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Emrg 1230 > Week 8- Lung Sounds V/Q Issues > Flashcards

Week 8- Lung Sounds V/Q Issues Flashcards

1
Q

Chest Auscultation for Lung Sounds

A
  • Listening for normal and abnormal breath sounds
  • Using a stethoscope
  • Called auscultation
  • Min of 4 locations on either the anterior chest wall OR
  • Posterior 4 locations
  • Evaluate air entry into the lungs and compare right to left sides
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2
Q

Normal breath sounds are classified as

A
  • Tracheal
  • Bronchial
  • Bronchovesicular
  • Vesicular sounds
  • The patterns of normal breath sounds are created by the effect of body structures on air moving through airways
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3
Q

In addition to their location, breath sounds are described by:

A
  • Duration (how long the sound lasts)
  • Intensity (how loud the sound is)
  • Pitch (how high or low the sound is)
  • Timing (when the sound occurs in the respiratory cycle)
  • Sounds diminish as they go through the smaller airways
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4
Q

Tracheal

A
  • Directly over the trachea
  • Harsh sounding like air through a pipe
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5
Q

Bronchial

A
  • Present over large airways in the anterior chest near the 2nd and 3rd intercostal spaces
  • Loud and high patched
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6
Q

Bronchovesicular

A
  • Posterior chest between the scapulae and in the centre of the anterior chest
  • Softer than bronchial sounds, equal during expiration and inspiration
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7
Q

Vesicular

A
  • Over the lung tissues
  • Soft, blowing or rustling sounds normally heard
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8
Q

What would cause diminished air flow?

A
  • Obstruction
  • Edema
  • Allergic rxn
  • Mucus, blood
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9
Q

What would cause absent airflow?

A
  • Collapsed lung, pneumo
  • Severe bronchoconstriction
  • Severe obstruction
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10
Q

What would cause differences in air flow from right to left?

A
  • Flail chest
  • Pneumo
  • Intubation pushed to far
  • Pneumonia
  • Tumours
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11
Q

Adventitious (not normal) Lung Sounds

A
  • Crackles
  • Wheezes
  • Stridor
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12
Q

Crackles

A

NITRO
- Light cracking, popping sounds produced by air passing through moisture
- bronchitis, heart failure

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13
Q

Wheezes

A

VENTOLIN
- High pitched, musical sounds produced when air moves through smaller, partially obstructed airways (sounds like a whale)
- Asthma, partial obstruction spasm

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14
Q

Stridor

A
  • High pitched inspiratory sound from partial obstruction in the larynx or trachea
  • Croup
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15
Q

Pleural Friction Rub

A
  • Squeaking or grating sounds of the pleural linings rubbing together when the linings rubbing together when the linings are inflamed and lose their lubrication
  • They appear during the entire respiratory cycle
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16
Q

Consolidation

A
  • Infectious pus causing collapse of the alveoli (area of infection in the lungs)
17
Q

Effusion

A
  • Fluid in the pleural space causing a decrease in functioning lung tissue
18
Q

What is ventilation?

A
  • Process of air movement in and out of the lungs
19
Q

What does ventilation requires?

A
  • Neurological control for inflation
  • Contact: brain stem to the muscles
  • Functional diaphragm
  • Functional intercostal muscles
  • Patent and functional airway
  • Functional alveoli
20
Q

What are some ventilation problems?

A
  • Airway obstruction (foreign body, epiglottitis)
  • Chest wall impairment (trauma, muscular dystrophy)
  • Neurological control impairment (CNS depressant drugs, stroke)
21
Q

Treatment we can use for ventilation…

A
  • Patent and unobstructed airway maintained
  • OPA/ NPA/ King LT/ ETT
  • Assist ventilation
  • BVM
22
Q

Diffusion

A
  • Process of gas exchange between capillaries and alveoli
23
Q

What does diffusion require?

