Medical Emergencies, Pt 1 (Respiratory, Cardiac, Diabetic, Altered Mental Status, Anaphylactic Emergencies) Flashcards
Tidal Volume
The volume of air moved in one cycle of breathing
Respiratory
distress
Increased respiratory effort caused by impaired respiratory function
Hypoxemia
Decreased oxygen levels in the blood
Ventilation
The process of air moving in and out of the lungs
Minute volume
Tidal volume * RR
Amount of air moved in and out of lungs in one minute
Dead air space
Air that occupies the space between the mouth and alveoli but does not reach the area of gas exchange
Plasma oncotic presure
Pull exerted by large proteins that draw water from body into the bloodstream
Hydrostatic pressure
Pressure within blood vessels that pushes water out of the bloodstream
Major structures in Respiratory system (Top to Bottom)
- Nasal cavity (cleanses, warms & humidifies air)
- Pharynx & larynx (carries air to trachea, produces sound)
- Trachea (transports air to & from lungs)
- Bronchial tubes (airway passages inside lungs)
- Lungs (site of gas exchange between air & blood)
Inspiration
Inhalation
- Active process
- Intercostal muscles contract & move ribcage up & out
- Diaphragm contracts & moves down and out
- Abdominal muscles contract
Expiration
Exhalation
- Passive process
- Intercostal muscles relax & move ribcage down and in
- Diaphragm relaxes and moves up and in
- Abdominal muscles relax
Boyle’s Law
The concept that the volume of a gas is inversely proportionate to the pressure
Conditions for adequate perfusion
- An oxygen-rich environment of at least 21% oxygen.
- A patent (open) airway with adequate inhalation and expiration for oxygen to reach the alveoli for gas exchange.
- An adequate circulation of blood to transport oxygen and nutrients and to get rid of waste products.
Respiratory
distress
Increased respiratory effort caused by impaired respiratory
function.
Respiratory failure
When respiratory compensatory mechanisms begin to fail and
respiration becomes inadequate.
Respiratory arrest
Complete stoppage of breathing; also called apnea.
Dyspnea
Shortness of breath or perceived difficulty in breathing.
Tripod position
When patients sit or stand and lean forward, and place their
hands on a hard surface or their knees; sign of respiratory
distress.
Hypoxia
The absence of sufficient oxygen in the body cells. (Severe respiratory distress)
Bronchoconstriction
Constriction of the smooth muscle of the bronchi and
bronchioles that causes a narrowing of the air passage.
Bronchodilator
A drug that relaxes the smooth muscle of the bronchi and
bronchioles, and reverses bronchoconstriction.
Metered Dose Inhaler
A device that consists of a plastic container and a canister of
medication used to form an aerosolize that a patient can inhale.
Early & Late S&S of Hypoxia
EARLY:
- Pale, cool, clammy skin
- Tachycardia
- Elevated blood pressure
- Agitation/Altered mental status
- Headache
- Tachypnea and dyspnea as possible initial signs, but can be delayed until hypoxia is severe
LATE:
- Cyanosis
- Bradycardia
- Confusion
- Coordination problems
- Sleepiness
- Altered mental status with decreased cognitive and psychomotor function (the inability of the patient to think or perform simple tasks)
Where cyanosis is visible
- Conjuctiva (inner eye)
- Mucosa (Inner mouth)
- Fingernail beds
- Circumoral area (around lips)
S&S of Breathing difficulty
- Altered mental status
- Barrel chest (prominent thorax, retracted abdomen)
- Tripod position
- Retractions, use of accessory muscles
- Flared nostrils
- Pursed lips
- “Two word” dyspnea
- Pale, cyanotic, flushed skin
- Pedal edema
- Sacral edema
- Noisy breathing (wheezing, stridor, coughing, gurgling, snoring, crowing)
- Abnormal lung sounds
- Shallow, gasping breaths
- Changes in breathing rhythm
- Hyper- or hypotension
- Extremely fast or slow pulse
- Extremely fast or slow RR
- SpO2 <95%
Asthma (Path)
- Chronic reactive airway disease that causes airway obstruction resulting from bronchospasms, increased mucous secretions, and mucosal edema
- Patient may be prescribed a bronchodilator (inhaler)
Characterisitcs:
- There is often a trigger (exercise, allergens, air pollutants, infection, stress)
- Wheezing, especially on expiration
Emphysema
- Form of COPD
- Permanent destruction of the alveolar walls that results in a decreased surface area
- Recurrent inflammation damages and eventually destroys the alveolar walls, creating a large air space distal to the bronchioles
- Results in poor elasticity and makes the lungs less compliant & bronchiolar collapse on expiration
- This traps air in the lungs and leads to over distention, which results in a “barrel-chest” appearance.
