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The Respiratory System
 

The Respiratory System

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    The Respiratory System The Respiratory System Presentation Transcript

    • The Respiratory System Emergency Medical Technician - Basic dr shabeel pn www.hi-dentfinishingschool.blogspot.com
    • Respiratory System Purpose
      • Takes in oxygen
      • Disposes of wastes
        • Carbon dioxide
        • Excess water
      O 2 + Glucose CO 2 + H 2 O The Cell
    • Respiratory System Anatomy Nasopharynx Oropharynx Epiglottis Larynx Trachea Bronchi Bronchioles Carina
    • Respiratory System Anatomy
      • Lung
        • Right lung 3 lobes
        • Left lung 2 lobes
    • Respiratory System Anatomy
      • Bronchioles
        • Smallest airways
        • Walls consist entirely of smooth muscle (no cartilage present)
        • Constriction increases resistance to airflow
        • Dilation reduces resistance to airflow
    • Respiratory System Anatomy
      • Alveoli
        • Air sacs
        • Site of oxygen and carbon dioxide exchange with blood
    • Respiratory System Anatomy
    • Respiratory System Anatomy
      • Diaphragm
    • Respiratory System Anatomy
      • Pleura
        • Double-walled membrane
        • Visceral layer covers lung
        • Parietal layer lines inside of chest wall, diaphragm
    • Respiratory System Physiology Inspiration Active process Chest cavity expands Intrathoracic pressure falls Air flows in until pressure equalizes Expiration Passive process Chest cavity size decreases Intrathoracic pressure rises Air flows out until pressure equalizes
    • Respiratory System Physiology
        • Automatic Function
          • Primary drive: increase in arterial CO 2
          • Secondary (hypoxic) drive: decrease in arterial O 2
      Normally we breathe to remove CO 2 from the body, NOT to get oxygen in
    • Respiratory Pathophysiology
      • Airway (Obstruction)
        • Tongue
        • Foreign body airway obstruction
        • Anaphylaxis/angioedema
        • Upper airway burn
        • Maxillofacial/laryngeal/ tracheobronchial trauma
        • Epiglottitis
        • Croup
        • Aspiration
        • Asthma
        • Chronic Obstructive Airway Disease
          • Emphysema
          • Chronic bronchitis
    • Respiratory Pathophysiology
      • Gas Exchange Surface (Blood Flow or Gas Diffusion)
        • Pulmonary Edema
          • Left-sided heart failure
          • Toxic inhalations
          • Near drowning
        • Pneumonia
        • Pulmonary Embolism
          • Blood clots
          • Amniotic fluid
          • Fat embolism
    • Respiratory Pathophysiology
      • Thoracic Bellows (Ventilation)
        • Chest Trauma
          • Simple rib fractures
          • Flail chest
          • Pneumothorax
          • Hemothorax
          • Sucking chest wound
          • Diaphragmatic hernia
        • Pleural effusion
        • Spinal cord trauma (High C-spine lesion)
        • Morbid obesity
        • Neurological/neuro-muscular disease
          • Poliomyelitis
          • Myasthenia gravis
          • Muscular dystrophy
          • Guillian-Barre syndrome
    • Respiratory Pathophysiology
      • Control System (Decreased Respiratory Drive)
        • Head trauma
        • CVA
        • Depressant drug toxicity
          • Narcotics
          • Sedative-hypnotics
          • Ethyl alcohol
    • Respiratory Assessment
      • Initial Assessment (A, B, C, D)
      • Manage life threats
      • Complete focused history and physical
    • Initial Assessment
      • Airway
        • Listen to patient breathe, talk
          • Noisy breathing is obstructed breathing
          • But all obstructed breathing is not noisy
          • Snoring = Tongue blocking airway
          • Stridor = “Tight” upper airway from partial obstruction
    • Initial Assessment
      • Airway
        • Anticipate airway problems with
          • Decreased LOC
          • Head trauma
          • Maxillofacial trauma
          • Neck trauma
          • Chest trauma
      OPEN—CLEAR—MAINTAIN
    • Initial Assessment
      • Breathing
        • Is patient moving air?
        • Is air moving adequately?
        • Is the patient’s blood being oxygenated?
    • Initial Assessment
      • Breathing
        • LOOK
          • Symmetry of chest expansion
          • Increased respiratory effort
          • Changes in skin color
        • LISTEN
          • Air movement at mouth, nose
          • Air Movement in peripheral lung fields
        • FEEL
          • Air movement at mouth, nose
          • Symmetry of chest expansion
        • RATE
          • Tachypnea
          • Bradypnea
        • POSITIONING
          • Orthopnea
          • Tripod position
    • Initial Assessment
      • Breathing
        • Signs of respiratory distress
          • Nasal flaring
          • Tracheal tugging
          • Retractions
          • Neck, pectoral muscle use on inhalation
          • Abdominal muscle use on exhalation
        • Skin Color
          • Pale, cool moist skin (Early sign of hypoxia)
          • Cyanosis (Late, unreliable sign of hypoxia)
    • Initial Assessment
      • Breathing
        • If trauma patient has compromised breathing, bare chest, assess for:
          • Open pneumothorax
          • Flail chest
          • Tension pneumothorax
    • Respiratory Assessment
      • Circulation
        • Is heart beating?
        • Is there major external hemorrhage?
        • Is patient perfusing?
        • Effects of hypoxia:
          • Adults (early): tachycardia
