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