Respiratory Emergencies Flashcards
Lungs fail to work
Carbon Dioxide accumulates in the blood. Co2 combines with water to form hydrogen ions. Resulting in acidosis.
Impaired Bentilation Causes
Upper Airway Obstruction- foreign body, infection, trauma
Lower Airway Obstruction- disease, mucus, edema
Chest Wall Impairment- flail chest, pneumonia, restrictive (scoliosis)
Neuromuscular Impairment- Lou Gehrig disease, OD
Guillain Barre Syndrome
Progressive muscle weakness and paralysis move from the feet up.
Pickwickian Syndrome
Obesity hypoventilation syndrome
Serious injury to the spinal cord above _____ may…
above C5 may block the nerve impulses that stimulate breathing
Botulism
Rare.
Acquired by giving infants raw honey.
Can cause muscle paralysis and ultimately hinder breathing
Alcohol, Narcotics and Opiates
Reduce the respiratory drive
Hyperventilation
Creates alkolosis
Hypoventilation
Creates acidosis
Respiratory Alkolosis
Cause numbness and tingling in the hands, feet and mouth
Carpopedal Spasm
Hands and feet clinch like a claw due to hyperventilation
Why breathing into bag is bad
1) rebreathing too much carbon dioxide can cause hypoxia
2) may be compensatory and does not need to be fixed
Causes for hyperventilation
Stressor such as a family fight, or bad news.
Psychological Support for hyperventilation
Breathing with the patient
Count to two between breaths
Talk to the patient
Sing a song
Turbinates
Highly vascular
Mucus covered that traps particulate matter
Large surface area allows air to be warmed and humidified
Angiodema
Vascular reaction characterized by swelling of eyes, lips, rounded and mouth
Hypopharynx
Where Oro and nasopharynx meets
Gag reflex
Vagus nerve
Larynx
Voice box
Glottis
Vocal cords
Arytenoid cartilage
Two pearly white lumps at distal end of vocal cords
Pyriform Fossa
Pockets of tissue on sides of glottis
Cilia
Small hairlike structures that wave in a pattern to move particulate matter up and out of the airway
Block Spots in lungs
Food or objects that were inhaled and become permanently lodged within lung
Goblet cells
Line the irways
Produce mucus that blankets lining of airway
Gas Exchange
Process by which deoxygenated blood from the pulmonary circulation releases carbon dioxide and is resupplied with oxygen before entering cardiac circulation
Alveolar Cell Types I and II
Type 1- (pneumocystis) are empty and allow for better gas exchange
Type 2-make new type 1 cells and produce surfactant
Surfactant
Reduces surface tension and helps keep alveoli expanded
Shunt
Collapsed alveoli do not participate in gas exchange. Blood from right side of heart bypasses alveoli and returns to left side unoxygenated resulting in hypoxemia.
Polycythemia
Thick blood
COPD patients generate a surplus of RBC’s that cause strain on right side of heart due to the blood trying to push through tiny capillaries
Cor Pulmonale
Right sided heart failure because of chronic lung disease
Dead Space
Left over gas in airway. (1ml of dead space per pound)
Restrictive Lung Diseas
E.g kiphosis, loridosis, scoliosis
Limits air movement
Respiration
Oxygen is taken into the body, distributed to the cells, and used by cells to make energy
Ventilation
Movement of air in and out of the lungs
Diffusion
Movement of oxygen from interstitial to alveoli for use
Perfusion
Circulatory component of respiratory system
Hearing Breuer Reflex
Regulates depth of inspiration to not overinflated the lungs
Negative Pressure
Air sucked into lungs and then pushed out
Exhalation
Passive process
Sternum Rib retrations
Often present in children and infants causing bony retrations
Wheezing
High pitched whistling made by air forced through narrow airway (asthma, CHF, or foreign body)
Crackles
Popping open of alveoli and caused by increased fluid in the lungs
Rales
High pitched crackles
Rhonchi
Low pitched crackles
Stridor
Airway obstruction
Blood tinged sputum
Tuberculosis or small airway vessel rupture from excessive coughing
Purulent
Pus like fluid
Sputum Color Meaning
Frothy, pink- CHF Thick- dehydration Purulent- infection Yellow, green, brown- old secretions Clear or white- bronchitis Blood streaked- tumor, tuberculosis, pulmonary edema, trauma from coughing
Agonal Breathing
Irregular gasps widely spaced. Not actual breathing
Apneuistic Breathing
Prolonged inspiratory “fish breathing”
Indicitave of severe damage to the brain
Ataxic Breathing
Chaotically irregular indicate severe brain injury
Biot Respirations
Irregular pattern, rate and depth with patterns of apnea
Indicates brain injury or herniation
Cheyenne-Stokes Respirations
Crescendo-decrescendo with period of apnea inbetween
Indicates brain injury
Eupnea
Normal breathing
Hyperpnea
Increased rate and death of breathing (overdose)
Hypopnea
Decreased rate and death
Kussmaul
Deep respirations
Caused by body’s attempt to rid body of metabolic acidosis
Seen with DKA patients
Accompanied
Cerebellum Injury
Hyperpnea
Cheyenne Stokes
Apnea
Brain stem Injury
Apneuistic
Biot
Ataxic
Agonal
Anitussive
Suppresses cough.