          • Adults (late): bradycardia
          • Children: bradycardia
    • Initial Assessment
      • Circulation
        • Don’t let respiratory failure distract you from assessing for circulatory failure
        • Low oxygen or high carbon dioxide levels can depress cardiovascular function
    • Respiratory Assessment
      • Disability
        • Restlessness, anxiety, combativeness = hypoxia Until proven otherwise
        • Drowsiness, lethargy = hypercarbia Until proven otherwise
      Just because the patient stops fighting, he’s not necessarily getting better!!!
    • Initial Management
      • Patient Responsive/Breathing Adequate
        • Oxygen may be indicated
        • Oxygenate immediately if patient has:
          • Decreased level of consciousness
          • Possible shock
          • Possible severe hemorrhage
          • Chest pain
          • Chest trauma
          • Respiratory distress or dyspnea
          • History of any kind of hypoxia
    • Initial Management
      • Patient responsive, breathing inadequate
        • Open/maintain airway
        • Place nasopharyngeal airway
        • Assist ventilations
          • Mouth to Mask
          • 2-person Bag-valve Mask
          • Manually Triggered Ventilator
          • 1-person Bag-valve Mask
    • Initial Management
      • Patient unresponsive, breathing adequate
        • Open/maintain airway
        • Place nasopharyngeal or oropharyngeal airway
        • Suction airway as needed
        • Provide oxygen by non-rebreather mask
        • Frequently reassess
    • Initial Management
      • Patient unresponsive, breathing inadequate
          • Open/maintain airway
          • Place nasopharyngeal or oropharyngeal airway
          • Suction airway as needed
          • Assist ventilations
            • Mouth to Mask
            • 2-person Bag-valve Mask
            • Manually Triggered Ventilator
            • 1-person Bag-valve Mask
          • Frequently reassess
    • Initial Management
      • Patient not breathing
        • Open airway
        • Place nasopharyngeal or oropharyngeal airway
        • Ventilate patient
          • Mouth-to-Mask
          • 2-Person Bag-Valve Mask
          • Manually Triggered Ventilator
          • 1-Person Bag-Valve Mask
        • Frequently reassess
    • Initial Management
      • Golden Rules
        • If you think about giving O 2 , give it!!!
        • If you decide to give oxygen, give a lot of it!!!
        • If you can’t tell whether a patient is breathing adequately, he isn’t !
        • If you’re thinking about assisting a patient’s breathing, you probably should be!
    • Focused History and Physical
      • Chief Complaint
        • Dyspnea
          • Subjective sensation that breathing is excessive, difficult, or uncomfortable
        • Respiratory Distress
          • Objective observations that indicate breathing is difficult or inadequate
    • Focused History and Physical
      • History of Present Illness (OPQRST)
        • Gradual or sudden onset?
        • What aggravates or alleviates?
        • How long has dyspnea been present?
        • Coughing? Productive cough?
        • What does sputum look/smell like?
        • Pain present? What does pain feel like? How bad? Does it radiate? Where?
    • Focused History and Physical
      • Past History
        • If Then???
        • Hypertension, MI, Diabetes CHF with Pulmonary Edema
        • Chronic Cough , Smoking, COPD
        • “ Recurrent” Flu
        • Allergies, Acute Episodes of SOB Asthma
        • Lower Extremity Trauma, Pulmonary Embolism
        • Recent Surgery, Immobilization
    • Focused History and Physical
      • Medications
        • If Then???
        • “ Breathing” Pills, Inhalers Asthma or COPD
        • Albuterol Montelukast
        • Aminophylline Oxtriphylline
        • Ipratropium Cromolyn
        • Terbutaline Prednisone
        • Salbumatol
        • Zafirlukast
    • Focused History and Physical
      • Medications
        • If Then???
      • Lasix, hydrodiuril, digitalis CHF
      • Coumadin, BCP’s Pulmonary embolism
    • Focused History and Physical Exam
      • Crackles (Rales)
        • Fine, “crackling”
        • Fluid in smaller airways, alveoli
      • Rhonchi
        • Coarse, “rumbling”
        • Fluid, mucus in larger airways
      • Stridor
        • High pitched, “crowing”
        • Upper airway restriction
      • Wheezing
        • “ Whistling”
        • Usually more pronounced on exhalation
        • Generalized: narrowing, spasm of the smaller airways
        • Localized: foreign body aspiration
    • Mild Breathing Difficulty
      • May be hypoxic
      • Can move adequate tidal volume
      • Can answer questions, speak in complete sentences, is alert
      • High concentration O 2 by non-rebreather mask
      • Consider bronchodilators if patient wheezing
    • Moderate Breathing Difficulty
      • May be hypoxic
      • May be moving adequate tidal volume
      • Having difficulty answering questions, speaks in choppy sentences, is restless/irritable
      • High concentration O 2 by non-rebreather mask
      • Get ready to assist ventilations if needed (patient may resist assistance at this time)
      • Consider bronchodilators if patient wheezing
    • Severe Breathing Difficulty
      • Getting sleepy
      • Not speaking or speaking with very few words
      • Previously wild, now seems “cooperative”
      • Assist ventilations with BVM and oxygen
      • Time BVM ventilation with patient’s ventilatory efforts
      • Interpose extra ventilations if necessary