A
  • Alveolar and capillary walls that are permeable to respiratory gases
  • Interstitial spaces not enlarged or filed with fluid
  • Surface area of sufficient size
  • Presence of gases for diffusion
24
Q

What are diffusion problems?

A
  • Inadequate oxygen concentrations (fire environments, CO poisoning)
  • Alveolar pathologies (lung disease, inhalation injury)
  • Interstitial space pathologies (pulmonary edema, near-drowning)
  • Capillary bed path pathologies (severe atherosclerosis)
25
Q

Treatment we can use for diffusion…

A
  • Increase O2 concentration
  • Reduce inflammation
  • Remove fluid in the interstitial spaces
26
Q

Perfusion

A
  • Circulation of blood through the pulmonary capillary bed
27
Q

What does perfusion require?

A
  • Adequate blood volume
  • Adequate hemoglobin
  • Functioning pulmonary capillaries
  • Functioning left ventricle
28
Q

What are perfusion problems?

A
  • Impaired blood flow (shock, anemia, pulmonary embolus)
  • Capillary bed pathologies (trauma(
29
Q

What is the treatment perfusion problems…

A
  • Ensuring adequate circulating volumes of fluid
  • Raise hemoglobin levels
  • Optimizing left ventricular function
30
Q

V/Q Mismatch

A
  • V= Ventilation
  • Q= Perfusion
  • When your lungs are functioning properly, 4 L of air enter the resp. track per min and 5 L of blood go through the capillaries per min. This leads to a V/Q of 0.8. Once the air is humidified by the respiratory tract, it ends up in the vicinity of 1.0
  • Ideally, V/Q is equal meaning there is just enough O2 to fully saturate the blood
31
Q

Shunt & Dead Space

A
  • An area with perfusion but no ventilation (V/Q of O) is termed shunt
  • An area with ventilation but no perfusion is termed dead space
  • Very rarely can anyone have “True/Pure” shunts or dead space, as this is incompatible with life
  • Most often it’s a condition between normal and wither of the 2 conditions
32
Q

Shunt

A
  • Pathological condition which results when the alveoli of the lungs are perfused with blood as normal, but ventilation (supply of air) fails to supply the perfused region (low V/Q)
33
Q

Dead Space

A
  • Alveoli are ventilated but no perfused (high V/Q)
34
Q

Oxygen Control of Blood

A
  • Oxygen is present in blood in 2 forms: (dissolved in the plasma, bound to hemoglobin)
  • When carries as oxyhemoglobin, each hemo can carry 4 O2 molecules= fully saturated
  • Nears full saturation at PO2 of 80-100 mmHg
35
Q

Oxygen Saturation

A
  • Increases rapidly when the PO2 is 10-60 mmHg (up to about 90% at 60 mmHg)
  • Further increases in PO2 relate to a small change in saturation
  • After this point, changes in O2 concentration relates to small changes in O2 saturation
36
Q

Blood plasma

A
  • PO2 is the most important factor in determining how well oxygen binds to HB
37
Q

Pulse Oximetry

A
  • In normal adults be 95-100%
  • SPO2 of less than 90 is a clinical emergency
  • Cyanosis may not be present until SPO2 is less than 90%
  • Cyanosis may not be evident in anemic or dark skinned pts
38
Q

What are factors that affect reading?

A
  • Light- bright lights may affect the probe
  • Shivering- movement may make it difficult for the probe to pick up a signal
  • Pulse volume- the oximeter only detects pulsatile flow. When BP is low, pulse may be weak and may not be able to detect a signal
  • Vasoconstriction- reduces blood to the peripheries. If pt is cold may be difficult to detect
  • CO Poisoning- may give false readings
  • Nail polish
39
Q

Assessments- Initial

A
  • Toxic environments
  • Alterations in mental status
  • Cyanosis
  • Absent breath sounds
  • Audible stridor
  • One-two word dyspnea
  • Tachycardia
  • Pallor and diaphoresis
  • Accessory muscle use

Emrg 1230 (24 decks)

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