Respiratory part 2

child can use a spacer

Crepitus

liver or spleen injury more chance for internal bleeding  (spleen on left)

damage to intrathoracic vessel

pnuemothorax or hemothorax

acceleration or deceleration (body stops but organs keep going)

bandaging and binding of area

base of the lung

• pain on inspiration
• coughing
• diminished breath sounds w/rapid and shallow resp
• bruising over fracture
• crepitus

• 2 or more broken ribs in a row in more than one place
• marked by paradoxical movement
• will have dyspnea, pain and contusion
• leads to resp failure
• surgery is usually req

• bruising of lungs
• can cause aveoli rupture, hemorrhage in aveoli, inflammation and edema monitor pt for 12-24 hours  because resp distress/failure can show up in 12-24 hours

because resp distress/failure can show up in 12-24 hours

• EARLY SIGNS
• SOB
• restlessness
• apprehension
• chest pain
• copious sputum
• late signs
• Tachycardia
• tachypenea
• cyanotic
• dyspnea

• impaired gas exchange
• leading to hypercapnea

• ICU on ventilator
• epidural for pain
• no opoid pain meds due to resp distress

• pt in fire in small space
• burns in facial and thoracic area
• if nose hairs are singed
• soot or ash in sputum

• thermal damage can cause edema to upper airways
• smoke inhalation mostly happens in upper airway
• if its lower then steam
• CO or cyanide poisoning may occur
• chemical damage to airways

• <5 norm non smoker
• <10 norm for smoker
• 10-20 mild
• 20-40 moderate
• 40-60 sever and that is usually fatal

• in mild to moderate levels
• headache
• dizziness
• dyspnea
• nausea
• cherry red appearance
• moderate to severe levels
• confusion
• seizures
• can have perm neuro damage
• coma
• death
• Pneumonia is common side effect

• heart swells
• blood vessels constrict
• work on patient longer

aspiration

asphyxiation

larygospasms and the spasms stop water from entering lungs

pink, frothy sputum, pt can be given diuretic to help restore oxygenation

salt water is hypertonic, and causes fluids to rush into aveoli thus causing hypovolemia and possible shock

• fresh water is hypotonic causes cells to lyse causing electrolytes to be diluted, causes dysrythmia and death
• and impairs surfactant production

pulmonary edema

• early phase is constriction
• late phase is inflammation (could happen 4-12 hours later) (basophils are eosinophilis are activated)

• cold dry air causes 40-90% of bronchial asthma
• use inhaler before exercise

-the airway narrow in response to a stimulus and cause limited air flow in and out-it increases the work of breathing and traps the residual volume of the lungs distal to then arrowed airway-inspired air mixes with a large amount of residual air (this reduces the amount of O2 avail in aveoli). Air that we breathe in is mixed with air we can’t get rid of (dilutes it)-decreased alveolar ventilation reduces oxygen available for exchange

autonomic nervous system

bronchoconstriction

bronchodialation

fresh fruit and salad, and sulfites in wine and beer

they can improve

ASA and other NSAIDs, betablockers

• pt does not resp to routine treatment (rescue inhaler)
• and pt has severe asthma with frequent attacks

in severe asthma attacks you will see the skin pulling into the ribs during breathing

inhaled steroids

brochodialtor first (can give once every 20 mins up to 3 times) then steroidal inhaler

are abluterol inhalers and nebs

a long acting bronchodialtor

• (chemically related to caffine) theophaphyline is a bronchodialtor (the only xanthine used as a bronchodialtor) it is also an adjunct. Always used with another med.  must draw blood levels freq to measure for toxicity.
• Aminophyline and dyphiline is the IV form (lot of incompatibilities with this med)

pts with glaucoma and renal failure and prosthetic hypertrophy

• take up to an hour to works and ....have same precautions as antihistamines they are preventative
• Ipratropium bromide (atrovent) and tiotropium (spiriva)
• not used in acute attack

hypoglycemia, poor wound healing

synergistic (meaning it increases the effect of the beta agonist)

• glucocortiroids, chromolyn, and leukotriene
• they are preventive and inhibit inflammatory response (create unpleasant taste in mouth)
• Cromolyn sodium
• nedocromil
• (take up to two weeks to work)

dry mouth

• oral
• preventative
• anti inflammatory
• children over 12
• take on empty stomach
• can damage liver  (jaundice, dark urine, hives, chalky stool)
• consist of
• montelukast (singular)
• zafirlukast (accolate)
• zileuton (zyflo)

• can be used in children over 2
• and for treatment of allergic rhinitis

• in COPD
• chronic
• cough lasting longer than 3 months
• lungs don't return to normal after excubation
• (Chronic Bronchitis)
• thick mucous
• barrel chest
• can lead to right sided heart failure
• more likely to have cyanosis with
• (emphysema)
• destruction of aveoli walls
• tri-pod position
• an enzyme deficiency can cause (serum alpha 1 antitypsin level)

because it will cause hypercapnea (elevated co2) pts will intake too much O2 and cant blow it off will become alkalonic

• encourage purse lip breathing
• encourage pneumonia and flu vaccine
• give solumedrol mixed with iprotropiaum

• cut down down on dairy and salt
• eat high fat, protein and low carb
• (think bacon, eggs and hold the toast)
• peppermint/licorice are natural expectorants

• could be tumor, air, fat, bone marrow, amniotic fluid
• clots form in deep vein and mostly in thigh or right side of heart

fliter is inserted in inferior vena cava to prevent clots from traveling to heart

clot buster

• pulmonary angiagram
• CT of chest
• plasma D dimer
• (do coag test after D dimer to determine clot type)