Respiratory emergencies take two Flashcards
How does wheezing sound like?
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 wheezing an indication of?
swelling and constriction/narrowing of the lower airways, typically due to bronchoconstriction, inflammation, or mucus.
If wheezing is diffuse, what does that mean and it is a primary indication of what?
diffuse (heard over all the lung fields) is a primary indication for the administration of a beta 2 agonist medication by metered-dose inhaler (MDl) or by small-volume nebulizer (SVN). (vasodilator)
In which conditions is wheezing typically heard in?
Wheezing is usually heard in asthma, emphysema, and chronic bronchitis. It can also be heard in pneumonia, congestive heart failure, and other conditions WHEN they cause bronchoconstriction
With severe obstruction of the lower airways by bronchoconstriction and inflammation, what can happen to the wheezing sound
It can significantly diminish or become absent because the velocity of the air moving is no longer adequate
How does Rhonchi (AKA coarse crackles) sound like?
snoring or rattling noises
What does Rhonchi indicate?
They indicate obstruction of the larger conducting airways of the respiratory tract by think secretions of mucus
In what conditions is Rhonchi typically heard in?
chronic bronchitis, emphysema, aspiration, and pneumonia.
What is unique about Rhonchi?
the quality of sound changes if the person coughs or sometimes even when the person changes position.
How does crackles (AKA rales) sound like?
bubbly or crackling sounds heard during inhalation
What does rales indicate?
fluid has surrounded or filled the alveoli or small bronchioles. The crackling sound is commonly associated with the alveoli and terminal bronchioles “popping” open with each inhalation.
Where do you typically hear crackles first?
The bases of the lungs posteriorly reveal crackles because of the natural tendency of fluid to be pulled downward by gravity
In which conditions is crackles heard in?
pulmonary edema or pneumonia
Patho of emphysema?
The lung tissue loses its elasticity, the alveoli become distended with trapped air, and the walls of the alveoli are destroyed. Loss of the alveolar wall reduces the surface area in contact with pulmonary capillaries. Therefore, a drastic disruption in gas exchange occurs and The patient becomes progressively hypoxemic and begins to retain carbon dioxide.
Unique S/S of emphysema?
*Pursed lips to create positive end expiratory pressure
*barrel chest
*hyperventilation
*use of accessory muscles
*Wheezing and Rhonchi sounds
Patho of chronic bronchitis?
Chronic bronchitis involves inflammation, swelling, and thickening or the lining of the bronchi and bronchioles and excessive mucus production. The inflamed and swollen bronchioles and thick mucus restrict airflow Lo the alveoli so that they do noL expand fully, causing respiratory distress and possible hypoxia.
Unique S/S of chronic bronchitis?
*a productive cough that persists for at least three consecutive months a year for at least two consecutive years (HALLMARK SIGN)
*crackles and crackles usually heard
*Wheezes and, possibly, crackles at the bases or the lungs
*Asterixis (flapping of the extended wrists)
Emergency medical care for COPD patients? (Emphysema and chronic bronchitis)
- Open airway
- Adequate breathing
- Position of comfort
- Administration of supplemental oxygen (start with NC at 2L/min and rising up to 6L/min and/or 1L above their home oxygen. reach 88%-92%)
- Use MDI or SVN
You should use CPAP for an COPD patient if….
*Moderate to severe dyspnea with the use of accessory muscles and paradoxical abdominal movement
*Respiratory rate >25 per minute
(do pressure at 5-10 cm H2O)
In an COPD patient, if CPAP is not helping the patient and their condition is deteriorating, you should….
Remove the CPAP device and begin BVM ventilation
Patho of Asthma?
Asthma is 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.
What contributes to increased air resistance in an asthma patient?
*Bronchospasm (constriction of the smooth muscle in the bronchi and bronchioles)
*Edema (swelling) of the inner lining in the airways
*Increased secretion of mucus that causes plugging of the airways
A prolonged life-threatening attack that produces inadequate breathing and severe signs and symptoms is called
acute severe asthma or status asthmaticus
acute severe asthma or status asthmaticus does not respond to…
oxygen, bronchodilators, or steroids. TRANSPORT NOWWWWW