respiratory emergencies a comprehensive look respiratory system provided for the passage of o2 to...
TRANSCRIPT
Respiratory Emergencies
A Comprehensive Look
Respiratory system Provided for the passage of O2 to enter Necessary for energy production and for CO2 to exit Waste product of body’s metabolism.
Upper airway Mouth and nose to larynx Nasopharynx: Tonsils, uvula Oropharynx: Tongue
Uvula
composed of connective tissue containing a number of racemose glands, and some muscular fibers
Lower Airway Below the larynx to the alveoli
Pharynx Muscular tube Extends vertically from back of the soft
palate to superior aspect of the esophagus
Allows air to flow in and out of the respiratory tract and food to pass into the digestive tract
Larynx Joins the pharynx with the trachea Consists of the thyroid and cricoid
cartilage, glottic opening, vocal cords, cricothyroid membrane.
Trachea: 10 to 12 centimeter long tube that connects the
larynx to the two mainstem bronchi. Lined with respiratory epithelium containing
cilia and mucous producing cells. Mucous traps particles that the upper airway
did not filter. Cilia move the trapped particles up into the
mouth where it is expelled or swallowed.
Bronchi: At the carina bifurcates into the right a left mainstem bronchi.Alveoli Bronchioles divide into the alveolar ducts and terminates into the alveoli Comprise the key functional unit of the respiratory system Contain an alveolar membrane that is only 2 cells thick Most CO2 and O2 exchange takes place Become thinner as they expand Surface area totals more than 20 square meters, enough to cover half a
tennis court The hollow structure resists collapse due to the presence of a surfactant, a
chemical that decreases their surface tension and makes it easier for them to expand.
Carina
Atelectasis Aveolar collapseLung Parenchyma Parenchyma: Principal or essential parts of an
organ Organized into the lobes Right lung has three lobes where as the left
lung has only two as it shares thoracic space with the heart.
Pleura Membranous connective tissue that
covers the lungs Visceral: Envelopes the lungs and does
not contain nerve tissue Parietal: Lines the Thoracic cavity and
contains nerve fibers
RESPIRATION AND VENTILATION Ventilation: The mechanical process that moves air into
and out of the lungs Pulmonary or external respiration: Alveoli Cellular or internal respiration occurs in the peripheral
capillaries It is the exchange of respiratory gases between the RBCs and various body tissues
Cellular respiration in the peripheral tissue produces CO2 which is picked up by the blood in the capillaries and transports it as bicarbonate ions through the venous system to the lungs.
RESPIRATORY CYCLE Nothing within the lung parenchyma makes it contract or
expand Ventilation depends upon changes of pressure within the
thoracic cavity Begins when the lungs have achieved a normal expiration and
the pressure inside the thoracic cavity is equal to the atmospheric pressure
Respiratory centers in the brain communicate with the diaphragm by way of the phrenic nerve, signaling it to contract. This initiates the respiratory cycle
Then……….
Thorax increases; pressure within decreases; becomes lower than atmospheric pressure; with the negative pressure, air rushes in; the alveoli inflate with the lungs, becoming thinner allowing oxygen and CO2 to diffuse across their membranes.
When the pressure in the thoracic cavity is again that of the atmospheric pressure, the alveoli are maximally inflated.
Pulmonary expansion stimulates microscopic stretch receptors in the bronchi and bronchioles that signal the respiratory center by way of the vegus nerve to inhibit respiration and the influx of air stops.
At the end of respiration: Respiratory muscles relax Size of the chest cavity decreases Elastic lungs recoil forcing air out of the lungs
(expiration)
Expiration is passive Respiration is active process using
energy
Use of Accessory muscles: Strap muscles of the neck, and
abdominal muscles to augment efforts to expand the thoracic cavity
Pulmonary Circulation During each cardiac cycle, the heart
pumps just as much blood to the lungs as it does to the peripheral tissues.
Bronchial arteries that branch from the aorta supply most of their blood.
Bronchial veins return blood from the lungs to the superior vena cava.
Hypoventilation: Reduction in breathing rate and depth
Pneumothorax: Air or gas in the pleural cavity
Hemothorax: Accumulation of blood or fluid containing blood in the pleural cavity
Pulmonary embolism: Blood clot that travels to the pulmonary circulation and hinders oxygenation of blood
Hypoxic Drive The body constantly monitors the PaO2 and the pH. COPD Chronically elevated PaCO2 Body no longer uses PaCO2 levels to stimulate breathing Hypoxic drive increases respiratory stimulation when
PaO2 level falls and inhibits respiratory stimulation when PaO2 levels increase.
Hypoxemia: Decreases partial pressure of oxygen in the blood
Respiratory Acidosis: Retention of CO2 can result from impaired ventilation due to problems occurring in either the lungs or in the respiratory center of the brain.
Respiratory Alkalosis results from increased respiration and excessive elimination of CO2.
