Pulmonology 2
Terms
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- What is the most important factor in the development of respiratory disorders?
- Genetic predisposition
- What is the most important external factor in the development of respiratory disorders?
- Smoking
- Define COPD
- Chronic Obstructive Pulmonary Disease; a disease characterized by a decreased ability of the lungs to perform the funtion of ventilation
- What are the processes involved in gas exchange?
-
Ventilation
Diffusion
Perfusion - Define ventilation
- The mechanical process of moving air in and out of the lungs
- Define diffusion
- The movement of molecules through a membrane from an area of greater concentration to an area of lesser concentration
- What is the normal oxygen concentration of oxygen in the alveoli?
- 104mmHg
- What is the normal oxygen concentration in the pulmonary arterial circulation?
- 40mmHg
- What is the normal carbon dioxide concentration in the pulmonary capillaries?
- 45mmHg
- What is the normal concentration of carbon dioxide in the alveoli?
- 40mmHg
- What is the normal measurement of the respiratory membrane?
- 0.5-1.0 micrometers
- The concentration gradient provides the driving force in moving oxygen to where?
- Capillaries
- The larger the difference between the concentration of oxygen in the _______________ and the _________________________, the greater the diffusion of oxygen into the bloodstream.
- alveoli, capillaries
- Define perfusion
- The circulation of blood through the capillaries
- Define hemoglobin
- The transport protein that carries oxygen in the blood
- Adequate perfusion is dependent on what 3 conditions?
-
Adequate blood volume
Intact pulmonary capillaries
Efficient pumping of blood by the heart - What are the two ways in which oxygen is transported into the bloodstream?
- Bound to hemoglobin or dissolved in plasma
- Describe the oxygen dissociation curve.
- As oxygen binds to hemoglobin, the structure changes so that it more readily binds additional oxygen molecules and as the hemoglobin releases the oxygen molecules, it more readily sheds additional oxygen
- Define respiration
- The exhange of gases between a living organism and its environment
- Disease states that affect the ___________ respiratory tract will result in obstruction of air flow to the ___________ structures.
- upper, lower
- Traumatic injury to the chest wall or diapraghm will disrupt the normal mechanics and cause what in the pleural space?
- Loss of negative pressure which will allow air to enter
- True or false: Certain neuromuscular diseases, such as muscular dystrophy, multiple sclerosis, or amyotrophic sclerosis(ALS or Lou Gehrig's Disease) impair muscular function so as to limit the ability to generate a negative pressure within the chest cavi
- True
- Define pneumothorax
- A collection of air in the pleural space, causing a loss of the negative pressure that binds the lung to the chest wall
- Define open pneumothorax
- Air enters the pleural space through an injury to the chest wall
- Define closed pneumothorax
- Air enters the pleural space through an opening in the pleura that covers the lung
- Define tension pneumothorax
- Air in the pleural space cannot escape, causing a build-up of pressure and collapse of the lung
- Define hemothorax
- A collection of blood in the pleural space
- Define flail chest
- One or more ribs fractured in two or more places, creating an unattached rib segment
- Describe Cheyne-Stokes respirations
- Progressively increasing tidal volume, followed by declining volume, separated by period of apnea. Typically seen in older pts with terminal illness of brain injury.
- Describe Kussmaul's respirations
- Deep, rapid breaths that results as a corrective measure against conditions such as DKA that produce metabolic acidosis
- Describe Central Neurogenic Hyperventilation
- Deep rapid respirations that are caused by strokes or injury to the brainstem. In this case there is a loss of normal regulation of ventilatory controls and respiratory alkalosis is often seen.
- Define Ataxic (Biot's) respirations
- Repeated episodes of gasping ventilations separated by periods of apnea. Seen in pts with increased ICP.
- Define Apneustic respiration
- Long, deep breaths that are stopped during the inspiratory phase and separated by periods of apnea. Results from stroke or severe central nervous system disease.
