathing and severe signs and symptoms.
Should we or should we not administer O2 to acute severe Asthma?
Yes but the patient does not respond to either O2 or medication therapy. And you should transport the patient immediately.
What are the two types of asthma
Extrinsic asthma or allergic asthma usually results from a reaction to dust Smoke or other irritants in the air..
Intrinsic asthma , which occurs due to infection , emotional stress, or strenuous excerise
S/S of asthma
Dyspnea (shortness of breath); can progressively
worsen, (Dyspnea perception is different for patients
and is not related to the degree of bronchoconstric.
tion, swelling, and airway resistance.)
• Cough. Olten begins carly and can be the only sign or
symptom of an asthma attack, especially in elderly; a
cough can be productive and olten worsens at night.
• Wheezing on auscultation (typically expiratory). Can
become diminished or absent with a severe reduction
in airflow in the bronchioles.
• Tachypnea
• Taichycardia (A heart rate greater than 120 bpm with
lachypnea often indicates a severe asthma attack.)
• Lse of accessory muscles
• Diaphoresis secondary due to an increase in the work
of breathing; if profound it is usually accompanied by
a decreasing level of agitation and altered mental status
• Anxiety and apprehension
• Speaks in sentences (mild), phrases (moderate), or
only words or syllables (severe)
• Possible fever (This can be triggered by an upper
respiratory tract infection, )
• Chest tightness
• Inability to sleep; dyspnea often worsens at night
(indicates poor asthma sympiom control)
SpO2 <94%
Symptoms of gastroesophageal reflux
• Pulsus paridoxus (drop in systolic blood pressure of
>10 mml lg during inhalation) indicates a severe asthma
auack. This can be detected when the pulse amplitude
decreases or the pulse is completely abolished during
inhalation but retumns on exhalation
• Reduction in the`peak expiratory flow rate (PEFR) is
often measured regularly by asthmatics on mainte-
nance therapies
Eighty percent of all asthma cases have a slow onset
True
Indicators of a critically ill Asthma attack patient are:
Upright positon
• Signs and symptoms of severe respiratory distres
• Tachypnea (520/minute and olten >40/minute.
• Tachveardia (usually >120 bpm)
• Pulsus paradoxus (a drop in systolic blood pressure
ol 10 mmllg or more on inhaling)
• Pale, cool skin with diaphoresis
• Accessory muscle use
Specch in single words or syllables
• Wheczing absent due to severe bronchiole obstue-
tion and minimal airflow
* Decreasing consciousness and bradypnea indicating
severe hypercarbia and the progression from respira-
tory distess to impending respiratory failure
15
• Extreme fatigue or exhaustion; the patient is too tired
to breathe
“ SpO, <90% while on supplemental oxygen
What rate should you provide CPAP to an severe asthma attack?
10-12 times per min adult
Beta 2 should be administered in an asthma patient to
Reverse bronchoconstriction
Patho of Pneumonia
Is a acute infectious disease Is cause by bacterium or a virus Is that effects the lower respiratory track and causes Lung inflammation and fluid or pus filled aveoli. This leads to ventilation disturbance in the aviola with poor gas exchange hypoxemia and eventual cellular hypoxia
S/S of Pneumonia
Malaise and decreased appetite
• Fever (may not occur in the elderly)
• Cough (might be productive or nonproductive)
• Dyspnea (less frequent in the elderly)
○ Tachypnea and tachycardia
• Chest pain (sharp and localized and usually made
worse when breathing deeply or coughing)
• Decreased chest wall movement and shallow
fespiralions
Splinting of thorax by patient with his arm
• Crackles, localized wheezing, and rhonchi heard on
auscultation
• Altered mental status, especially in the elderly
• Diaphoresis
• Cyanosis
* SpO, <94%
Emergency medical care for Pneumonia patient
No different from any patient.Having difficulty in breathing and sure the patient has adequate or ventilation. Administer supplemental oxygen via nasal canula at two liters per minute and titrate upward to establish and maintain an s b 02 have ninety four percentAdminister supplemental oxygen via nasal canula at 2 l per minute and titrate upward to establish and maintain an SP02 have 94%.
Patho of embolism
Pulmonary embolism is a sudden blockage of blood flow through a pulmonary artery or one of its branches.The embolism is usually caused by a blood clot, but it can be caused by a air bubble.A fat particle, a foreign object.Or an amniotic fluid. The blockage prevent blood from flowing into the lungs.
Suspect pulmonary embolism in any person with a sudden onset of unexplained dyspnea and chest pain typically sharp and localized to a specific area of the chest.
True
S/S of pulmonary embolism
Sudden onset of unexplained dyspnea
• Signs ol dilliculty in breathing or respiratory distress:
rapid breathing
• Sudden onset of sharp, stabbing chest pain predomi
nantly during inhalation
• Cough (might cough up blood)
• Tachypnea
• Tachycardia
• Syncope (fainting)
• Cool, moist skin
• Restlessness, anxiety, or sense of doom
• Decrease in blood pressure or hypotension (late sign)
• Cyanosis (might be severe) (ate sign)
• Distended neck veins (late sign)
• Crackles
• Fever
• SpO, <94%
Signs of complete
Circulatory collapse
Describe cardiogenic edema
Typically related to an inadequate pumping function of the left, Ventrical Is that drastically increases the pressure in the pulmonary capillaries
Describe non cardiogenic e dema
Results from the destruction of the capillary bed that allows fulid to leak out
Patho of acute pulmonary edema
Caused by a cardiogenic etiology occurs when an excessive amount of fluid collects in the spaces between the aveoli and the capillaries. This intrusion of fluid distrubs normal gas exchange by reducing the capability of oxygen and carbon dioxide to diffuse across the aveolar capillary surface because of the collection of water, both in the aveoli and between the alveoli and capillaries, which makes less oxygen available to. The blood flowing through the capillaries.
Use CPAP for acute pulmonary edema
True
S/S of acute pulmonary edema
Dyspnea, especially on exertion
◦ Dilliculty in breathing when lying flat (orthopnea)
◦ Waking up suddenly short of breath (paroxysmal noc-
turnal dyspnea also known as PND)
• Pink and/or frothy sputum (cardiogenic cause only)
• Tachycardia
• Anxiety, apprehension, combativeness, and conlusion
• Tripod position with legs dangling
• Fatigue
• Crackles and possibly wheezing on auscultation
• Cyanosis or dusky-color skin
• Pale, moist skin
• Distended neck veihs (cardiogenic cause only)
• Swollen lower extremities (cardiogenic cause only)
• Cough
•Fever
• Symptoms of cardiac compromise (cardiogenic Cause
only)
* SpO, <94%
Emergency medical care for acute pulmonary edema
Begin CPAP With a BVM and provide oxygen. Apply CPAP to patients which can maintain their own airway, GCS > 10, and have an SpO2 of > 94%
Sympathetic Crashing Acute Pulmonary Edema (SCAPE) patho
It is a sudden onset Pulmonary Is edema caused by an increase in sympathetic nerveous system output. This causes a systemic vasoconstriction, causing blood to be shunted to the core of the body, resulting in hypertension and an increase in the pressure in the aorta and arteries. This sudden increase in after loading. High resistance in the aorta makes the heart’s ability to pump the blood out less effective. Fluid begins to build up in the area between the aveolus and the capillary, where gas exchange occurs, not allowing for appropriate oxygen diffusion.