Can be bad because coughing naturally clears secretions from the airway
Pulse Oximetry
Measures percentage of hemoglobin that has oxygen attached to it
Keep saturation abover 93% saturation
Capnography ROCS
Increase in 10 to 35 mmHg
Aerosol Therapy
Delivers liquid medications by smaller particles to facilitate the delivery of medication into the lower airway at 6lpm
Larger particles may be formed at lower oxygen setting and won’t reach the lower airway
Aerosol for burns and croup
Can greatly humidify and “cool” the airway of a burn patient with aerosoling normal saline
Spacer
Collects medication and allows higher concentration of medication to be delivered and will lose less to the environement
Oxygen in Body
97% bound to hemoglobin and 3% bound in plasma
Orthopnea
Difficulty breathing laying down
CPAP
Contraindications are hypotension (increase thoracic pressure decreasing perload)
AMS
Vomiting
Settings CPAP
5 to 15cm of water and 5 to 10lpm of oxygen
Poiseuille’s Law
The diameter of a tube decreases, resistance to flow decrease exponentially
Laryngotracheobronchitis
EXAMPLE is croup
Inflammation of larynx, trachea, and bronchi
Upper Airway Inflammation
Croup Epiglottitis Peritonsillar Abscess Diphtheria Enlarged Tonsils
Croup
Usually between 6months to 3 years
Barking or seal cough
May be caused by laryngotracheobronchitis
Epiglottitis
Inflammation of epiglottitis usually by infection
Sore throat, fever, hoarseness, and hyper extension of the neck
Aspiration
Inhalation of anything other than air
Can cause pnuemoitis and pneumonia
Aspiration of stomach contents increase mortality significantly
Obstructive Lower Airway Disease
Asthma
Findings include pursed lips, increased I/E ratio, abdominal muscle use, and JVD.
Asthma
Increased reactivity of the trachea and bronchi to a variety of stimuli
TRIANGLE of Asthma edema, bronchospasm, and mucus production
Status Asthmaticus
Severe, prolonged asthmatic attack that cannot be stopped with traditional treatment
Bronchospasm
Caused by constriction of the smooth muscle that surrounds larger bronchi in the lungs
-can occur from allergen, dust, perfume, animal dander, or change in temperatures-
Bronchial Edema
Swelling of bronchial and bronchi
Creates turbulent air flow, wheezing, and air trapping
(Corticosteroids)
Mucus Production
Thick secretions may plug distal airway and contibute air trapping
COPD
Empheseyma and Chronic Bronchitits
When the tracheobronchial tree becomes so weak it collapses
Chronic Bronchitis
Sputum production most days of month for 3 or more months out of the year for more than 2 years
Chronic and reoccurrence cough
Almost always a smoker
Assessment of Chronic Bronchitis
Crackles, Edema, infections, sputum production
Hypoxia Drive
Body stimulates breathing from a decrease in partial prsssure of oxygen
Atelactisis
When alveoli completely collapse eventually including entire lung segments
Lung Cancer
Tumors in large airways causing hemoptysis
Common site for metastasis (cancer formation from other sites)
Pulmonary Edema
Fluid build up in lung tissue
Assessment revealed rales or rhonchi
ARDS (Acute Respiratory Distress Syndrome)
Shock lung, Da Nang lung, hyaline membrane in neonates
Pneumothorax
Air collects between visceral and parietal pleura
Bleb
Weak spot in the lung causing spontaneous pneumothorax
Coughing or lifting
Pleural Effusion
Fluid collects between visceral and parietal pleura
Pulmonary Embolism
Blood clot in the lungs
S1Q3T3 on ECG
SUDDEN dyspnea, cyanosis, sharp pain in chest
PE causes
Clot forms in the greater saphenous vein
Thrombophlebitis
Holman Sign for PE
Calf pain from thrombophlebitis
Greenfield Filter
Filter placed in placed with patients that have a history of DVT’s that help trap clots or coagulated blood (basically a net)
Cape cyanosis
Deep cyanosis of the face, neck, chest and back despite good-quality CPR and ventilation with 100% oxygen
Cystic Fibrosis
Produce copious amounts of thick mucus in respiratory and digestive tracts
Pertussis
“Whooping Cough” contagious bacterial disease “the 100 day cough”
Can cause vomiting, hypoxia, conjuctivial hemmorage