Characteristics:
Expiratory wheezing
Bronchitis
- A form of COPD
- Caused by irritants which trigger inflammation of the bronchi.
- Chronic bronchitis initiates resistance in the small airways, resulting in a V/Q imbalance that decreases oxygenation
- Causes thick mucus production that does not allow oxygen to reach the alveoli–> decreases oxygenation.
Characteristics:
A chronic, productive cough.
Pneumonia
- Acute infection of the lung that can be viral or bacterial, and can involve one lobe of the lung, part of a lobe, all of one side of the lung, or both sides of the lungs
Pneumonia can be caused by:
1) pathogens that colonize and form a bacterial infection, which cause alveolar inflammation and edema
2) a viral infection, which destroys the epithelial bronchiolar cells, causing capillaries to fill with blood and fluid.
3) In aspiration pneumonia, the surfactant is destroyed within the alveoli, which causes them to collapse (also called atelectasis).
Aspiration pneumonia commonly arises after resuscitation, when an airway was not secured properly or timely enough so that gastric distention and vomiting occurs.
S&S:
- Coughing (w/ green, yellow, bloody mucus), chest pain (worse in inhalation), fever, chills, headache, pale skin, fatigue
Atelectasis
Collapse of part or (much less commonly) all of a lung
Pulmonary embolism
- Obstruction of the pulmonary arteries, which blocks the blood flow to the area distal to the obstruction and results in hypoxia.
- The alveoli distal to the blockage are unable to produce enough surfactant, which results in atelectasis. With the alveoli collapsed, exchange of oxygen and carbon dioxide is impaired.
- Pulmonary embolism is generally the result of a thrombi (clot) developing in the large veins of the lower extremities (Deep Vein Thrombosis)
- Prolonged immobilization, irregular heart rhythms such as atrial fibrillation, pregnancy, heart failure, and recent surgery are some of the many causes of a thrombus.
S&S: - Sharp, pleuritic chest pain - Shortness of breath - Anxiety - Cough (w/ bloody sputum) - Pale skin - Tachycardia/tachypnea - Patient may enter cardiac arrest Often patients present as: - Lightheaded - Pain or swelling in leg(s)
Spontaneous Pneumothorax
- A spontaneous pneumothorax results when a subpleural bleb (a small cystic space) develops at the surface of the lung
- The result is an air leak into the pleural space
- The lung collapses, which causes a decrease in lung capacity (tidal volume) and compliance
- Often results from COPD
- In some cases, very thin, tall individuals who strain or have severe coughing spells will develop a spontaneous pneumothorax
S&S:
- Sharp chest pain
- Shortness of breath
- Fatigue
- Tachycardic
- Tachypneic
- Low SpO2
- Signs of hypoxia or displays cyanosis
- Diminished or absent lung sounds on one side
Hyperventilation Syndrome
- Pt. is breathing more oxygen than what the body needs, typically from tachypnea.
- Could be a sign of infection, heart attack, bleeding, or psychological disorder. It is commonly associated with patients who are emotionally disturbed or who have panic attacks.
- When a patient hyperventilates, excess air can enter the gastrointestinal tract and cause symptoms such as bloating or pressure in the abdominal area.
- Hyperventilating releases too much carbon dioxide, which decreases blood flow to the brain
- Nervous system disorders from hyperventilating result from calcium-level changes that cause numbness and tingling sensations in the lips and extremities, spasms of the muscles.
- For a patient with coronary artery disease, this spasm could cause the patient to have a heart attack.
S&S:
- weakness
- agitation
- dizziness
- anxiety
- shortness of breath (SOB)
- Can cause some patients to experience chest pain and to exhibit wheezing
- numbness and tingling sensations in the lips and extremities
- spasms in the hands and feet, and twitching of the muscles.
- spasms of the heart may occur.
Epiglottitis
- Acute infection of the epiglottis more commonly associated with infants and children.
- The infection and inflammation (usually beginning at the base of the tongue and above the epiglottis) may spread not only to the epiglottis, but also to other upper airway structures.
- With continued inflammation and swelling of the epiglottis, complete blockage of the airway may occur, leading to death.
S&S:
- Patients will commonly be found sitting upright and leaning forward
- Head and neck thrust forward while drooling.
- Patients normally have a high temperature (100°F or higher)
- May present with inspiratory stridor.
Pertussis
Pertussis (also called whooping cough) is an infectious bacterial illness that affects the upper respiratory passages by causing damage to the cilia
S&S:
- Spasms of coughing that creates a “whoop” sound when the patients inhale.
- Patient has violent episodes of coughing in an attempt to remove thick mucus from the respiratory passages.
