Respiratory Emergencies

Paroxysmal nocturnal dyspnea

comes on suddenly in the middle of the night and may be an ominous sign of left-sided heart failure.

hyperventilation

compensatory mechanism for acidosis

inhalation

creates a negative pressure in the chest allowing the air to actively enter the lungs

Healthy adults have a hemoglobin level of

12 to 14 g/dL.

heart rhythms without a pwave

SVT,VTACH,Afib,Aflutter,Junctional

An acute form of laryngotracheobronchitis is a common cause of

croup a condition characterized by stridor, hoarseness, and a barking cough that most commonly occurs in infants and small children.

Apneustic breathing is caused by

damage to the pneumotaxic center in the brain.

Guillain-Barré syndrome,

characterized by progressive muscle weakness and paralysis advancing up the body from the feet, can result in ineffective breathing if the paralysis reaches the diaphragm.

In emphysema

groups of alveoli merge into large blebs, or bullae, which are far less efficient at gas exchange than normal lung tissue because they have less surface area available.

blood tinged sputum can be caused by

heart failure

what leads do I and AVL look at what portion of the heart

high lateral

When a patient has chronic hypoventilation, bicarbonate (HCO3) ions migrate into the cerebrospinal fluid, fooling the brain into thinking that acid and base are in balance.

respiratory center switches to hypoxix drive

a pt with orthopnea

seeks a sitting position when short of breath

quiet tachypnea suggest possible

shock

Patients with chronic bronchitis

tend to be more sedentary and may be obese.

Asthma considered a reactive airway disease because

the asthma attack occurs most often when the patient is exposed to a trigger.

Bronchospasm is caused by

the constriction of the smooth muscle that surrounds the larger bronchi in the lungs.

the mediastinum consists of

the heart, large blood vessels, conducting airways (trachea and mainsteam bronchi)

As carbon dioxide level dips

the pH level rises

The oxyhemoglobin dissociation curve illustrates

the relationship between oxygen saturation and the amount of oxygen dissolved in the plasma (PaO2).

Blood-tinged sputum may be a warning sign of

tuberculosis

Biot respirations are seen

when the center that controls breathing rhythm is damaged. This pattern is grossly irregular, sometimes with lengthy apneic periods.

Wheezing is caused by

air forced through constricted tubes, which causes them to vibrate.

poiseuille law

as the diameter of the tube decreases, resistance to flow increases

cor pulmonale is defined as

Right sided heart failure secondary to chronic lung disease

cor pulmonale

Right-sided heart failure that occurs because of chronic lung disease

what is the criteria for atrial fibrillation

no distinct p waves, irregularly irregular

respiratory alkalosis causes

numbness in hands, feet and mouth, leads to carpopedal spasm/periorbital paresthesia

difficulty with exhalation is most characteristic of

obstructive lung disease

Obstructive disease

occurs when the positive pressure of exhalation causes the small airways to pinch shut, trapping gas in the alveoli.

chronic bronchitis

Blood gas levels tend to be abnormal, with elevated PaCO2 (hypercapnia) and decreased PaO2 (hypoxemia) levels.

minute volume =

Respiratory Rate x Tidal Volume

the classic presentation of a patient with emphysema includes

A barrel chest (a chest that is larger in diameter from front to back than from side to side resulting from years of having air trapped in the thorax) Muscle wasting because of cannibalizing muscle mass for energy Pursed-lip breathing because of the obstructive disease

The most common obstructive airway diseases are:

Emphysema Chronic bronchitis Asthma

Inferior leads

II, III, aVF

pulsus paradoxus

In adults and children, profound intrathoracic pressure changes can make the peripheral pulse weak or imperceptible during inspiration and can make it easier to palpate during exhalation

A patient's ability to move an adequate supply of air for ventilation may be hindered by:

Limited ability of the diaphragm to move (such as advanced pregnancy, obesity, and air or blood in the abdomen) Conditions that restrict chest wall movement (such as crush injuries, tightly applied immobilization devices, and an abnormal spinal curvature, as associated with scoliosis or kyphosis) Injuries that disrupt the integrity of the thoracic cage (such as flail chest)

Pickwickian syndrome

Obesity hypoventilation syndrome (also known as Pickwickian syndrome) is respiratory compromise caused by morbid obesity.

Cyanosis that does not respond to reoxgenation indicates a

PE

When a patient is breathing but gas exchange is impaired, the carbon dioxide level in the blood rises.

Severe atelectasis Pneumonia Pulmonary edema Asthma COPD

orthopnea.

Shortness of breath induced by lying flat is called

Cheyne-Stokes respirations

The depth of breathing gradually increases and then decreases, followed by an apneic period. Exaggerated Cheyne-Stokes respirations may be seen in patients with severe brain injury.

97% of oxygen in the body is bound to hemoglobin.

The other 3% is dissolved in the plasma.

Amyotrophic lateral sclerosis

This disease is fatal, with death usually attributable to respiratory failure as the muscles of respiration become unable to maintain adequate ventilation.

Botulism

This somewhat rare disease is usually caused by food poisoning or by giving infants raw (unpasteurized) honey, which may be contaminated with spores of the bacterium. Botulism can cause muscle paralysis and is usually fatal when it reaches the muscles of respiration.

Hyperventilation occurs when

breathe more than metabolic need by increasing the rate or depth of respiration, or both. The result is alkalosis.

hypoventilation

carbon dioxide accumulates in the blood when the lungs fail to work properly

acidosis

carbon dioxide combines with water to form bicarbonate ions and hydrogen ions (carbonic acid) which results in acidosis

Crackles are

discontinuous noises caused by the popping open of air spaces (fine crackles) or by the movement of fluid or secretions in the larger airways (coarse crackles).

A patient presents with a barrel chest, muscle wasting, and pursed lip breathing are symptoms of what

emphysema

Chronic obstructive pulmonary disease (COPD) comprises at least two distinct clinical entities:

emphysema and chronic bronchitis.

the electrode for v4 is placed where

fifth intercostal space at the midclavicular line

the bodys immediate response to mild hypoxemia is

increased heart rate

Since ammonia is a highly water-soluble gas

inhaling it causes acute upper airway irritation.

exhalation

is a passive process

hyperventilation

is a result of the patient getting too little carbon dioxide

Hypoxic drive

is a state in which a person's stimulus to breathe comes from a decrease in PaO2 rather than from the normal stimulus.

Hepatojugular reflux

is distention the jugular veins when the liver is gently pressed and is specific to right-sided heart failure.

Aspiration

is the inhalation of anything other than breathable gases

In BPAP,

one level of pressure can be delivered during inspiration (inspiratory positive airway pressure) and a different level of pressure can be delivered during exhalation (expiratory positive airway pressure).

bronchioles

lack cilia, have no protective blanket of mucus, and are not shielded by smooth muscle or more rigid structures.

paroxysmal nocturnal dyspnea may be a sign of

left-sided heart failure

most effective body system for correcting acidosis

lungs

a person who experiences sharp chest pain followed by increasing dyspnea after coughing likley has

pleurisy

a pateints peripheral pulses become extremely weak during inhalation is called

pulses paradoxus