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99 Cards in this Set

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What is the most important factor in the development of respiratory disorders?
Genetic predisposition
What is the most important external factor in the development of respiratory disorders?
Smoking
Define COPD
Chronic Obstructive Pulmonary Disease; a disease characterized by a decreased ability of the lungs to perform the funtion of ventilation
What are the processes involved in gas exchange?
Ventilation
Diffusion
Perfusion
Define ventilation
The mechanical process of moving air in and out of the lungs
Define diffusion
The movement of molecules through a membrane from an area of greater concentration to an area of lesser concentration
What is the normal oxygen concentration of oxygen in the alveoli?
104mmHg
What is the normal oxygen concentration in the pulmonary arterial circulation?
40mmHg
What is the normal carbon dioxide concentration in the pulmonary capillaries?
45mmHg
What is the normal concentration of carbon dioxide in the alveoli?
40mmHg
What is the normal measurement of the respiratory membrane?
0.5-1.0 micrometers
The concentration gradient provides the driving force in moving oxygen to where?
Capillaries
The larger the difference between the concentration of oxygen in the _______________ and the _________________________, the greater the diffusion of oxygen into the bloodstream.
alveoli, capillaries
Define perfusion
The circulation of blood through the capillaries
Define hemoglobin
The transport protein that carries oxygen in the blood
Adequate perfusion is dependent on what 3 conditions?
Adequate blood volume
Intact pulmonary capillaries
Efficient pumping of blood by the heart
What are the two ways in which oxygen is transported into the bloodstream?
Bound to hemoglobin or dissolved in plasma
Describe the oxygen dissociation curve.
As oxygen binds to hemoglobin, the structure changes so that it more readily binds additional oxygen molecules and as the hemoglobin releases the oxygen molecules, it more readily sheds additional oxygen
Define respiration
The exhange of gases between a living organism and its environment
Disease states that affect the ___________ respiratory tract will result in obstruction of air flow to the ___________ structures.
upper, lower
Traumatic injury to the chest wall or diapraghm will disrupt the normal mechanics and cause what in the pleural space?
Loss of negative pressure which will allow air to enter
True or false: Certain neuromuscular diseases, such as muscular dystrophy, multiple sclerosis, or amyotrophic sclerosis(ALS or Lou Gehrig's Disease) impair muscular function so as to limit the ability to generate a negative pressure within the chest cavity.
True
Define pneumothorax
A collection of air in the pleural space, causing a loss of the negative pressure that binds the lung to the chest wall
Define open pneumothorax
Air enters the pleural space through an injury to the chest wall
Define closed pneumothorax
Air enters the pleural space through an opening in the pleura that covers the lung
Define tension pneumothorax
Air in the pleural space cannot escape, causing a build-up of pressure and collapse of the lung
Define hemothorax
A collection of blood in the pleural space
Define flail chest
One or more ribs fractured in two or more places, creating an unattached rib segment
Describe Cheyne-Stokes respirations
Progressively increasing tidal volume, followed by declining volume, separated by period of apnea. Typically seen in older pts with terminal illness of brain injury.
Describe Kussmaul's respirations
Deep, rapid breaths that results as a corrective measure against conditions such as DKA that produce metabolic acidosis
Describe Central Neurogenic Hyperventilation
Deep rapid respirations that are caused by strokes or injury to the brainstem. In this case there is a loss of normal regulation of ventilatory controls and respiratory alkalosis is often seen.
Define Ataxic (Biot's) respirations
Repeated episodes of gasping ventilations separated by periods of apnea. Seen in pts with increased ICP.
Define Apneustic respiration
Long, deep breaths that are stopped during the inspiratory phase and separated by periods of apnea. Results from stroke or severe central nervous system disease.
What are the major peripheral nerves that supply the diaphragm and intercostal muscles?
The phrenic and intercostal nerves
Any change in the concentration of oxygen in the alveoli can limit the diffusion of oxygen and produce _______________.
hypoxia
Define hypoxia
State in which insufficient oxygen is available to meet the oxygen requirements of the cell.
True or false: Not all diseases that alter the structure or patency of the alveoli will limit diffusion.
False. Any disease that that causes an alteration will limit diffusion.
True or false: Disease states that alter the thickness of the respiratory membrane will limit the diffusion of gases.
True
What is the most common cause of thickening of the respiratory membrane?
Accumulation of fluid and inflammatory cells in the interstitial space.
True or false: Fluid can accumulate in the interstitial space if high pressure within the pulmonary capillaries forces fluid out of the circulatory system.
True
Increased interstitial fluid is seen in pts with ___________-sided heart failure (cardiogenic causes) and s due to _____________________venous pressure as a result of poor functioning of the ____________ ventricle.
left, increased, left
What is the major transport protein for oxygen and plays a significant role in the elimination of carbon dioxide?
Hemoglobin
Any reduction in the normal circulating hemoglobin will affect _______________.
perfusion
Define pulmonary shunting
When an area of lung tissue is appropriately ventilated but no capillary perfusion occurs and available oxygen is not moved into the circulatory system.
When approaching a scene what are two questions to consider?
Is the scene safe?
Are there visual cues to the pts medical complaint?
What are 3 aspects of your general impression of respiratory status in pts?
Position
Color
Mental status
Ability to speak
Respiratory effort
Define pallor
Paleness
Define diaphoresis
Sweatiness
Define cyanosis
Bluish discoloration of the skin due to an increase in reduced hemoglobin in the blood. The condition is directly related to poor ventilation.
Define nasal flaring
Excessive widening of the nares with respiration
What are 3 signs of respiratory distress?
