Respiratory Emergencies Flashcards
Intrinsic risk factors
Genetics
Circulatory problems
Sedentary lifestyle
Extrinsic risk factors
Smoking
working conditions
environmental
Goal of respiratory emergencies
correct hypoxia
angle of louis
external landmark of the biforcation (carina) of the bronchus
Alvioli
- Functional unit of respiratory system
- 300 million in both lungs
- 1 cell thick and connected to blood supply
- air passes through diffusion
- Damage to alveoli decreases surface area which will decrease area of resp.
- Coated with surfactant to prevent collapsing
Layers around the lung
Visceral pleura- lays on the lung
Parietal pleura- lines the pleural space
Atmospheric pressure
14.7psi
Inspiratory reserve
3000ml
Expiratory reserve
1200ml
Residual volume
1200ml
Peak flow
maximum rate of air flow during a force expiration
COPD primary chemoreceptors
Peripheral chemoreceptors
Peripheral chemoreceptors
- Located in the carotid/aortic bodies
- Back up system, when patient has chronic high C02 levels - hypoxic drive
- Respond to low levels of 02
- Increased 02 levels decrease rate, depth etc.
BOHR EFFECT
An effect by which an increase of carbon dioxide in the blood and a decrease in pH results in a reduction of the affinity of hemoglobin for oxygen.
Apnea
not breathing
Orthopnea
Fluid filling the lungs when laying down
Dyspnea
Difficulty breathing
Tachypnea
rapid breathing
Cheyne Stokes
rapid breathing with periods of apnea
Hyperventilation
more rapid than normal
Kussmaul
(diabetic ketoacidosis)
Deep, rapid breathing
PND (Paroxismal nocternal dyspnea)
more difficulty breathing at night
Rales
bubbles in water
Rhonchi
hair folicles rubbed together
Diminished
abcde
Silent
Movement but no sound (very bad)
ARDS
Complications from trauma, toxins, aspiration, infections, O.D’s
Result in a increase in capillary permeability, stiff lungs and decrease pulmonary capacity
Seen in post injury or illness
Is managed with PEEP and corticosteroids
Blue bloaters (smokers)
-Altered ventilation - perfusion relationships in lungs
-Hypoventilation/Hypoxemia (↓ lung capacity, ↑ residual volume with air-trapping)
-Polycythemia (more RBC’s)
Increased CO2retention
Rt. side CHF
Overweight
PRODUCTIVE COUGH*
Short & stocky body build
Rhonchi sounds in lungs
EMPHYSEMA pathophysiology
Loss of elasticity within alveoli
Resulting in enlargement of alveoli sacs
Leads to destruction of alveoli and failure of supporting structures to maintain alveolar integrity
Reduction of elasticity leads to the trapping of air in alveoli
Emphysema leads to?
Pulmonary hypertension
Right sided CHF
Cor pulmonale—hypertrophy of Rt. Ventricle
Polycythemia(more RBC’s)
Emphysema s/s
Pink puffers caused by
Decreased Pa02 which produces more RBC’s
High hematocrit levels
Barrel chest: excessive chest muscle use to breath, increase in the anterior/posterior chest diameter
Thin and emaciated looking due to increase caloric need to breath
Pursed lip breathing
Prolonged & rapid respiratory rate
Acute s/s of emphysema
- Acute onset brought on by number of reasons, causes exacerbation of disease
- Tripod breathing
- Accessory muscle use
- Dry or productive cough
- Wheezes or rhonchi
- Prolonged expiratory phase
- Associated sx/sx tachycardia, diaphoresis, cyanosis, irritability, confusion, drowsiness, cardiac problems
- Low SAO2
- Central site vs peripheral site
Asthma
Life long asthma
Increased incidence of death after age 45
Causes of Asthma
Extrinsic (more common in children, improves with age)
“Non-allergic” Inhaled allergen Cold temperature Vigorous exercise Emotional stress
Causes of Asthma
Intrinsic (more commonly as adult)
Infection ASA, ibuprofen Beta blockers (inhibits beta so alpha stimulation takes place) Exposure to smoke, fumes Psychological stress
s/s of Asthma
Smooth muscle contraction
Increased secretion of mucus
Inflammatory changes in the bronchiole walls
Alveolar hypoventilation and marked ventilation-perfusion mismatch leading to hypoxia and C02 retention.
Increased air resistance leads to air trapping due to hyperventilation of alveoli.
s/s of asthma
Dyspnea—measure in words
Cough
Bronchospasm
-Wheezes
-Quiet chest
*So tight there are no lung sounds
*Ominous sign because of lack of air movement.
Accessory muscle use
-Subclavicular in-drawing
Pulsus paradoxus
Tachycardia
Low pulse ox
Hypoxia and fatigue
Associated s/s
-diaphoresis, tachycardia, unable talk
Abnormal capnography - shark fin shape
Peak airway flow rate
Special questions
-Hx of intubation/hospitalizations
Usual treatment
-Frequency of inhaler use, other meds and infectionStatus Asthmaticus
Severe prolonged asthma attack
Key point: Cannot be broken with normal routine medication use
Same as other asthma attacks except more rapid onset and patient in life threatening situation.
