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ch 16 lecture respiratory

Terms in this set (64)

Hypercarbic Drive
Chemoreceptors -
Detect pH and CO2 in blood/CSF and Impulses to brain
Hypoxic Drive
-Default if hypercarbic drive quits
-respiratory system become insensitive to CO2 and to respond instead to low levels of oxygen
Signs of Eupnea
• Patent airway
• Adequate rate
• Adequate Hdal volume
• Clear breath sounds
• No increased work of breathing • Skin pink/warm/dry
• DiagnosHcs without flags • SpO2
• Capnography
• Cap refill
• Heart rate
Signs of respiratory distress
fast or slow rate
use of accessory muscles
tripod position
nasal flaring
increased effort to breath
irregular rhythm
shallow breaths
cyanosis
retractions
cool clammy skin
cause respiratory distress - Ventilation problem
think: flail chest, asthma, etc
cause respiratory distress - increased stance around alveoli
Think: inflammaHon, ARDS, etc.
cause of respiratory distress - • Filling of alveoli
Think: CHF, pneumonia, etc.
cause of respiratory distress - Inadequate perfusion
Think: heart or blood disorder
cause of respiratory distress results in
shortness of breath (SOB)
What to ask your patient when shortness of breath
Ask your paHent: Does it feel like you're not able to get the air in, or does it feel like the air is going in but you're just not geEng enough oxygen?
when there are metabolic needs not being met
• Inadequate venHlaHon? • Inadequate respiraHon? • Inadequate circulaHon?
untoward breath sounds
wheezing
-high pitched whistling
-initially on expiraton
-located lower airways
cause of wheezing
bronchoconstriction
-think asthma, COPPD, etc
Treatment for wheezing
beta 2 agonist: ALBUTEROL
Rhonchi
coarse rattling noise
may change with cough
often in larger airway
cause of rhonchi
thick mucus secretions
think pneumonia, aspiration
treatment of rhonchi
O2
conditions that cause dyspnea
chronic bronchitis/ emphysema = COPD
asthma
pneumonia
pulmonary embolism
pulmonary edema: CHF
Pulmonary edema: ARDS
Pneumothorax
HypervenHlaHon syndrome
Epiglottis
Pertussis
CysHc fibrosis
Viral respiratory infection
Poisonous exposure
COPD (Chronic Bronchitis)
Primary cause: smoking
Patho of COPD
• Irritated airways
• InflammaHon/swelling • Increased mucus
• Mucus plugs
• Narrower airways
• Recurrent infecHons
* all = scar tissues/ narrower airways
S/S Chronic Bronchitis
typically overweight
chronic cyanotic skin
productive cough
dyspnea
coarse rhonchi
wheezing/ crackles
recurring infections
clubbing nails
COPD: Emphysema
primary cause: smoking
patho emphysema
alveoli lose elasticity
alveolar walls destroyed
exhalation becomes active
result of emphysema
Hypoxia
CO2 retention
emphysema S/S
Thin with barrel chest
non-productive cough
prolonged exhalation
BBS diminished
whezing/ rhonchi
pursed lip breathing
pink complexion
tachycardia
diaphoreis
tripod position
home O2
Treatment O2
target < 94%
failure of hypoxic drive (too much O2 is rare pre-hospital)
dyspnea demands O2
CPAP
keeps alveoli inflated
splints terminal bronchus
eases ventilatory effort
may require coaching
BVM
assist ventilations
beware brotrauma
Only trauma Pt NOT getting O2
cardiac/ stroke
Asthma S/S
* Bronchospasm in lower airways
• Increased mucus/edema
• Many triggers
-Dust to stress
• Acute alacks
-No s/s between alacks
• Status asthmaHcus
-Prolonged alack
-Unresponsive to meds
Asthma S/S 2
• Sudden dyspnea
• Non producHve cough • Wheezing
• Tachypnea
• Tachycardia
• Anxiety
• Chest Hghtness
• SpO2 < 94% w/o O2
• Tripod posiHon
• History and MDI
Asthma Treatment - O2
• NRB
• BVM
-beware of barotrauma
CPAP
Asthma Treatment - Albuterol: Beta 2 agonist
• MDI
• Small volume nebulizer
Pneumonia
Infection of Lungs:
• Bacterial or viral
• Fluid/pus in alveoli
• Common in elderly or immunosuppressed
S/S Penumonia
• Dyspnea
• Malaise
• Fever
• Cough
Treatment
• O2 PRN
Pulmonary Embolism (PE)
Clot in Pulmonary Artery
• Cardiovascular problem • V/Q mismatch
(PE) severity
size/location
-can effect right sided heart failure
DOE Dyspnea on exertion
dyspnea lying flat
tachycardia
JVD
cough: pink frothy sputum
swollen feet: pitting edema
tripod with legs down
crackles/ wheezing
skin pale/ moist
Pulmonary embolism (PE) - Risks
• Immobility
• Oral contracepHon • Recent surgery
• History of clots
• Smoking
PE - S/S
• Sudden dyspnea
• Tachycardia/tachypnea
• Localized stabbing chest pain • Cough: blood
• Skin: cool/moist
Pulmonary Edema - Cardiogenic CHF
• LeL-sided heart failure
• Decreased blood flow
• Fluid offloads into alveoli
Pulmonary Edema - non-cariogenic: ARDS
• inflammation
• Alveolar/capillary walls destroyed
• Fluid moves in and around alveoli
• Pneumonia, aspiraHon, toxic gas, etc.
