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What are the common causes of Upper Airway Obstruction?
Tongue, Foreign Matter, Trauma, Burns, Allergic Reaction & Infection
What is the management for UAO in a conscious pt?
If pt can speak - encourage coughing.
If pt cannot speak perform adb thrusts.
What is the management for UAO in unconscious pt?
1. Open airway. 2. attempt to give two ventilations - if they fail, reposition head and try again. 3. administer abd thrust/chest compressions. 4. Attempt finder sweeps only if foreign body is visualized. a. If removed, resume vent. b. If not, continue abd. and/or chest compressions and sweeps. 5. Visualize airway with laryngoscope and remove foreign body with Magill forceps and resume vent's.
What is COPD?
Chronic bronchitis AND emphysema together.
Name the ten lung fields.
- 6 in front = 2 at Clavicle, 2 @ nipples, 2 @ bases
- 4 in back = 2 under scapula, 2 bases
1. Refers to inflammatory changes & excessive mucus prod. in the bronchial tree. 2. Characterized by hyperplasia & hypertrophy of mucus producing glands. 3. Results from prolonged exposure to irritants. 4. Bronchi are filled with excess mucus.
What is hyperplasia?
What is hypertrophy?
Increase in size
What would be some physical exam findings for a Chronic Bronchitis pt?
- overweight & always out of breath
- thick & goopy (ronchi) LS
- Ankle edema
- Hepatic (Liver) congestion (engorged Liver and JVD)
- "Blue Bloater" large and cyanotic
What is the clinical definition of Chronic Bronchitis?
- Clinically diagnosed by the presence of a cough with sputum production occuring on most days for at least 2 months in the year and for at least 2 consecutive years.
- Alveoli are not seriously affected (no structural change)
- Diffusion remains relatively normal
What is the pathophys. of CB?
- Results from an increase in mucus-secreting cells in the resp. tree
- Alveoli relatively unaffected.
- Decreased alveolar ventillation
What are findings during assessement of CB pt?
- Frequent resp. infections
- Productive cough - color, smell, viscosity
What is "shunt" in V/Q?
Blood circulating/air not
What is Emphysema?
- an anatomical desc. of patho changes in the lung
- end stage of a process that progresses SLOWLY for many yrs.
- Characterised by:
- Permanent abnormal enlargement of the air spaces beyond term. bronchioles (structural change - perm.)
- Destruction of alveoli (struct/perm)
- Failure of supporting structures to maintain alveolar integrity.
Emphysema results in:
- reduced alv func surface area
- red. elasticity, leading to air trapping
- incr. residual volume while vital capacity stays normal
- assoc. red. in arterial PO2 - incr. red blood cell production and polycythemia
- decr. in alveolar memb. surf area and # of pulm cap's which decreases area for gas exchange and incr. resistance to pulm bld flw
- expiration becomes a muscular act
- chest becomes rigid, barrell shaped
- use of accessory mucls in neck, chest and abd
Assessment of Emphysema pt reveals:
- barrell chest due to incr. wrk of brthng
- prolonged expiration and rapid rest phase
- thin, emaciated (burning calories w/ WOB)
- Pink skin due to extra red cell prodctn (body incr. RBC's over time to compensate w/ more O2)
- Hypertrophy of accessory muscles
- Normal ETCO2 lvls >45 mm Hg all the time
- "Pink Puffers"
Emphysema pt's present w/:
- acute episode of worsening dyspnea even at rest
- incr. in sputum
- incr. in malaise
- nocturnal dyspnea and wheezing
- frequent headaches
- resp. distress
- sit upright leaning foward to help brthng
- pursed-lip to maintain Positive press airway
- accessory muscle use
- Prolonged exp. phase
- CO2 up / O2 sat down
Management of emphysema:
- no BVM
- no CPAP
- Give O2 and transport
Nrml pt. CO2 lvls drive breathing
abnormal - pt O2 levels drive breathing (COPDer)
production of extra red blood cells