Apneustic breathing
breathing: Damage to the pneumotaxic center in the brain (regulates inspiratory pause)
(1) Causes a short, brisk inhalation with a
... [Show More] long pause before exhalation
(2) Indicates severe pressure or direct trauma to the brain
Characteristics of Cystic Fibrosis
hereditary disease affecting the respiratory and digestive systems
ii. People with CF produce large amounts of thick mucus in the respiratory and digestive tracks.
(a) Makes them susceptible to chronic respiratory infection
(b) They often require hospitalization.
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Complications of ET tube placement
Bleeding, Hypoxia, laryngeal swelling, Laryngospasm, vocal cord damage, mucosal necrosis, barotrauma
Complications of intubating a burn patient
Laryngeal edema can develop with alarming speed.
i. Early endotracheal (ET) intubation could be lifesaving.
Complications of hyperventilation
Releases more carbon dioxide than normal
i. Results in alkalosis
Respiratory alkalosis causes numbness or tingling in the hands and feet and around the mouth.
(may lead to carpopedal spasms)
With PPV, hyperventilating patient may lead to decreased oxygenation. Hyperventilation with a BVM is harmful because it does not allow enough time for exhalation, which worsens air trapping from bronchoconstriction and can cause lung injury. Hyperventilation also increases intrathoracic pressure, which increases the workload of the heart [2]. This is especially harmful in CHF patients whose cardiac output is already compromised.
Complications of toxic inhalation
Highly water-soluble gases react with moist mucous membranes, causing swelling and irritation in the upper airway.
b. Less water-soluble gases may get deep into the lower airway, where they do damage over time.
i. Example: Phosgene and nitrogen dioxide
May lead to Atelectasis (alveolar collapse)
Congestive heart failure (CHF)
heart cannot pump fast enough or powerfully enough to empty its chambers.
left ventricle is the most commonly damaged during an AMI, as well as from chronic hypertension.
(a) The right side continues to pump normally.
(b) The left side cannot keep up, resulting in blood backup.
(c) The pressure in the left atrium and pulmonary veins increases.
(d) Serum is forced out of the pulmonary capillaries into the alveoli.
(e) Serum mixes with air to produce foam (pulmonary edema).
(f) Process results in left-sided heart failure.
Signs and symptoms include:
(a) Extreme restlessness and agitation
(b) Confusion
(c) Severe dyspnea and tachypnea
(d) Tachycardia
(e) Elevated blood pressure
(f) Crackles and wheezes
(g) Frothy pink sputum
Continuous quantitative ETCO2 wave forms
First Phase (A-B) initial stage exhalation
Point B mixture of alveolar gas with dead space, resulting sudden uprise of carbon dioxide levels
Point B-C expiratory upslope
Point C-D expiratory/alveolar plateau
Point D maximal etco2
Fresh gas introduced during inspiratory downstroke.
With bronchoconstriction, caused by asthma, COPD, and sometimes pneumonia, air is released inconsistently from the constricted lower airways. This causes the normally rectangular-shaped capnography waveform to have a "shark-fin" appearance
Indications for removal of a dual lumen airway
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Orthopneia
Shortness of breath from lying flat
Pathophysiology of COPD
Emphysema damages or destroys the terminal bronchiole structures.
i. Groups of alveoli merge into large blebs (bullae), which have less surface area for gas exchange.
ii. These branches of the tracheobronchial tree become weak and collapse during exhalation, which traps air in the alveoli.
Chronic bronchitis
defined as sputum production most days of the month for 3 or more months out of the year for more than 2 years.
i. Excessive mucus production in the bronchial tree, accompanied by chronic or recurrent productive cough
ii. Almost always a heavy cigarette smoker and usually overweight, congested, and sometimes has a bluish complexion
iii. Abnormal blood gas levels, with elevated PaCO2 (hypercapnia) and decreased PaO2 (hypoxemia)
Causes of diffuse wheezing in COPD:
i. Left-sided heart failure (cardiac asthma)
ii. Smoke inhalation
iii. Chronic bronchitis
iv. Acute pulmonary embolism
Pleural(needle) decompression
land marks: just above third rib midclavicular. if serious trauma is present to anterior. then 4th-5th intercostal space midaxillary
The immediate response to hemorrhage is______
vasoconstriction, secondary response is platelet plugging
Upper GI bleed
-Coffee-ground emesis is vomiting of dark brown, granular material that resembles coffee grounds. It results from upper GI bleeding that has slowed or stopped, with conversion of red Hb to brown hematin by gastric acid
-Hematemesis is vomiting of red blood and indicates upper GI bleeding, usually from a peptic ulcer,vascular lesion, or varix
-Melena is black, tarry stool and typically indicates upper GI bleeding, but bleeding from a source in the small bowel or right colon may also be the cause. [Show Less]