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Pulmonology part 2 resp diseases
- 2. Management of Respiratory Disorders Basic Principles: Maintain the airway. Protect the cervical spine if trauma is suspected. Any patient with respiratory distress should receive oxygen. Any patient suspected of being hypoxic should receive oxygen. Oxygen should never be withheld from a patient suspected of suffering from hypoxia.
- 3. UpperAirway Obstruction Common Causes Tongue, foreign matter, trauma, burns Allergic reaction, infection Assessment Differentiate cause Persistent increases in ETCO2 levels Management Conscious Patient If the patient is able to speak, encourage coughing. If the patient is unable to speak, perform abdominal thrusts.
- 4. UpperAirway Obstruction Unconscious Patient Open the airway. Attempt to give two ventilations. If ventilations fail, reposition the head and reattempt. Administer chest compressions.
- 5. UpperAirway Obstruction Unconscious Patient Attempt finger sweeps if foreign body is visualized. If foreign body is removed, resume ventilation. If unsuccessful, continue abdominal thrusts and sweeps. Visualize the airway with the laryngoscope. Remove foreign body with Magill forceps and resume ventilations.
- 7. Adult Respiratory Distress Syndrome Accumulation of pulmonary edema that is caused by fluid accumulation in the interstitial space within the lungs The result of increased vascular permeability Decreased fluid removal
- 8. Adult Respiratory Distress Syndrome Sepsis Aspiration Pneumonia Pulmonary Injury Burns/Inhalation Injury OxygenToxicity Drugs High Altitude Hypothermia Near-Drowning Syndrome Head Injury Pulmonary Emboli Tumor Destruction Pancreatitis
- 9. Adult Respiratory Distress Syndrome Pathophysiology High Mortality Multiple Organ Failure Affects Interstitial Fluid Causes increase in fluid in the interstitial space; disrupts diffusion and perfusion Assessment Symptoms Related to Underlying Cause Dyspnea, confusion, agitation Abnormal breath sounds Crackles (rales)
- 10. Adult Respiratory Distress Syndrome Management Manage the underlying condition Provide supplemental oxygen Support respiratory effort Provide positive pressure ventilation if respiratory failure is imminent PEEP Monitor cardiac rhythm and vital signs Consider medications Corticosteroids
- 11. Obstructive Lung Disease Types: Emphysema Chronic Bronchitis Asthma Causes: Genetic Disposition Smoking and Other Risk Factors
- 12. Emphysema Pathophysiology Exposure to Noxious Substances • Destruction of the walls of the alveoli • Increase residual volume • Altered respiratory drive
- 13. Emphysema Assessment History Recent weight loss Dyspnea with exertion Cigarette and tobacco usage Lack of Cough
- 14. Emphysema Assessment Physical Exam • Barrel chest • Prolonged expiration and rapid rest phase • Thin • Pink skin due to extra red cell production • Hypertrophy of accessory muscles • “Pink Puffers” © Ray Kemp/911 Imaging
- 15. Chronic Bronchitis Pathophysiology Results from an increase in mucus-secreting cells in the respiratory tree Alveoli relatively unaffected Decreased alveolar ventilation Assessment History Frequent respiratory infections Productive cough “Blue-Bloater”
- 16. Chronic Bronchitis Physical Exam Often overweight Rhonchi present on auscultation Jugular vein distention Ankle edema Hepatic congestion
- 17. Bronchitis and Emphysema Management Maintain airway CPAP Support breathing Monitor oxygen saturation Be prepared to ventilate or intubate Monitor cardiac rhythm Establish IV access Administer medications Bronchodilators and corticosteroids
- 18. Asthma Pathophysiology Chronic Inflammatory Disorder Results in widespread but variable air flow obstruction The airway becomes hyperresponsive Induced by a trigger, which can vary by individual Causes release of histamine, causing bronchoconstriction and bronchial edema 6–8 hours later, immune system cells invade the bronchial mucosa and cause additional edema
- 19. Asthma Assessment Identify immediate threats One-to-two-word dyspnea, pulsus paradoxus, tachycardia, and decreased oxygen saturation Obtain history SAMPLE and OPQRST History History of asthma-related hospitalization? History of respiratory failure/ventilator use?
- 20. Asthma Physical Exam Presenting signs may include dyspnea, wheezing, and cough. Wheezing is not present in all asthmatics. Speech may be limited to 1–2 consecutive words. Look for hyperinflation of the chest and accessory muscle use. Carefully auscultate breath sounds and measure peak expiratory flow rate.
