Inflammatory changes

excessive mucus production

hyperplasia & hypertrophy of mucus-producing glands

prolonged exposure to irritants

Chronic Bronchitiis

SxS

Dyspena w/ airway resistance

productive cough

Rhonchi

Peripheral edema

Cyanosis: 'Blue bloaters"

typically overweight

finger clubbing

Emphysema

causes

Emphysema is a slow progression

Smoking

Pollution

Allergens

Respiratory infection

Emphysema

Results

-Decreased alveolar surface area

-increased residual volume

-Reduction in arterial PO2

Effects of decreased alveolar surface area

"Barrel chested"

Emphysema

Results

Decreased alveolar surface

Increased residual volume

Reduction in arterial PO2

Process of expiration

"Barrel chested"

Emphysema

SxS

Onset

Physical appearence

Chest tightness

DOE

Pulse Lipped

Cough

Wheezing & rhonchi

"Pink Puffer"

Emphysena

Initial Presentation

Worsening dyspnea

Paroxysmal nocturnal dyspnea (PND)

Sputum production

Generalized malaise

Emphysema

Clinical appearence

Orthopnean (difficulty breathing when lying down: is relived once on lies up)

Tripod position

Purse-lipped breathing

Accessory muscle use

Emphysema

Management

IV access

Supplemental O2

Monitor VS, cardiac rhythm

Pulse oximetery

Visualize sputum is productive cough

Assit ventilation

Intubate

Emphysema

Medication

Albuterol

Alupent

Steriods (long term / hospital)

Nebulized anticholinergics

Methylxanthines

Reactive airway disease

 Exacebating factors

-Extrinsic

-Intrinsic

Childhood asthma

Asthma

Causes

-Airway irritability

-Allergens

-Stress

Asthma

Pathophysiology

Acute

Reverse airflow obstruction

Bronchospasm

Excess mucus

Inflammation

Asthma

internal resistance to airflow

Increased resistance to airflow results in:

-Alveolar hypoventilation

-Ventilation-perfusion mismatching

-Hypercapnia

-Air trapping

Asthma

Increased demand on respiration system

 Accessory muscle use

Respiratory fatigue

Asthma

SxS

Tripod position

Respiratory distress

Altered mental status

Asthma

Breath Sounds

Expiratory whezzing

Inspiratory wheezing

In an acute, severe asthmatic...Silence isn't golden

Asthma

SxS

Diaphoresis & pallor

Chest tight, retractions

short word strings

tachypena

Tachycardia

Pulse paradoxus

Elevated BP

Asthma

Prehosp care

ABC's

Hi flow O2

IV fluid

patient assurance

POC

Monitor VS, cardiasc rythm

Pulse Ox

Asthma

drugs

Albuterol HHN

Epinephrine 1:1000 SQ

Asthma

Peak flow meter

Peak flow meter is based upon'

Age

Sex

Height

Weight

Respiratory effort

Prolonged asthma exacebation

Imminatent danger of respiratory failure

life threating emergency

Status Asthmaticus

Prehospital care

IV fluids

High flow O2

Assits ventilation

Albuterol HHN

Epinephrine SQ

Haemophilus Influenza (Type A)

SxS

Cough

Pleurtic chest pain

fever w/ chills

Bacterial Pneumonia

Pathophysiology

Infection in the alveoli

Fluid & purulent sputum

Aspiration

Bacterial pneumonia

SxS

Pleuritic chest pain

Dyspnea

Productive cough

coarse rhonchi

wheezing, rales

Wheezing, rales

Tachycardia

fever w/ chills

Hemoptysis

Bacterial Pneumonia

Mangement

Antibiotics

Hydration (oral, IV fluids)

O2 as needed

Monitor pulse ox, ECG rythms

Hospitalization

Aspiration Pneumonia

Pathophysiology

Foreigh material

inflammation

Aspiration Pneumonia

Physiological effects

Volume

pH

Aspiration Pneumonia

Aspiration of

Nonbacterial

Stomach contents

Bacterial

Rositive end Expiratory Pressure

(PEEP)

-Maintains a degree of positive pressure pressure AT THE END OF EXHALATION

-Intubation w/PEEP

Description of device

-Boehringer valve

connected to a bag-valvedevice

Range of PEEP

-

Biphasic Positive Airway Pressure

BiPAP

BiPAP

Combines partial ventialtion support & CPAP

Sleep apena

leak-tolerant system