MEASURES OF RESPIRATORY FUNCTION Respiratory rate: Adults 12 to 20 Children 18 to 24 Infants 40 to 60Eupnea: Normal Respiration Fever Increases Emotion Increases Pain Increases Hypoxia Increases Acidosis Increases Stimulant Drugs Increases Depressant Drugs Decreases Sleep Decreases
Total Lung Capacity Total amount of air contained in the lung at the end of the maximal
respiration 6LTidal Volume Average volume of gas inhaled or exhaled in one respiratory cycle 500 mL (5 to 7 cc/kg)Dead Space VolumeThe amount of gas in the tidal volume that remains in the airpassageways unavailable for gas exchange. Anatomic dead space includes the trachea and bronchi Physiologic dead space from COPD, obstruction or atelactesis 150 ml
Minute Volume Amount of gas moved in and out of the
respiratory tract in one minute Vmin = VT x Respiratory Rate Alveolar Minute Volume Amount of gas that reaches the alveoli for
gas exchange in one minute VA-min = (VT – VD) X Respiratory rate
RESPIRATORY PROBLEMS Dyspnea: An abnormality of breathing
rate, pattern, or effort Hypoxia: Oxygen deficiency Anoxia: The absence or near-absence
of oxygen
Modified forms of respiration Coughing: forceful exhalation of a large volume of air form the
lungs, expelling foreign materials from the lungs Sneezing: Sudden forceful exhalation from the nose. Nasal
irritation Hiccoughing: Sudden inspiration; caused by spasmodic
contraction of the diaphragm with spasmodic closure of the glottis. No physiologic purpose. Occasionally been associated with MI on the inferior (diaphragmatic) surface of the heart
Sighing: Slow, deep, involuntary inspiration followed by a prolonged expiration; hyperventilates the lungs and reexpands atlectatic alveoli; occurs once a minute
Grunting: Forceful expiration; occurs against a partially closed epiglottis; usually an indication of respiratory distress.
Accessory Respiratory Muscles: Intercostal Suprasternal Supraclavicular Subcostal retractions Abdominal musclesIn Infants Nasal flaring Grunting
COPD
Purse their lips
Pulsus ParadoxusComparison of blood pressure between that ofinspiration and that of exhalation A drop in blood pressure greater than 10 torr Drop in blood pressure during inspiration Drop is due to increased pressure in the
thoracic cavity that impairs the inability of the ventricles to fill.
ABNORMAL RESPIRATORY PATTERNSKusssmaul’s Respirations Deep, slow or rapid, gasping breathing, Commonly found in diabetic ketoacidosisCheyne-Stokes Respirations Progressively deeper, faster breathing alternating gradually
with shallow, slower breathing. Indicates brain-stem injuryBiot’s Respirations Irregular pattern of rate and depth with sudden, periodic
episodes of apnea Indicates increased intracranial pressure
Central Neurogenic hyperventilation Deep, rapid respirations Indicates increased intracranial pressure
Agonal Respirations Shallow, slow, or infrequent breathing Indicates brain anoxia
Rales: Fine, bubbling sound; on inspiration; fluid in smaller bronchioles
Rhonchi; Course, rattling noise on inspiration; associated with inflammation, mucous or fluid in the bronchioles
Stridor: Harsh, high-pitched heard on inhalation; laryngeal edema or constriction
Snoring: Partial obstruction of the upper airway by the tongue
Gurgling: Accumulation of blood, vomitus, or other secretions in the upper airway
Tension Pnuemothorax Any tear in the lung parenchyma can cause a pneumothorax. Tension: Large pneumothorax that affects other structures in
the chest Progressively worsening compliance when bagging Diminished unilateral breath sounds Hypoxia with hypotension Distended neck veins Marked increase in pressure can prevent ventricles from
adequately filling decreasing cardiac output Tracheal deviation
Tachypnea/Bradypnea Respiratory effort: How hard a patient
has to work to breathe Orthopnea: Difficulty breathing while
lying supine
Hypothermia Combines the mechanisms of convection, radiation, and
evaporation Accounts for a large proportion of the body’s heat loss Heat is transferred to from the lungs to inspired air by
convection and radiation Evaporation in the lungs humidifies the inspired air. During expiration, warm humidified air is released into the
environment, creating heat loss
Respiratory Shock Respiratory system is not able to bring oxygen
into the alveoli and remove CO2 Blood leaves the pulmonary circulation without
adequate oxygen and with an excess of CO2 The cells become hypoxic while the
bloodstream becomes acidic
RESPIRATORY CONTROL Respiratory centers within the brainstem control
respiration Inspiration and expiration occur automatically and are
triggered by impulses generated in the respiratory center of the medulla oblongata during normal respiration
The medullary respiratory system contains chemoreceptors that respond to changes in the CO2 and pH levels in the CSF
CO2 rapidly diffuses across the blood-brain barrier in to the CSF while H+ and bicarbonate ions do not.
Two Respiratory Centers in the PonsApneustic Located in the lower pons Acts as a shut-off switch to inspiration If non-functional, prolonged inspiration interrupted by occasional expirationPneumotaxic Center Located in the upper pons Moderates the activity of the apneustic center and provide fine tuningMedulla Oblongata CO2 receptorsInternal Carotid Arteries CO2, O2 and B/P receptorsAorta CO2, O2 and B/P receptorsLungs Stretch receptors
Pons Modifies rate and depth of breathing
Medulla Oblongata Sets basic rate and depth of breathing
Nasal Canulae 4 to 6 liters per minute 22 to 44% oxygen
Non-rebreather 10 to 15 liters per minute 80 to 100% oxygen
Inhaler: Bronchodilator
Inhaler: Stimulation of the Sympathetic Nervous System
One metered dose
Inhalerpurse lips around inhalerdepress inhaler as patient inhales
deeplyPatient hold their breath for a few
seconds
Inhaler: Breathing difficulties with history of COPD/Asthma
Inhaler
The patient is not responsive enough
The maximum dose has been taken