Cystic firbrosis
Cystic fibrosis is an inherited disease involving glands within the body, including the glands that make mucus and sweat. This disease also affects the pancreas, liver, and intestines.
S&S:
- Coughing,large amounts of mucus
- Fatigue
- Frequent occurrences of pneumonia
- Abdominal pain & distention
- Coughing up blood
- Nausea
- Weight loss
Viral respiratory infections
- Viral respiratory infections are infections of the upper airway, including the common cold and the flu.
S&S:
- Runny nose
- nasal congestion
- sneezing
- sore throat
- cough
- headache
- In severe cases, such as the flu, upper respiratory infections can enter the lungs, which cause inflammation and an increase in mucous production.
Pulmonary edema
Pulmonary edema is the result of fluid accumulating in the extravascular spaces (spaces between the alveoli and capillaries) in the lung. There are two types of pulmonary edema: cardiogenic and noncardiogenic.
S&S:
- Anxiety
- Pale, sweaty skin
- Tachycardia
- Hypertension
- Dyspnea (Labored breathing)
- Coughing up frothy sputum
- Gurgling/crackles/wheeses auscultated
- Cannot lay supine
- Weight gain
CPAP may be useful
Cardiogenic edema
Cardiogenic pulmonary edema is caused by arteriosclerotic disease, hypertension, or problems with the valves of the heart.
Arteriosclerosis
Hardening of the arteries, also called atherosclerosis, is a common disorder. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques
NOT to be confused with arterioLOsclerosis
Noncardiogenic edema (causes?)
Noncardiogenic pulmonary edema is often referred to as ARDS (acute respiratory distress syndrome), in which the destruction of capillary beds causes fluid to leak from them, forming fluid inside the alveoli.
Causes of noncardiogenic pulmonary edema include pneumonia, aspiration of foreign substances, exposure to a toxic gas, high altitudes and trauma (pulmonary contusion).
Commonly inhaled poisons ( and S&S)
- Carbon monoxide
- Solvents
- Hydrogen sulfide
- Glue
- Nitrous oxide
- Natural gas
- Chlorine gas
Common S&S:
dysphoria, altered level of consciousness, hallucinations, fluid buildup in the lungs, and cardiac arrest.
Pulses paradoxus
- A decrease in pulse strength during inhalation; a drop in blood pressure of more than 10 mmHg during inhalation
- Resulting from increased pressure within the chest that suppresses the filling of the ventricles of the heart with blood.
Snoring
Tongue partially blocking the upper airway at the pharynx
Can hear w/out stethoscope
Gurgling
Fluid in upper airway
Can hear w/out stethoscope
Stridor
A harsh, high-pitched sound heard on inspiration that indicates swelling of the larynx or obstruction of the upper airway.
Can hear w/out stethoscope
Wheezing
Constriction & inflammation resulting in decreased diameter of bronchioles
Can hear w/ stethoscope
Rales
Fluid surrounding and filling alveoli
Can hear w/ stethoscope
Rhonchi
Mucus blocking larger bronchioles
Can hear w/ stethoscope
Crowing
A sound similar to that of a cawing crow that indicates that the muscles around the larynx are in spasm and beginning to narrow the opening into the trachea.
Can hear w/out stethoscope
Beta 2 agonist side effects
- Tachycardia
- Nervousness
- Tremors
- Dry mouth
- Nausea
Metered dose inhaler
A device consisting of a plastic container and a canister of
medication that is used to form an aerosol that a patient can
inhale.
Small volume nebulizer
A device that uses compressed air or oxygen to nebulize a liquid
medication into a mist that a patient can inhale.
Spacer
A chamber that is connected to an MDI to collect the medication
until it is inhaled.
Circulatory
system
System composed of the heart and blood vessels that bring
oxygen and nutrients to and takes wastes away from body cells;
also called the cardiovascular system.
Cardiac conduction system
The specialized contractile and conductive tissues of the heart
that generate electrical impulses and cause the heart to beat;
also called the coronary conduction system.
Automaticity
The ability of cells within the cardiac conduction system to
generate a cardiac impulse on their own.
Arteries
Blood vessels that carry blood away from the heart.
Veins
Veins that carry deoxygenated blood from the lungs to the left
atrium of the heart.
Capillaries
Tiny blood vessels that connects an arteriole to a venule.
Arteriole
The smallest branch of an artery, which at its distal end leads
into a capillary.
Venule
The smallest branch of a vein.
Effects of Stimulation of Sympathetic Nervous System
Increase in heart rate and contractility
Effects of Stimulation of Parasympathetic Nervous System
Stimulation of this nervous system decreases heart rate and increases blood flow to other areas of the body, including the stomach and genitals
