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What are the common causes of Upper Airway Obstruction?
Tongue, Foreign Matter, Trauma, Burns, Allergic Reaction & Infection
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What is the management for UAO in a conscious pt?
If pt can speak - encourage coughing.
If pt cannot speak perform adb thrusts.
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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.
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What is COPD?
Chronic bronchitis AND emphysema together.
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Name the ten lung fields.
- 6 in front = 2 at Clavicle, 2 @ nipples, 2 @ bases
- 4 in back = 2 under scapula, 2 bases
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Chronic Bronchitis
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.
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What is hyperplasia?
Overactivity
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What is hypertrophy?
Increase in size
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What would be some physical exam findings for a Chronic Bronchitis pt?
- overweight & always out of breath
- thick & goopy (ronchi) LS
- JVD
- Ankle edema
- Hepatic (Liver) congestion (engorged Liver and JVD)
- "Blue Bloater" large and cyanotic
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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
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What is the pathophys. of CB?
- Results from an increase in mucus-secreting cells in the resp. tree
- Alveoli relatively unaffected.
- Decreased alveolar ventillation
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What are findings during assessement of CB pt?
- Frequent resp. infections
- Productive cough - color, smell, viscosity
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What is "shunt" in V/Q?
Blood circulating/air not
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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.
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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
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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"
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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
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Management of emphysema:
- no BVM
- no CPAP
- Give O2 and transport
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Carboxic Drive
Nrml pt. CO2 lvls drive breathing
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Hypoxic Drive
abnormal - pt O2 levels drive breathing (COPDer)
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Polycythemia
production of extra red blood cells
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