Week 3 - Secretion Management Flashcards
Describe how muco-ciliary clearance occurs within the airways
Cilia extend from larynx to terminal bronchioles
Cilia beat in the sol layer of watery fluid
They penetrate and propel gel-like mucus from smaller to larger airways
Describe the properties of mucus in the lungs
Soft, elastic solid, which flows more like a viscous liquid when stress placed on it
The greater the stress, the less viscous
What are the three components of a cough?
Inspiration - to near TLC
Compression - close epiglottis, expiratory muscles contract
Expiration - open glottis, dynamic airway compression
What factors impair cough?
Altered flow properties of secretions - more viscous/ elastic
Inability to generate sufficient inspiratory flow
Pain/fear
Reduced cough reflex - e.g. GA, vagal nerve damage
What is a huff?
Forced exhalation through open mouth and glottis
Explain how a huff works
During a huff, pleural pressure becomes positive and equal to airway pressure at the EPP
From the EPP to mouth, the pressure outside airway is greater than that within
This creates dynamic compression, which moves toward mouth
Describe three manual airway clearance techniques
Percussion - rhythmic clapping on chest with loose wrist and cupped hand
Vibrations - fine oscillations of the hands on exhalation
Shakes - coarser oscillations of the hands on exhalation
Name some precautions of manual techniques
Current large, frank haemoptysis Severe clotting disorder Uncontrolled thoracic pain Rib fractures/ OA/ cancer Active pulmonary TB Pneumothorax/ surgical emphysema Over incisions, burns, frail skin
Name 4 adjuncts for secretion clearance
PEP mask
Acapella
Bubble PEP
Flutter
How are adjuncts thought to work?
Stabilise airways Prevent premature airway closure Reduce gas trapping Homogenise distribution of ventilation Counteract early airway closure Can be less tiring than ACBT