Rapid transport with Rx enroute.
s/s hyperventilation
Carpal/pedal spasms - due to relative hypocalcemia
Cystic Fibrosis
Inherited disorder of exocrine glands
Cause abnormal secretions of thick mucous which plugs bronchi and GI tract
Fatal disease with life expectancy of avg. 22-28 years
Associated chronic bronchitis, sinusitis, emphysema and respiratory failure
Rx per Sx & Sx
PE Patho
- Blockage of pulmonary artery by thrombus, embolus or other foreign matter
- Results in partial or complete collapse of lung
- Can limit left heart return resulting in decrease cardiac output and obstructive shock
- Most common cause is thrombus
PE causes
Venostasis-bed rest, traveling, age, burns, obesity, varicose veins
Venous injury - Fx or surgery
Increased blood coagulation
Pregnancy - post partum
Disease - COPD, CHF, AFib, MI, Infection
Multiple trauma
BCP - estrogen in pills increase clotting factors
PE s/s
Dyspnea, low SA02 Tachypnea Obvious labored breathing Chest pain Cough Hemopytsis Diaphoresis Hypotension Tachycardia, JVD
Myasthenia gravis
Gradual muscular weakness
- eyes
- throat
- mouth
Gullian Barre
Progressive weakness of lower extremities which moves up body into chest leading to inability to breath. Is self limiting
ALS
*Progressive muscular weakness
Eventually affects respiratory muscles and pt quits breathing
Terminal Disease
Spontaneous Pneumothorax
Partial to complete collapse of the lung as a result of a ruptured bleb on the pleural lining of the lung
- Sudden onset of SOB
- Decrease or absent lung sounds
- Cough
- Sharp chest pain which may be referred to shoulder
Spontaneous Pneumothorax
COPD history
Young, tall, white male adults
Congenital bleb ( on lung
May be precipitated by sneeze or forceful cough
Atelectasis
Partial collapse of lung due to incomplete expansion, obstruction of airway or lung tissue
S/S of Atelectasis
Absent or diminished breath sounds SOB Mucous plugs Excessive secretions Foreign body obstruction Splinting respirations with poor lung expansion
Laryngospasm
Spasm of the muscle in larynx resulting in partial or total airway obstruction
S/S of Laryngospasm
Stridor or air hunger Accessory muscle use Cyanosis Decreased LOC Apnea
causes of Laryngospasm
Upper airway inflammation (smoke inhalation)
Foreign body
Trauma
Near drowning
Pleurisy
Inflammation of the pleura
May or may not have effusion (fluid in pleural space)
Pain due to pleural linings (pleura) rubbing
May hear friction rub with respirations
s/s of Pleurisy
Sharp pain in chest or back, referred to shoulder Fever Dyspnea Tachycardia Diaphoresis Pain increases on inhalation
Pneumonia
Most commonly unrecognized respiratory emergency in field
Acute inflammation of respiratory bronchioles
Spread by droplet
Viral or bacterial
Pneumonia s/s
Chest pain
Flu-like symptoms
Rales? or other lung sounds
May have wheezes
Legionnaires Disease
Acute bacterial infection
Causes pneumonia
Patients die from complications of renal failure and respiratory failure
Tuberculosis
Airborne disease transported by droplets
TB bacilli enter body and multiply, they usually affect the lungs but infect any part
Most commonly seen in homeless, migrants, immunilogically suppressed or jailed
*MASK THESE PATIENTS!
Vocal Cord Dysfunction Syndrome
swell or dilate for no reason
Infrared light pulse ox
SaO2
Red light Pulse Ox
SpO2
normal SAT
95-99
Mild hypoxia
91-94
Moderate hypoxia
86-91
Severe hypoxia
85%
Bronchodilators
Terbutaline (Brethine)
Metaproterenol (Alupent)
Albuterol (Proventil, Ventolin)
Isotherine (Bronkosol)
Corticosteroids (anti-inflammatory)
Solu-medrol
Vanceril
Azmacort
Aerobid
Oral or injected respiratory meds
Theophylline (theodur,slo-bid,theo-air)
Popular before inhalers
Prevents certain cells lining bronchi (mast cells) from releasing chemicals, such as histamines
Inspection
Assess for injury Check Anterior & Posterior diameter Accessory muscle use Rate, rhythm and equality of breathing Skins, JVD, edema
Palpation
Stress the skeletal structures
Check for SQ emphysema
Crepitus
Auscultation
Patient position Sitting upright Slightly forward Shoulders rounded Check equipment Tap dial to check One for heart tones, one for lung sounds
Muffled heart tones
- Soft and distant sounding
* Due to excessive fluid or blood in pericardial sac