- What are the major peripheral nerves that supply the diaphragm and intercostal muscles?
- The phrenic and intercostal nerves
- Any change in the concentration of oxygen in the alveoli can limit the diffusion of oxygen and produce _______________.
- hypoxia
- Define hypoxia
- State in which insufficient oxygen is available to meet the oxygen requirements of the cell.
- True or false: Not all diseases that alter the structure or patency of the alveoli will limit diffusion.
- False. Any disease that that causes an alteration will limit diffusion.
- True or false: Disease states that alter the thickness of the respiratory membrane will limit the diffusion of gases.
- True
- What is the most common cause of thickening of the respiratory membrane?
- Accumulation of fluid and inflammatory cells in the interstitial space.
- True or false: Fluid can accumulate in the interstitial space if high pressure within the pulmonary capillaries forces fluid out of the circulatory system.
- True
- Increased interstitial fluid is seen in pts with ___________-sided heart failure (cardiogenic causes) and s due to _____________________venous pressure as a result of poor functioning of the ____________ ventricle.
- left, increased, left
- What is the major transport protein for oxygen and plays a significant role in the elimination of carbon dioxide?
- Hemoglobin
- Any reduction in the normal circulating hemoglobin will affect _______________.
- perfusion
- Define pulmonary shunting
- When an area of lung tissue is appropriately ventilated but no capillary perfusion occurs and available oxygen is not moved into the circulatory system.
- When approaching a scene what are two questions to consider?
-
Is the scene safe?
Are there visual cues to the pts medical complaint? - What are 3 aspects of your general impression of respiratory status in pts?
-
Position
Color
Mental status
Ability to speak
Respiratory effort - Define pallor
- Paleness
- Define diaphoresis
- Sweatiness
- Define cyanosis
- Bluish discoloration of the skin due to an increase in reduced hemoglobin in the blood. The condition is directly related to poor ventilation.
- Define nasal flaring
- Excessive widening of the nares with respiration
- What are 3 signs of respiratory distress?
-
Nasal flaring
Intercostal muscle retraction
Use of accessory respiratory muscles
Cyanosis
Pursed lips
Tracheal tugging - Define tracheal tugging
- Retraction of the tissues of the neck due to airway obstruction or dyspnea
- True or false: Most significant abnormalities in the respiratory tract must be viewed as potentially life-threatening.
- False. All significant abnormalities are considered life-threatening.
- Define asphyxia
- A decrease in the amount of oxygen and an increase in the amount of carbon dioxide as a result of some interference with respiration.
- What are several life threatening respiratory findings? (Answers listed in order from most ominous to least severe)
-
Alterations in mental status, Severe central cyanosis, Absent breath sounds
Audible stridor, 1-to-2 word dyspnea
Tachycardia >or= 130, Pallor and diaphoresis, Intercostal and sternocleidomastoid retractions, Use of accessory muscles - Define dyspnea
- Difficult or labored breathing; sensation of "shortness of breath"
- Define tachycardia
- Rapid heart rate
- Define orthopenea
- Dyspnea while lying supine
- Define paroxysmal nocturnal dyspnea
- Short attacks of dyspnea that occur at night and interrupt sleep
- Define hemoptysis
- Expectoration of blood from the respiratory tree
- Define crepitus
- Crackling sounds
- Define subcutaneous emphysema
- Presence of air in teh subcutaneous tissue
- Define tactile fremitus
- Vibratory tremors felt through the chest by palpation
- Define tracheal deviation
- Any position of the trachea other than midline
- What are the 3 types of normal breath sounds?
-
Bronchial (tubular)
Bronchovesicular
Vesicular - Describe bronchial (tubular) breath sounds
-
Loud, high-pitched sounds over the trachea
Expiratory phase longer than inspiratory phase - Describe bronchovesicular breath sounds
-
Softer, medium-pitched sounds over the mainstem bronchi (below clavicles or between scapulae)
Expiratory and inspiratory phases equal - Describe vesicular breath sounds
- Soft, low-pitched sounds heard over the lung periphery
- What are 3 types of abnormal breath sounds?
