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Flashcards in Respiratory Emergencies Deck (73):
1

Intrinsic risk factors

Genetics
Circulatory problems
Sedentary lifestyle

2

Extrinsic risk factors

Smoking
working conditions
environmental

3

Goal of respiratory emergencies

correct hypoxia

4

angle of louis

external landmark of the biforcation (carina) of the bronchus

5

Alvioli

-Functional unit of respiratory system
-300 million in both lungs
-1 cell thick and connected to blood supply
-air passes through diffusion
-Damage to alveoli decreases surface area which will decrease area of resp.
-Coated with surfactant to prevent collapsing

6

Layers around the lung

Visceral pleura- lays on the lung
Parietal pleura- lines the pleural space

7

Atmospheric pressure

14.7psi

8

Inspiratory reserve

3000ml

9

Expiratory reserve

1200ml

10

Residual volume

1200ml

11

Peak flow

maximum rate of air flow during a force expiration

12

COPD primary chemoreceptors

Peripheral chemoreceptors

13

Peripheral chemoreceptors

-Located in the carotid/aortic bodies
-Back up system, when patient has chronic high C02 levels - hypoxic drive
-Respond to low levels of 02
-Increased 02 levels decrease rate, depth etc.

14

BOHR EFFECT

An effect by which an increase of carbon dioxide in the blood and a decrease in pH results in a reduction of the affinity of hemoglobin for oxygen.

15

Apnea

not breathing

16

Orthopnea

Fluid filling the lungs when laying down

17

Dyspnea

Difficulty breathing

18

Tachypnea

rapid breathing

19

Cheyne Stokes

rapid breathing with periods of apnea

20

Hyperventilation

more rapid than normal

21

Kussmaul

(diabetic ketoacidosis)
Deep, rapid breathing

22

PND (Paroxismal nocternal dyspnea)

more difficulty breathing at night

23

Rales

bubbles in water

24

Rhonchi

hair folicles rubbed together

25

Diminished

abcde

26

Silent

Movement but no sound (very bad)

27

ARDS

Complications from trauma, toxins, aspiration, infections, O.D’s

Result in a increase in capillary permeability, stiff lungs and decrease pulmonary capacity

Seen in post injury or illness

Is managed with PEEP and corticosteroids

28

Blue bloaters (smokers)

-Altered ventilation - perfusion relationships in lungs
-Hypoventilation/Hypoxemia (↓ lung capacity, ↑ residual volume with air-trapping) 
-Polycythemia (more RBC's)
Increased CO2 retention
Rt. side CHF
Overweight
PRODUCTIVE COUGH*
Short & stocky body build
Rhonchi sounds in lungs

29

EMPHYSEMA pathophysiology

Loss of elasticity within alveoli
Resulting in enlargement of alveoli sacs
Leads to destruction of alveoli and failure of supporting structures to maintain alveolar integrity
Reduction of elasticity leads to the trapping of air in alveoli

30

Emphysema leads to?

Pulmonary hypertension
Right sided CHF

Cor pulmonale—hypertrophy of Rt. Ventricle

Polycythemia(more RBC's)

31

Emphysema s/s

Pink puffers caused by
Decreased Pa02 which produces more RBC’s
High hematocrit levels
Barrel chest: excessive chest muscle use to breath, increase in the anterior/posterior chest diameter
Thin and emaciated looking due to increase caloric need to breath
Pursed lip breathing
Prolonged & rapid respiratory rate

32

Acute s/s of emphysema

-Acute onset brought on by number of reasons, causes exacerbation of disease
-Tripod breathing
-Accessory muscle use
-Dry or productive cough
-Wheezes or rhonchi
-Prolonged expiratory phase
-Associated sx/sx tachycardia, diaphoresis, cyanosis, irritability, confusion, drowsiness, cardiac problems
-Low SAO2
-Central site vs peripheral site

33

Asthma

Life long asthma
Increased incidence of death after age 45

34

Causes of Asthma
Extrinsic (more common in children, improves with age)

“Non-allergic”
Inhaled allergen
Cold temperature
Vigorous exercise
Emotional stress

35

Causes of Asthma
Intrinsic (more commonly as adult)

Infection
ASA, ibuprofen
Beta blockers (inhibits beta so alpha stimulation takes place)
Exposure to smoke, fumes
Psychological stress

36

s/s of Asthma

Smooth muscle contraction
Increased secretion of mucus
Inflammatory changes in the bronchiole walls
Alveolar hypoventilation and marked ventilation-perfusion mismatch leading to hypoxia and C02 retention.
Increased air resistance leads to air trapping due to hyperventilation of alveoli.

37

s/s of asthma

Dyspnea—measure in words
Cough
Bronchospasm
-Wheezes
-Quiet chest
*So tight there are no lung sounds
*Ominous sign because of lack of air movement.
Accessory muscle use
-Subclavicular in-drawing
Pulsus paradoxus
Tachycardia
Low pulse ox
Hypoxia and fatigue
Associated s/s
-diaphoresis, tachycardia, unable talk
Abnormal capnography - shark fin shape
Peak airway flow rate
Special questions
-Hx of intubation/hospitalizations
Usual treatment
-Frequency of inhaler use, other meds and infection

38

Status Asthmaticus

Severe prolonged asthma attack
Key point: Cannot be broken with normal routine medication use
Same as other asthma attacks except more rapid onset and patient in life threatening situation.
Rapid transport with Rx enroute.

