Respiratory Patho

1. Respiratory Patho

2. Chronic Obstructive Pulmonary Disease • Also called COLD-- chronic obstructive lung disease • Emphysema • Chronic bronchitis • Asthma

3. Emphysema • What is it? • Destruction of alveolar walls-- below the bronchioles • Decreases surface area • Decreases area available for exchange • Increase resistance to pulmonary blood flow

4. Emphysema cont... • Can lead to pulmonary hypertension • Cor pulmonale = right heart failure • Lungs can not recoil and air is trapped • Residual lung capacity increases • PO2 decreases over time • Increased RBC • Polycythemia-- high hematocrit

5. Emphysema cont... • PCO2 increased • Hypoxic drive • Causes • Complications of disease • Pneumonia • URI • Dysrhythmias cancer

6. Emphysema cont... • Home drugs • Bronchodilators • Steroids • Later-- oxygen

7. Emphysema cont.. • Assessment • Weight loss-- thin • Dyspnea esp on exertion • Cough only in AM • Barrel chest • Tachypnea

8. Emphysema cont.. • Pink puffers • Enlarged accessory muscles • Clubbing of fingers • Pursed lips-- prolonged expiration-- active now • Wheezing or rhonchi may or may not be present

9. Chronic bronchitis • Increase in the number of mucous cells • Large amount of sputum • Diffusion normal • Hypercarbia due to deceased alveolar ventilation

10. Chronic bronchitis • Assessment • Overweight • Blue bloaters • Rhonchi • RHF-- JVD, pedal edema

11. Management of COPD • Goal??? • Treat hypoxia • Reverse bronchoconstriction • Reassure patient-- EMONTIONAL support • Oxygen using patient distress to determine amount • Monitor for cardiac dysrhythmias

12. Management of COPD • IV 5% D/W or NS KVO • Nebulizer • Albuterol, Proventil Ventolin • isoethharine, Bronksol • metrproterenol, Alupent • Sympathomimetic, Beta agonist B2 selective

13. Management of COPD • Bronchodilation • Uses-- COPD, Pul edema, asthma, severe allergic reactions • Contraindications-- tachycardia • Monitor B/P, pulse, ECG • Side effects-- tachycardia, palpitations, anxiety,headache, dizzy

14. Asthma • Asthma patients do die • Increasing deaths over 45 years old • Higher death rate in Afro-Americians • definition • Chronic disease due to air flow obstruction • Small airways consrtict

15. Asthma • Causes of acute excerbations • allergens • cold air • irritants-- smoke, pollen • medications

16. Asthma • Phase one • Release of histamine • Bronchoconstriction and bronchial edema • Usually will respond to Beta agonist • Phase two • WBC invade bronchioles • Cause edema and swelling of bronchioles

17. Asthma • Phase 2 will not respond well to Beta agonists • May need steroids • Assessment • Dyspnea and wheezing • Cough • Hyperressonance

18. Asthma • Assessment cont. • Tachypnea • Use of accessory muscles • Speech dyspnea • History-- what did pt take • beta agonist?, steroids, anticholinergics, bronchodilators?

19. Asthma • History of admissions to hospital for asthma • Hx of intubations? • Management • Corect hypoxia, reverse bronchospasm • Treat inflammatory process

20. Asthma treatment • Emotional support • Primary and secondary survey • Oxygen • EKG and pulse ox • Beta agonist-- nebulizer • Epinephrine SQ 0.3-0.5 mg or cc 1:1000 solution Peds 0.01 mg.kg up to 0.3mg

21. Asthma treatment • Aminophyllin-- Xanthine bronchodilator (not a beta agonist) • Solu Medrol--- steroid

22. Status Asthmaticus • Severe, prolonged asthma attack which can not be broken by usual treatment • Wheezing may be absent-- silent chest • Severe acidosis • May have to intubate

23. Pneumonia • More prevalent in??? • Elderly • HIV positive • Peds • Infection in the lungs • Bacterial, viral, fungal

24. Pneumonia • Assessment • “looks sick” • fever and chills • tachypnea, tachycardia • general weakness-- malaise • Productive cough-- yellow, blood-tinged • Chest pain-- upper abd pain

25. Pneumonia • Rhoncho, wheezing, rales • percussion??? • Management • Emotional support • Primary and secondary survey • O2, EKG, Pulse ox, IV-- may be dehyrated • Position, when would nebulizer be used?

26. Toxic inhalation • May cause inflammation and constriction or laryngospasm or edema of larynx • superheated air • toxic products • chemicals • inhaled steam

27. Toxic inhalation • Scene safety • If hoarseness, brassy cough or stridor-- possible laryngeal edema-- be careful • May need to intubate • Humidified O2, IV, EKG, Pulse ox • Be careful about nebulized drugs

28. Carbon monoxide • Odorless, tasteless gas • binds with hemoglobin 200 faster than oxygen • receptor sites do not transport oxygen • cellular hypoxia • history-- how long and where

29. Carbon monoxide • Signs and symptoms • headache and irritability • confusion or agitation • vomiting, chest pain, LOC, seizures • Cyanotic, cherry red is late sign

30. Carbon monoxide • Management • Remove from site • Airway, high oxygen • treat for respiratory depression or shock • Hyperbaric

31. Pulmonary embolus • Blood, air, foreign body that lodges in pulmonary artery • Many are diagnosed on autopsy • S and S • Sudden unexplained SOB • Chest pain may or may not be present • Shock symptoms

32. Pulmonary embolus • Who is at risk • long term immoblization • BCP • Hx of thrombophlebitis • Delivery • long bone fx

33. Pulmonary embolus • Management • Transport ASAP • High O2, position • Emotional support • IV, pulse ox, EKG, 12 lead • May need to tube

34. Hyperventilation syndrome • Anxiety or situational problem • consider other medical problems • do not minimize • loss of CO2 cause Respiratory Alkalosis • rapid and shallow respirations • nervous, dizzy, chest pain

35. Hyperventilation syndrome • Numbness and tingling-- mouth, hands, feet • carpopedal spasms • Treatment • EMOTIONAL SUPPORT • slow respirations

36. Central nervous system dysfunction • Head trauma, stroke, brain tumor, drugs • dysfunctional of spinal cord, nerves, respiratory muscles • spinal cord trauma, polio, myasthenia gravis, Lou Geriigh’s disease, MS, MD