Respiratory TMC Flashcards
What is the difference between obstructive and central sleep apnea?
If effort is being made, its obstructive, and if an effort is not being made then its central
Obstructive sleep apnea (OSA)
related to obsessive amount of soft tissue in the upper airway (people w/obesity, increased neck circumference. The trachea falls over the tracheal opening and obstructs the airway. The patient is trying to breathe but they can’t. SPO2 drops when the patient starts breathing
How is OSA treated?
certain level of CPAP
Apnea Hypopnea Index (AHI)
0-4 (normal)
5-14 (mild)
15-29 (moderate)
>30 (severe, and the next step is a titration study to see how much CPAP or BIPAP pressure us appropriate.
Central Sleep Apnea
no signal from the brain to breathe (when the patient goes to sleep the brain also goes to sleep). It is typically associated with a congenital defect
How is central sleep apnea treated?
mechanical ventilation, diaphragmatic breathing, pacemakers, or pharmacological agents (methylxanthine)
Guillain Barre
(ground up)
associated with circulating antibodies (some type of precluding infection or acute illness). The antibodies attack the body’s own nervous system. This leads to the demyelination of neural sheath. It begins from the lower extremities and move up
How is Guillain Barre treated?
monitor patient with MIP maneuver and vital capacity maneuver
What should you do if the MIP maneuver is ever <-20 (Guillain Barre)?
the patient has to be put on mechanical ventilation (the diaphragm is no longer strong enough and has severe weakening of it)
What does it mean if the vital capacity (VC) is <10 ml/kg (Guillain Barre)?
The patient has lost the ability to take a deep breath and blow it all the way out
What are some other treatments for Guillain Bare?
plasmapheresis (replacing bad antibodies with good ones) and IVIG
Myasthenia Gravis
related to an increased number in antibodies, but it doesn’t have to do with the myelin sheath. This deals with the neuromuscular junction, which is where ACH attaches to receptors (cholinergic) that make muscle movements. Antibodies impairs the ACH attaching to the receptors and allow the patient to move. Starts with the head then goes down to the feet
How may patients present with Myasthenia Gravis?
dysphasia (difficulty swallowing), dysphonia (difficulty speaking, droopy eyelids)
How is Myasthenia gravis treated?
can be treated with drugs for AcH, Tensilon test, monitor MIP <20 and VC< 10ml/kg (intubate if this is the case), and plasmapheresis
Obstructive Lung Diseases (CBABE)
-Cystic Fibrosis
-Bronchiectasis
-Asthma
-Chronic Bronchitis
-Emphysema
*Everything else is restrictive
What is the problem with all obstructive diseases?
They are all obstructive to expiratory flows. They are all accompanied with air trapping, barrel chest, or pursed lip breathing
What kind of things would you expect to see on an x-ray for a pt with an obstructive disease?
hyperinflation, more radiolucency, flattened diaphragm, or increased intercostal spaces
Asthma
associated with a reactive airway that leads to acute bronchospasm (smooth muscle of the airway is going to constrict; constriction causes airway to get smaller
How does a pt with Asthma present in the ER?
with expiratory wheezes, which is due to constriction and increased mucous production to the inflammatory process caused by something. This leads to an increase in airway resistance (RAW). This is why the patients purse lip breathe to extend exhalation, so they can take in a healthy tidal volume
Extrinsic Asthma
-Allergy
-High eosinophil count
-FeNO (biproduct of broken down eosinophil
Intrinsic asthma
something that causes asthma internally such as: obesity, exercise, pre-menstrual, night time or sleep associated asthma
Peak Flow Monitoring
(Patient inhales and blasts air out)
80-100% (good)
50-80% (need to increase meds)
<50% (seek medical attention)
What are some asthma key interventions?
-O2 therapy initially, in the absence of conclusive data like SPO2 and ABGs
-Xanthene’s medication given (IV/aminophylline, etc)
-Promote pulmonary hygiene
-Corticosteroids such as oral or IV prednisone
What should you do if a repeated bronchodilator does not work?
consider possible diagnosis of status asthmaticus. Instruct patient on the use of our Asthma Action Plan, a plan to self monitor and record daily results