39

s/s hyperventilation

Carpal/pedal spasms - due to relative hypocalcemia

40

Cystic Fibrosis

Inherited disorder of exocrine glands
Cause abnormal secretions of thick mucous which plugs bronchi and GI tract
Fatal disease with life expectancy of avg. 22-28 years
Associated chronic bronchitis, sinusitis, emphysema and respiratory failure
Rx per Sx & Sx

41

PE Patho

-Blockage of pulmonary artery by thrombus, embolus or other foreign matter
-Results in partial or complete collapse of lung
-Can limit left heart return resulting in decrease cardiac output and obstructive shock
-Most common cause is thrombus

42

PE causes

Venostasis-bed rest, traveling, age, burns, obesity, varicose veins
Venous injury - Fx or surgery
Increased blood coagulation
Pregnancy - post partum
Disease - COPD, CHF, AFib, MI, Infection
Multiple trauma
BCP - estrogen in pills increase clotting factors

43

PE s/s

Dyspnea, low SA02
Tachypnea
Obvious labored breathing
Chest pain
Cough
Hemopytsis
Diaphoresis
Hypotension
Tachycardia, JVD

44

Myasthenia gravis

Gradual muscular weakness
-eyes
-throat
-mouth

45

Gullian Barre

Progressive weakness of lower extremities which moves up body into chest leading to inability to breath. Is self limiting

46

ALS

*Progressive muscular weakness
Eventually affects respiratory muscles and pt quits breathing
Terminal Disease

47

Spontaneous Pneumothorax

Partial to complete collapse of the lung as a result of a ruptured bleb on the pleural lining of the lung
-Sudden onset of SOB
-Decrease or absent lung sounds
-Cough
-Sharp chest pain which may be referred to shoulder

48

Spontaneous Pneumothorax

COPD history
Young, tall, white male adults
Congenital bleb ( on lung
May be precipitated by sneeze or forceful cough

49

Atelectasis

Partial collapse of lung due to incomplete expansion, obstruction of airway or lung tissue

50

S/S of Atelectasis

Absent or diminished breath sounds
SOB
Mucous plugs
Excessive secretions
Foreign body obstruction
Splinting respirations with poor lung expansion

51

Laryngospasm

Spasm of the muscle in larynx resulting in partial or total airway obstruction

52

S/S of Laryngospasm

Stridor or air hunger
Accessory muscle use
Cyanosis
Decreased LOC
Apnea

53

causes of Laryngospasm

Upper airway inflammation (smoke inhalation)
Foreign body
Trauma
Near drowning

54

Pleurisy

Inflammation of the pleura
May or may not have effusion (fluid in pleural space)
Pain due to pleural linings (pleura) rubbing
May hear friction rub with respirations

55

s/s of Pleurisy

Sharp pain in chest or back, referred to shoulder
Fever
Dyspnea
Tachycardia
Diaphoresis
Pain increases on inhalation

56

Pneumonia

Most commonly unrecognized respiratory emergency in field
Acute inflammation of respiratory bronchioles
Spread by droplet
Viral or bacterial

57

Pneumonia s/s

Chest pain
Flu-like symptoms
Rales? or other lung sounds
May have wheezes

58

Legionnaires Disease

Acute bacterial infection
Causes pneumonia
Patients die from complications of renal failure and respiratory failure

59

Tuberculosis

Airborne disease transported by droplets
TB bacilli enter body and multiply, they usually affect the lungs but infect any part
Most commonly seen in homeless, migrants, immunilogically suppressed or jailed
*MASK THESE PATIENTS!

60

Vocal Cord Dysfunction Syndrome

swell or dilate for no reason

61

Infrared light pulse ox

SaO2

62

Red light Pulse Ox

SpO2

63

normal SAT

95-99

64

Mild hypoxia

91-94

65

Moderate hypoxia

86-91

66

Severe hypoxia

85%

67

Bronchodilators

Terbutaline (Brethine)
Metaproterenol (Alupent)
Albuterol (Proventil, Ventolin)
Isotherine (Bronkosol)

68

Corticosteroids (anti-inflammatory)

Solu-medrol
Vanceril
Azmacort
Aerobid

69

Oral or injected respiratory meds

Theophylline (theodur,slo-bid,theo-air)
Popular before inhalers
Prevents certain cells lining bronchi (mast cells) from releasing chemicals, such as histamines

70

Inspection

Assess for injury
Check Anterior & Posterior diameter
Accessory muscle use
Rate, rhythm and equality of breathing
Skins, JVD, edema

71

Palpation

Stress the skeletal structures
Check for SQ emphysema
Crepitus

72

Auscultation

Patient position
Sitting upright
Slightly forward
Shoulders rounded
Check equipment
Tap dial to check
One for heart tones, one for lung sounds

73

Muffled heart tones

*Soft and distant sounding
*Due to excessive fluid or blood in pericardial sac