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Respiratory Diseases and RSI (Week 6 CCT Acadian)
Terms in this set (15)
Give a short explanation of the pathophysiology of chronic bronchitis.
The goblet cells begin hypersecreting and cilia are damaged or killed off and are unable to clear the mucus up out of the airway, so you end up with chronic inflammation and infection which in turn also causes more mucus which continues on getting worse and worse until treatment is provided to assist in clearing the mucus. The mucus causes airways to have limited area for air to move through. While the air can move into the alveoli, because the force pulling out on the airway allowing the airways to expand, the air cannot move out as well or at all, as the airways are narrowed by mucus. Air trapping occurs. The air trapped becomes high in CO2 and low in O2 causing hypoxia. The overexpanding of the alveoli damages the collagen and elastin in the lungs, making the condition progress into emphysema.
Why do chronic bronchitis patients cough frequently?
Because their cilia are damaged or gone and not available to clear the excess mucus produced by the goblet cells in the airway. Coughing helps clear it and get it out.
What is air trapping?
Airways are pulled open by the force of breathing in, expanding the lungs, chest, airways. Air is allowed to move into the alveoli due to this. However, with expiration, the air is not able to move out of the alveoli through the airways due to mucus blocking it. Air trapped begins to have low levels of O2 and high levels of CO2.
Explain the impact of air trapping on oxygenation. Remember to differentiate oxygenation from ventilation.
Air cannot move out, so the CO2 exchanged for the O2 is trapped in the alveoli. O2 cannot move in, so the patient becomes hypercapneic and hypoxia. Pt begins breathing faster and deeper. Pt begins to experience air hunger, because the air is not moving out, and they cannot get O2 in.
Why do we see more airway collapse/ obstruction and air trapping on exhalation?
When you inhale, the diaphragm expands the chest cavity, allowing the air to move in. When you exhale, you do not have that force, so the airways are more narrow and collapse and obstruction can occur. This leads to air trapping, because the air can move in but not out.
Describe the three types of ventilation-perfusion mismatch (V/Q mismatch).
Low VQ ratio - some ventilation, but a lot of perfusion; ventilation cannot saturate the area of perfusion resulting in low oxygenation of the blood.
High VQ ratio - a lot of ventilation occurring, but not a lot of perfusion, preventing o2 from moving into the bloodstream. The blood is well oxygenated.
Silent unit - decreased ventilation and decreased perfusion
Describe the difference between obstructive and restrictive lung disease. Include an example of each in your analysis.
Restrictive lung disease, such as Pulmonary fibrosis, is when there is difficulty fully expanding the lungs, restricting the amount of air that can enter the lungs.
Obstructive lung disease, such as chronic bronchitis, is where there is a condition preventing the exhalation of the air from the lungs.
Obstructive: Difficulty moving air out of the lungs. (COPD, asthma)
Restrictive: Difficulty moving air into the lungs. (ARDS, fibrosis)
In the Strayer video, what does Dr. Strayer emphasize is the most important message of his talk regarding critical airway management? When during the management sequence should this task be accomplished? (Hint - pay close attention around the 7:00 mark.)
The most important thing is managing operator catecholamines and prevent bad outcomes by preparing for failure of laryngoscopy and failure of ventilation. You prepare prior to the first attempt and know what your backup will be prior to beginning and you have the equipment set up and available if failure occurs.
You are performing RSI on a patient. You have achieved paralysis. On your first attempt, you discover you cannot visualize the vocal cords and are unable to pass the ET tube. You find you are able to achieve reasonable chest rise with BVM. What should you do before attempting a second time to intubate?
Make changes to something, such as positioning, blade size/type, providers performing the skill, etc... because going in again without changing something will only get you the same results.
According to Strayer, what are the three types of dynamic airways and when should they be secured?
Bullets, bites, and burns should be intubated early.
You are examining the chest radiograph of an emphysema patient that you are preparing for an inter facility CCT.
Which of the following radiograph findings do you think would most likely be associated with this type of COPD?
A. Ground glass appearance
B. Flattened diaphragm
C. "Dirty lungs"
D. Thick bronchial walls
Which of the following settings on your mechanical ventilator would you want to pay extra close attention to while transporting an asthma patient?
A. Airway pressures
B. Tidal volume
Which of the following might assist, within the pre-hospital setting, at decreasing rate of vent acquired pneumonia?
A. Elevating the patient's head
B. Using a larger ET tube
C. Using a rescue airway device instead
D. All of the above
Tuberculosis is mainly acquired through?
B. Blood exposure
C. Skin contact
ARDS is associated with which type of pulmonary edema?
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