Hyperventilation Syndrome
Panic/anxiety alack:
-Feel unable to catch breath
-breathe faster/deeper
-blow off excessive CO2 + decrease free Ca
-carpal pedal spasms
-increased panic/anxiety
Pneumothorax S/S
• Sudden dyspnea/SOB
• Decreased BS one side
• Stabbing chest pain
• Tachypnea
• Diaphoresis
• Cyanosis late
• Subcutaneous emphysema • SpO2 < 94%
• Tall thin male
Pneumothorax Treatment
• O2
• BVM PRN
• Beware
• CPAP contraindicated
• ALS if tension pneumo
Pneumothorax - Patho
• Rupture of visceral pleura
• Air into pleural space
• Dead air displaces lung
• Lung collapses
• Trauma vs. spontaneous
Tension Pneumo
• Dead air mediasHnal shiL
• Vena cava twists
• Venous return blocked
• Cardiac output falls
Hyperventilation Syndrome S/S
• Nervous/anxious
• Numbness/Hngling
• Carpal pedal spasms • SOB
• Chest Hghtness
• Dizziness
• Tachypnea
• Tachycardia
Hyperventilation Syndrome Treatment
• Calm/reassure
• Coach slower breathing
• In mouth, out nose
• Breathe with me
• O2 PRN
• NO paper bag breathing
Bacterial Respiratory Infections - Epiglottis
• High fever and drooling
• Inspiratory stridor
• Life-threatening
• Nothing in mouth
Pertusis (whooping cough)
• "Whooping cough"
• Upper airway
• Highly contagious
• Starts as cold
• Can progress to pneumonia
Viral Respiratory Infections
• Bronchiolitis, common cold, flu, RSV
• Can lead to pneumonia
Bronchiolitis S/S
• Nasal congesHon
• Sore throat
• Fever
• Cough
• HA and body aches • Poor feeding
Bronchiolitis - Treatment
• O2: consider blow-by • Transport
Cystic Fibrosis
• Hereditary disease
• No cure
• Gland disorder
-thick mucus
• Block airway
• Repeated infecHons
-Cause scarring/damage
• Early death from pulmonary failure
Cystic Fibrosis Treatment
• O2
• Saline neb
• Rapid transport
How is respiratory distress different in kids and geriatrics?
• Kids: early sign of distress
• Geriatrics: late sign of severe distress
Signs seen more in kids?
• GrunHng
• See-saw breathing
Geriatrics and Kids?
• Distress can lead to failure more quickly in both.
S/S of Respiratory Distress in Pedis
• Anxiety
• Increased accessory muscle use
• Retractions earlier
• Tachypnea/tachycardia
• Nasal flaring
• Frequent coughing
• Grunting
• Prolonged exhalation
• Cyanotic extremities
S/S of Respiratory Failure in Pedis
• Head bobbing
• See-saw breathing
• Core cyanosis
• Loss of muscle tone
• Altered mental status • Bradycardia
• Diminished/absent BS • Hypotension
72 y/o f severe respiratory distress. She presents sitting up in her living room recliner. When you ask her name, she can barely say it. Vitals:
• BP: 92/70 mmHg
• Radial pulse weak/rapid/regular
• RR: 36 per minute, shallow/regular
• SpO2 82%
• Skin extremely pale, very cool, and diaphoretic with perioral cyanosis.
• Nail beds and fingertips are cyanotic.
Immediate care: CPAP
Emphysema
Treatment for respiratory emergency
• Patient positioning:
-Fowlers
* O2
-• NC/NRB
• Blow-by
Ventilation
-• BVM
• CPAP
Albuterol:
• MDI
• Small volume neb
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