Nasal flaring
Intercostal muscle retraction
Use of accessory respiratory muscles
Cyanosis
Pursed lips
Tracheal tugging
Define tracheal tugging
Retraction of the tissues of the neck due to airway obstruction or dyspnea
True or false: Most significant abnormalities in the respiratory tract must be viewed as potentially life-threatening.
False. All significant abnormalities are considered life-threatening.
Define asphyxia
A decrease in the amount of oxygen and an increase in the amount of carbon dioxide as a result of some interference with respiration.
What are several life threatening respiratory findings? (Answers listed in order from most ominous to least severe)
Alterations in mental status, Severe central cyanosis, Absent breath sounds
Audible stridor, 1-to-2 word dyspnea
Tachycardia >or= 130, Pallor and diaphoresis, Intercostal and sternocleidomastoid retractions, Use of accessory muscles
Define dyspnea
Difficult or labored breathing; sensation of "shortness of breath"
Define tachycardia
Rapid heart rate
Define orthopenea
Dyspnea while lying supine
Define paroxysmal nocturnal dyspnea
Short attacks of dyspnea that occur at night and interrupt sleep
Define hemoptysis
Expectoration of blood from the respiratory tree
Define crepitus
Crackling sounds
Define subcutaneous emphysema
Presence of air in teh subcutaneous tissue
Define tactile fremitus
Vibratory tremors felt through the chest by palpation
Define tracheal deviation
Any position of the trachea other than midline
What are the 3 types of normal breath sounds?
Bronchial (tubular)
Bronchovesicular
Vesicular
Describe bronchial (tubular) breath sounds
Loud, high-pitched sounds over the trachea
Expiratory phase longer than inspiratory phase
Describe bronchovesicular breath sounds
Softer, medium-pitched sounds over the mainstem bronchi (below clavicles or between scapulae)
Expiratory and inspiratory phases equal
Describe vesicular breath sounds
Soft, low-pitched sounds heard over the lung periphery
What are 3 types of abnormal breath sounds?
Snoring
Stridor
Wheezing
Rhonchi
Crackles (rales)
Pleural friction rub
What is one of the earliest indicators of respiratory disease?
Respiratory rate
Assume that an elevated respiratory rate in a pt with dyspnea is caused by _______________. A persistently slow rate indicates impending respiratory arrest.
hypoxia
Define pulsus paradoxus
A drop in the systolic blood pressure of 10 mmHg or more with each respiratory cycle
Clubbing fingers is a good indicator of what?
Long-standing hypoxemia, typical of pts with COPD or cyanotic heart disease
Define tachypnea
Rapid respirations
Define bradypnea
Slow respirations
What are 3 prehospital diagnostic tests for assessing pts respiratory status?
Pulse oximetry
Peak flow
Capnometry
What is measured by pulse oximetry?
Oxygen saturation (SaO2)
What is measured by capnometry?
Carbon dioxide at the end of the expiratory phase
What are 3 common causes of airway obstructions?
Tongue
Foreign matter
Trauma
Burns
Allergic reaction
Infection
Define Adult Respiratory Distress Syndrome (ARDS)
Form of pulmonary edema that is caused by fluid accumulating in the interstitial space within the lungs
In ARDS, fluid accumulation occurs as the result of ____________________ vascular permeability and ___________________ fluid removal from the lung tissue.
increased, decreased
What is the pathophysiology for ARDS?
ARDS is a disorder of lung diffusion that results from increased fluid in the interstitial space. Results in the inability to maintain proper fluid balance in the interstitial space.
Clinical symptoms of ARDS are related to the ________________________ ____________.
underlying cause
What is the hallmark treatment for ARDS pts?
Management of the pts underlying condition
Define Positive End-Expiratory Pressure (PEEP)
A method of holding the alveoli open by increasing expiratory pressure
What are the 3 most common obstructive lung diseases encountered in the prehospital setting?
Emphysema
Chronic bronchitis
Asthma
What is the pathophysiolohy of emphysema?
Gradual destruction of the walls of the alveoli which decreases the alveolar membrane surface area, thus lessening the area available for gas exchange.
Define Cor pulmonale
Hypertrophy of the right ventricle resulting from disorders of the lung
Define polycythemia
An excess of red blood cells
Define blebs
Destroyed lung tissue
Is emphysema associated with a cough?
Rarely, except in the morning
Emphysema pts usually have a ______________ chest and are often thin. Often called "________ ______________" because they have a pink color.
barrel, pink puffers
What is the pathophysiology for chronic bronchitis?
Gas exchange is decreased because there is lowered alveolar ventilation, which leads to hypoxia and hypercarbia. May lead to polycythemia, pulmonary HTN, cor pulmonale, and decreased vital capacity.
True or false: In emphysema, PaCO2 increases and becomes chronically elevated, forcing the body to depend on the hypoxic drive to control respirations.
True
In chronic bronchitis and emphysema, what are the 2 main management goals?
Relieve hypoxia
Reverse bronchoconstriction
What is the pathophysiology of asthma?
Chronic inflammatory disorder of the airways. Airways become hyperresponsive. 2-phase reaction; 1)release of chemical mediators such as histamine (results in constriction and edema; responds to inhaled beta-agonists) 2)does not respond to inhalants
What are 3 common presenting signs of asthma?
Dyspnea
Wheezing
Coughing
What are the 3 main goals in management of asthma?
Correct hypoxia
Reverse bronchospasm
Reduce inflammation
Define status asthmaticus
Severe, prolonged asthma attack that cannot be broken by repeated doses of bronchodilators