- 21. Asthma Physical Exam Capnography in Asthma • “Shark Fin” waveform on the capnograph
- 22. Asthma Management Treatment goals: Correct hypoxia Reverse bronchospasm Reduce inflammation Maintain the airway Support breathing High-flow, high-concentration oxygen or assisted ventilations as indicated
- 23. Asthma Monitor cardiac rhythm Establish IV access Administer medications: Beta-agonists Ipratropium bromide Corticosteroids
- 24. Special Cases of Asthma Status Asthmaticus A severe, prolonged attack that cannot be broken by bronchodilators Greatly diminished breath sounds Recognize imminent respiratory arrest Aggressively manage airway and breathing Transport immediately Asthma in Children Pathophysiology and management similar Adjust medication dosages as needed
- 25. Upper Respiratory Infection (URI) Upper Respiratory Infections Frequent patient complaint Common pediatric complaint Rarely life threatening Pathophysiology Frequently caused by viral and bacterial infections Affect multiple parts of the upper airway Typically resolve after several days of symptoms
- 26. Upper Respiratory Infection (URI) Assessment Look for underlying illness Evaluate pediatrics for epiglottitis Management Maintain the airway Support breathing Treat signs and symptoms
- 27. Pneumonia Infection of the Lungs Pathophysiology Bacterial andViral Infections Hospital-acquired vs. community-acquired Infection can spread throughout lungs Alveoli may collapse, resulting in a ventilation disorder
- 28. Pneumonia Assessment Focused History and Physical Exam SAMPLE and OPQRST Recent fever, chills, weakness, and malaise Deep, productive cough with associated pain Tachypnea and tachycardia may be present Breath sounds: Presence of crackles in affected lung segments Decreased air movement in the affected lung
- 29. Pneumonia Management Maintain the airway Support breathing High-flow, high-concentration oxygen or assisted ventilation as indicated Monitor vital signs Establish IV access Avoid fluid overload Medications Antibiotics, antipyretics, beta-agonists
- 30. Lung Cancer Pathophysiology General The primary problem is disruption of diffusion May also be alterations in ventilation by obstruction Majority are caused by carcinogens secondary to cigarette smoking or occupational exposure May start elsewhere and spread to lungs High mortality
- 31. Lung Cancer Assessment Focused History and Physical Exam SAMPLE and OPQRST History Cancer-related treatments and hospitalizations Physical Exam Evaluate for severe respiratory distress Management Follow general principles Administer oxygen, support ventilation Provide emotional support
- 32. Toxic Inhalation Pathophysiology Includes inhalation of heated air, chemical irritants, and steam Airway obstruction due to edema and laryngospasm due to thermal and chemical burns Assessment Focused History and Physical Exam SAMPLE and OPQRST History Determine nature of substance Length of exposure and loss of consciousness
- 33. Toxic Inhalation Management Ensure scene safety Enter a scene only if properly trained and equipped Remove the patient from the toxic environment Maintain the airway Early, aggressive management may be indicated Support breathing Establish IV access Transport promptly
- 34. Carbon Monoxide Inhalation Carbon Monoxide Odorless, Colorless Gas Results from the combustion of carbon-containing compounds Often builds up to dangerous levels in confined spaces such as mines, autos, and poorly ventilated homes Suicide attempts Hazardous to firefighters and rescue personnel
- 35. Carbon Monoxide Inhalation Pathophysiology Binds to Hemoglobin Prevents oxygen from binding and creates hypoxia at the cellular level Carboxyhemoglobin Assessment Focused History and Physical Exam SAMPLE and OPQRST History Determine source and length of exposure Presence of headache, confusion, agitation, lack of coordination, loss of consciousness, and seizures
- 36. Carbon Monoxide Inhalation Management • Ensure scene safety • Enter a scene only if properly trained and equipped • Remove the patient from the toxic environment • Maintain the airway • Support breathing • Establish IV access • Transport promptly © Scott Metcalfe
- 37. Pulmonary Embolism Pathophysiology Obstruction of a Pulmonary Artery Emboli may be of air, thrombus, fat, or amniotic fluid Foreign bodies may also cause an embolus Risk Factors Recent surgery, long-bone fractures, pregnancy, postpartum, oral contraceptive use, tobacco use
- 38. Pulmonary Embolism Assessment Focused History and Physical Exam SAMPLE and OPQRST History Presence of risk factors Sudden onset of severe dyspnea and pain Cough, often blood-tinged Physical Exam Signs of heart failure, including JVD and hypotension Warm, swollen extremities
- 39. Pulmonary Embolism Management Maintain the airway Support breathing High-flow, high-concentration oxygen or assist ventilations as indicated Intubation may be indicated Establish IV access Monitor vital signs closely Transport to appropriate facility
- 40. Spontaneous Pneumothorax Pathophysiology Pneumothorax Occurs in the absence of blunt or penetrating trauma Risk Factors Assessment Focused History SAMPLE and OPQRST history Presence of risk factors Rapid onset of symptoms Sharp, pleuritic chest or shoulder pain Often precipitated by coughing or lifting
- 41. Spontaneous Pneumothorax Assessment (cont.) Physical Exam: Decreased or absent breath sounds on affected side Tachypnea, diaphoresis, and pallor Management Maintain the airway Support breathing Monitor for tension pneumothorax Pleural decompression may be indicated if patient becomes cyanotic, hypoxic, and difficult to ventilate JVD and tracheal deviation away from the affected side
- 42. Hyperventilation Syndrome Characterized by rapid breathing, chest pains, numbness, and other symptoms Associated with anxiety or situational activity Many serious medical problems can cause hyperventilation
- 43. Hyperventilation Syndrome Assessment Focused History and Physical Exam SAMPLE and OPQRST History Fatigue, nervousness, dizziness, dyspnea, chest pain Numbness and tingling in hands, mouth, and feet Presence of tachypnea and tachycardia Spasms of the fingers and feet
- 44. Hyperventilation Syndrome Management Maintain the airway Support breathing Provide high-flow, high-concentration oxygen or assist ventilations as indicated Do not allow the patient to rebreathe exhaled air Reassure the patient