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Respiratory Patho. Chronic Obstructive Pulmonary Disease. Also called COLD-- chronic obstructive lung disease Emphysema Chronic bronchitis Asthma. Emphysema. What is it? Destruction of alveolar walls-- below the bronchioles Decreases surface area Decreases area available for exchange

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chronic obstructive pulmonary disease
Chronic Obstructive Pulmonary Disease
  • Also called COLD-- chronic obstructive lung disease
  • Emphysema
  • Chronic bronchitis
  • Asthma
emphysema
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
emphysema cont
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
emphysema cont5
Emphysema cont...
  • PCO2 increased
  • Hypoxic drive
  • Causes
  • Complications of disease
  • Pneumonia
  • URI
  • Dysrhythmias cancer
emphysema cont6
Emphysema cont...
  • Home drugs
  • Bronchodilators
  • Steroids
  • Later-- oxygen
emphysema cont7
Emphysema cont..
  • Assessment
  • Weight loss-- thin
  • Dyspnea esp on exertion
  • Cough only in AM
  • Barrel chest
  • Tachypnea
emphysema cont8
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
chronic bronchitis
Chronic bronchitis
  • Increase in the number of mucous cells
  • Large amount of sputum
  • Diffusion normal
  • Hypercarbia due to deceased alveolar ventilation
chronic bronchitis10
Chronic bronchitis
  • Assessment
  • Overweight
  • Blue bloaters
  • Rhonchi
  • RHF-- JVD, pedal edema
management of copd
Management of COPD
  • Goal???
  • Treat hypoxia
  • Reverse bronchoconstriction
  • Reassure patient-- EMONTIONAL support
  • Oxygen using patient distress to determine amount
  • Monitor for cardiac dysrhythmias
management of copd12
Management of COPD
  • IV 5% D/W or NS KVO
  • Nebulizer
  • Albuterol, Proventil Ventolin
  • isoethharine, Bronksol
  • metrproterenol, Alupent
  • Sympathomimetic, Beta agonist B2 selective
management of copd13
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
asthma
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
asthma15
Asthma
  • Causes of acute excerbations
  • allergens
  • cold air
  • irritants-- smoke, pollen
  • medications
asthma16
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
asthma17
Asthma
  • Phase 2 will not respond well to Beta agonists
  • May need steroids
  • Assessment
  • Dyspnea and wheezing
  • Cough
  • Hyperressonance
asthma18
Asthma
  • Assessment cont.
  • Tachypnea
  • Use of accessory muscles
  • Speech dyspnea
  • History-- what did pt take
  • beta agonist?, steroids, anticholinergics, bronchodilators?
asthma19
Asthma
  • History of admissions to hospital for asthma
  • Hx of intubations?
  • Management
  • Corect hypoxia, reverse bronchospasm
  • Treat inflammatory process
asthma treatment
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

asthma treatment21
Asthma treatment
  • Aminophyllin-- Xanthine bronchodilator (not a beta agonist)
  • Solu Medrol--- steroid
status asthmaticus
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
pneumonia
Pneumonia
  • More prevalent in???
  • Elderly
  • HIV positive
  • Peds
  • Infection in the lungs
  • Bacterial, viral, fungal
pneumonia24
Pneumonia
  • Assessment
  • “looks sick”
  • fever and chills
  • tachypnea, tachycardia
  • general weakness-- malaise
  • Productive cough-- yellow, blood-tinged
  • Chest pain-- upper abd pain
pneumonia25
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?
toxic inhalation
Toxic inhalation
  • May cause inflammation and constriction or laryngospasm or edema of larynx
  • superheated air
  • toxic products
  • chemicals
  • inhaled steam
toxic inhalation27
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
carbon monoxide
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
carbon monoxide29
Carbon monoxide
  • Signs and symptoms
  • headache and irritability
  • confusion or agitation
  • vomiting, chest pain, LOC, seizures
  • Cyanotic, cherry red is late sign
carbon monoxide30
Carbon monoxide
  • Management
  • Remove from site
  • Airway, high oxygen
  • treat for respiratory depression or shock
  • Hyperbaric
pulmonary embolus
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
pulmonary embolus32
Pulmonary embolus
  • Who is at risk
  • long term immoblization
  • BCP
  • Hx of thrombophlebitis
  • Delivery
  • long bone fx
pulmonary embolus33
Pulmonary embolus
  • Management
  • Transport ASAP
  • High O2, position
  • Emotional support
  • IV, pulse ox, EKG, 12 lead
  • May need to tube
hyperventilation syndrome
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
hyperventilation syndrome35
Hyperventilation syndrome
  • Numbness and tingling-- mouth, hands, feet
  • carpopedal spasms
  • Treatment
  • EMOTIONAL SUPPORT
  • slow respirations
central nervous system dysfunction
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