-
Snoring
Stridor
Wheezing
Rhonchi
Crackles (rales)
Pleural friction rub - What is one of the earliest indicators of respiratory disease?
- Respiratory rate
- Assume that an elevated respiratory rate in a pt with dyspnea is caused by _______________. A persistently slow rate indicates impending respiratory arrest.
- hypoxia
- Define pulsus paradoxus
- A drop in the systolic blood pressure of 10 mmHg or more with each respiratory cycle
- Clubbing fingers is a good indicator of what?
- Long-standing hypoxemia, typical of pts with COPD or cyanotic heart disease
- Define tachypnea
- Rapid respirations
- Define bradypnea
- Slow respirations
- What are 3 prehospital diagnostic tests for assessing pts respiratory status?
-
Pulse oximetry
Peak flow
Capnometry - What is measured by pulse oximetry?
- Oxygen saturation (SaO2)
- What is measured by capnometry?
- Carbon dioxide at the end of the expiratory phase
- What are 3 common causes of airway obstructions?
-
Tongue
Foreign matter
Trauma
Burns
Allergic reaction
Infection - Define Adult Respiratory Distress Syndrome (ARDS)
- Form of pulmonary edema that is caused by fluid accumulating in the interstitial space within the lungs
- In ARDS, fluid accumulation occurs as the result of ____________________ vascular permeability and ___________________ fluid removal from the lung tissue.
- increased, decreased
- What is the pathophysiology for ARDS?
- ARDS is a disorder of lung diffusion that results from increased fluid in the interstitial space. Results in the inability to maintain proper fluid balance in the interstitial space.
- Clinical symptoms of ARDS are related to the ________________________ ____________.
- underlying cause
- What is the hallmark treatment for ARDS pts?
- Management of the pts underlying condition
- Define Positive End-Expiratory Pressure (PEEP)
- A method of holding the alveoli open by increasing expiratory pressure
- What are the 3 most common obstructive lung diseases encountered in the prehospital setting?
-
Emphysema
Chronic bronchitis
Asthma - What is the pathophysiolohy of emphysema?
- Gradual destruction of the walls of the alveoli which decreases the alveolar membrane surface area, thus lessening the area available for gas exchange.
- Define Cor pulmonale
- Hypertrophy of the right ventricle resulting from disorders of the lung
- Define polycythemia
- An excess of red blood cells
- Define blebs
- Destroyed lung tissue
- Is emphysema associated with a cough?
- Rarely, except in the morning
- Emphysema pts usually have a ______________ chest and are often thin. Often called "________ ______________" because they have a pink color.
- barrel, pink puffers
- What is the pathophysiology for chronic bronchitis?
- Gas exchange is decreased because there is lowered alveolar ventilation, which leads to hypoxia and hypercarbia. May lead to polycythemia, pulmonary HTN, cor pulmonale, and decreased vital capacity.
- True or false: In emphysema, PaCO2 increases and becomes chronically elevated, forcing the body to depend on the hypoxic drive to control respirations.
- True
- In chronic bronchitis and emphysema, what are the 2 main management goals?
-
Relieve hypoxia
Reverse bronchoconstriction - What is the pathophysiology of asthma?
- Chronic inflammatory disorder of the airways. Airways become hyperresponsive. 2-phase reaction; 1)release of chemical mediators such as histamine (results in constriction and edema; responds to inhaled beta-agonists) 2)does not respond to inhalants
- What are 3 common presenting signs of asthma?
-
Dyspnea
Wheezing
Coughing - What are the 3 main goals in management of asthma?
-
Correct hypoxia
Reverse bronchospasm
Reduce inflammation - Define status asthmaticus
- Severe, prolonged asthma attack that cannot be broken by repeated doses of bronchodilators