Respiratory distress

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CPR
Forth Year

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Respiratory distress

  1. 1. VI RESPIRATORY DISTRESS
  2. 2. General considerations TERMS  PaO2 arterial O2 tension [ 75 torr ]  Hypoxia……….decr O 2  Anoxia……….absence of O2  normal respiratory rate …….16-18  Hypoventilation……..slow ventilation  Apnea…………no respiratory movem 
  3. 3. RESPIRATORY DISTRESS
  4. 4. Tachypnea…….increase Resp Rate  Hyperpnea……increase venti ie ^ depth[than normal] but just meets the demands.  Hyperventilation……. Increase venti than needs…………O2 level ^^^ …  Dyspnea……….difficulty in breathing  Orthopnea…….. difficulty in breathing in recumbent [not in upright ]   PaCO2 partial arterial CO2 tension [ 45 ]
  5. 5. Causes of respiratory distress Hyperventilation  Vasodepressor syncope  Asthma  Heart failure  Acute myocardial infarction  Hypoglycemia  Overdose reaction 
  6. 6. Hyperventilation Vasodepressor syncope Asthma Heart failure Acute myocar infarction Hypoglycemia Overdose reaction
  7. 7. GENERAL Management           1-recognition of respiratory distress 2-terminate dent proc 3-p: depend on patient some feels better on upright post if patient is unconsc………supine position 4-A, B,C 5-definitive care monitor vital signs ttt of anxiety Ttt pf respiratory problems
  8. 8. AIRWAY OBSTRUCTION         CAUSES: Foreign body……meat….large, alcohol, talk In dent a foreign body--Oral c ---- -pharynx-- > -RESP TR------as ex hand piece, head of mouth mirror ;gold crowns Congenital defects of airway Infections : epiglottitis , tonsillitis , Ludwig’s angina Trauma Tumors
  9. 9. Hand piece Head of m mirror crowns
  10. 10. prevention when Objects- usually …> G I T……. complications  rare-- bronchi ---respir complications         TO AVOID ASPIRATION & RESP COMP MANY MEASURES CAN BE USED A)RUBBER DAM B)ORAL PACKING C)POSITION D) assistant care E) suction, Magill intubation forceps F) ligature
  11. 11. RUBBER DAM
  12. 12. ORAL PACKING PHARYNGEAL CURTAIN
  13. 13. POSITION PATIENT TURN TO ONE SIDE HEAD- DOWN POSITION
  14. 14. Magill intubation forceps
  15. 15. Hemostats & Cotton pliers are not suitable for removal of objects
  16. 16. Management of airway obstruc N B important general points……  If object falls in air passage don’t allow the patient to sit up  recline the chair backwards….  do X –ray for chest & abdomen  put him in left lateral decubitus position with head down  encourage coughing  If object still not removed -emergency fibroptic bronchoscope  If failed --------thoracotomy
  17. 17. left lateral decubitus position with head down
  18. 18. Management of airway obstruc R-recognition of airway obst see if complete airway obst or incomplete        COMPLETE airway obst : sign of compl airway obst inability to speak inability to breathe inability to cough universal sign for choking
  19. 19. UNIVERSL sign for choking
  20. 20. universal sign for choking
  21. 21. If obst is relieved in 4-5 min ----normal  after 2-5m-----loss of consc  More 4------blood pr & pulse  disappear
  22. 22.  sign of partial airway obst Forceful cough  Wheezing  Crowing sound on inspiration  With more obst  absent voice sounds  Cyanosis  Lethargy  disorientation 
  23. 23. After R-recognition of airway obst  T-terminate dental ttt  P-supine … feet slightly elevated  A B C ……>>>>>  BASIC AIRWAY MANEUVERS
  24. 24. BASIC AIRWAY MANEUVERS B L S A- Air way opening by... head tilt-chin lift … This will open the airway obst… if tongue is the cause of the obstruction …. Or do jaw thrust maneuver if ……  B- Breathing care by… look listen &feel technique ….. in which rescuer put his ear near mouth & nose of patient & listens &feels for air exchange  and if airway is still obstructed 
  25. 25. Head tilt- chin lift technique
  26. 26. jaw thrust maneuver
  27. 27. look listen & feel technique
  28. 28. this may be due to foreign body …………… ***Try to remove this foreign body by  - abdominal thrust [ Heimlich],  chest thrust  back blow,  finger sweep  ****-if failed above & the object is at higher level …….> do emergency airway opening  by a-tracheostomy  b- cricothyrotomy 
  29. 29. abdominal thrust [ Heimlich],
  30. 30. -abdominal thrust , Preparing position
  31. 31. abdominal thrust [ Heimlich],
  32. 32. abdominal thrust [ Heimlich], patient on floor
  33. 33. abdominal thrust [ Heimlich ], rescuer aside
  34. 34. abdominal thrust [ Heimlich], in dental chair
  35. 35. chest thrust
  36. 36. chest thrust
  37. 37. finger sweep
  38. 38. b-cricothyrotomy
  39. 39. Hyperventilation          Means excess ventil more than required to maintain Pa O2 & PaCO2 there may be increase in rate of resp or depth or both Causes -pain………stress -acidosis -drugs Hypercapnea Cirrhosis CNS disorders
  40. 40. Signs & symptoms C V S: palpitation, tachycardia , pain  CNS : dizziness , disturbed consc or vision  RESPIR : short [ may in stress conditions] rapid breath, pain  GIT : pain  Musc : tremors, carpopedal tetany, stiffness  PSYCHIC :tension, anxiety 
  41. 41. main Predisposing factor :  stress……… PREVENTION  MEDICAL HIST  PHYSICAL EXAMIN  DENTAL CONSIDERATIONS  stress reduction 
  42. 42. management      1-R 2 -terminate dent proc….. remove dental materials 3-p MAY in upright posit to help respiration 4-A, B,C 7-definitive care     calm patient…….. Drug as diazepam ttt resp alkalosis
  43. 43. ASTHMA  Defin : paroxysmal attacks of difficult breathing ,tightness,& impending suffocation without fever…… Commoner in young people  Cause  may allergy  respir infections  physical exertion 
  44. 44. types I-----Extrinsic asthma [allergic ] more in children…. allergens ---- type I hypersensitivity  II------intrinsic asthma [ non allergic ] more in olders…. resp infect -develop of sympt  III------Mixed asthma : involved I & II  IV-----Status asthmaticus: not respond to 2-3 doses of B- adrenergic drugs 
  45. 45. Clinical picture Sympt& signs  cough  wheezing  dyspnea  tachpnea  active accessory ms of respiration  cyanosis  incr blood pressure 
  46. 46. Position in asthema
  47. 47. prevention History  Dental consideration  in acute attack avoid stress  use sedatives  avoid barbit &opium  avoid aspirrin [ aspirin asthma]  avoid sulfur dioxides as preservatives , local anesthesia 
  48. 48. MANAGEMENT OF ASTHMA           1R 2- terminate dent proc remove all dental material & instruments 3-p depend on patient 4-A, B,C 7-definitive care calm the patient………. bronchodilator as … adrenaline isuprel 8-subsequent dental care
  49. 49. bronchodilator as isuprel

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