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Syncope
Sudden temporary loss of consciousness; faint
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Coma
unconsciousness; no arousal
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Hypoxia
Reduced supply of O2
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Pathophysiology of Unconsciousness
- Inadequate cerebral circulation
- O2 deprivation
- Changes in Blood Quality
- Psychological changes
- CNS changes
- Poor physical condition
- Sign of underlying condition
- May be associated with Stress
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Inadequate Cerebral Circulation
- Reduces blood to the brain which cause reduced O2 to the brain
- It is the Most Common Mechanism of unsciousness
- <30ml blood/100g brain tissue
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O2 Deprivation
- Brain needs Glucose & O2
- 65% glucose intake & 20% O2 intake
- 20% total blood circulation must reach the brain every minute.
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Blood Quality Changes that can cause unconsciousness
- Hypoglycemia
- Hyperglycemia
- Allergic reactions
- Hyperventilation
- Drugs
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CNS Changes for Unconsciousness
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P-A-B-C-D
- Management for unconsciousness
- Position
- Airway
- Breathing
- Circulation
- Definitive Management
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Hyperventilation
- 22-40 brpm
- N=10-16 brpm
- Increased PaO2 and decreased PaCO2
- Ages:15-40
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PaO2
Arterial O2 blood gas level
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PaCO2
Arterial CO2 blood gas level
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Hypocapnia
- Abnormally low PaCO2 level
- N=40mmHg
- Hypocapnia=25-30mmHg
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Respriatory Alkalosis
Increased blood pH level
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Some reasons for hyperventilation
- High altitudes
- Stress/anxiety
- Pregnancy
- CNS stimulants
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Respiratory Disorders
- NONINFECTIOUS
- -Obstructive Airway Diseases
- -Pulmonary Embolism
- -Myasthenia Gravis; autoimmune that effects breathing muscles
- INFECTIOUS
- -Pneumonia
- -Legionnaires Disease; fever and pneumonia
- -TB
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Asthma
- Reactive Airway Disease; recurring
- Difficulty breathing bc broncial constriction
- Increasing problem in children
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Asthma Triggers
- Cold Temps
- Respiratory infections
- exercise
- stress
- allergens/food
- drugs
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Asthma Classifications
- Extrinsic: allergic & IgE; most common (35% of adults and many children)
- -Drug Induced: ingestion
- Intrinsic: nonallergic; endogenous(from within a person; 30% of asthma cases)
- -Exercise Induced
- Infectious: inflammation from infection
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Status Ashthmaticus
Continuous asthma attack withhout relief caused by any classification and can be life threatening
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Pathophysiology of Asthma
- Smooth muscle around bronchial contracts
- Increased mucuos production causing bronchial plugging and dehydration
- Alveolar Hypoventilation
- Hypercapnia: CO2 retention
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Asthma Treatment
- Mild: stop, position, calm, self adminster bronchodilator, if relief resume treatment
- Severe: stop, position, calm, self adminster bronchodilator, O2 4-6L/min, No relief after inhalar 1mg Epi, still no relief call 911
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COPD
- Chronic obstructive pulmonary disease
- Chronic Bronchitis
- Emphysema
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Chronic Bronchitis
- Prolonged exposure to irritants
- Excessive mucus secretions
- Hypercapnia
- Pulmonary hypertension
- Right ventricular hypertrophy
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Emphysema
- Destruction of alveoli
- Decrease elasticity recoil (air trapping, hyperinflation)
- Increased expiration difficulty
- Thin appearance
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What depends on the severity of an allergic reaction?
- Amount of Allergen
- Rate of exposure
- Route of exposure
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Type I Allergy
- Immediate hypersensitivity <60 mins
- Caused by IgE
- Acute; can be life threatening
- Generalized (anaphylaxis) or Local (hives etc..)
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Type II Allergy
Cell death (Cytolytic)
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Type III Allergy
Not IgE mediated, but have anaphylaxis type S&S (anaphylactoid reactions)
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Type IV Allergy
- Delayed hypersensitivity >12 hrs can take up to 48 hrs
- May be difficult to diagnose cause of time frame
- inflammation develops
- generalized or local
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Sensitizing Dose
- First exposure
- substance enters the body and antibodies are produced
- no reactions this time
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Challenging Dose
- Later Exposure
- Mast cells and Basophils undergo degranlation
- Body over reacts
- Histamine is released
- The quicker the reaction the more severe it is
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Histamines effect on smooth muscle
- Relaxes vascular smooth muscle
- Contracts nonvascular smooth muscle like GI and uterus
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Uriticaria
- Hives
- Itch and painful
- Caused by contact or ingestion
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Angioedema
- Localized non-inflammatory swelling from an allergy
- facial, tongue, throat
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Drugs to manage allergy
- Epinephrine
- Antihistamines
- Steroids
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