Ch 16 - Respiratory Emergencies

• Name the structures of the respiratory system:

  • Diaphragm
  • Chest wall muscles
  • Accessory muscles
  • Nerves from brain and spinal cord to muscles
• The upper airway consists of structures above the vocal cords:

  • Nose
  • Mouth
  • Jaw
  • Oral cavity
  • Pharynx
  • Larynx
• The lower airway consists of structures below the vocal cords:

  • Trachea
  • Bronchi
  • Bronchioles
  • Alveoli surrounded by pulmonary capillaries
• Air travels thru the trachea into the lungs to:

  1. Bronchi (larger airways)
  2. Bronchioles (smaller airways)
  3. Alveoli (where actual exchange occurs)
• What are the 2 processes that occur during respiration?

  Inspiration and expiration
• Inspiration


  Active process of breathing in (inhalation) that requires muscular contraction
• Expiration


  Passive process of breathing out (exhalation) where muscles relax
• Respiration

  • Oxygen is provided to blood
  • Carbon dioxide is removed from blood
  • Takes place rapidly at level of alveoli
• During respiration, the brainstem constantly senses the level of carbon dioxide in the arterial blood. -- stimulates breathing and balances pH

  • low: slow and shallow respirations - Iess carbon dioxide expired
  • high: rapid and deep respirations - more carbon dioxide diffuses out of bloodstream
• Oxygen exchange can be hindered by:

  • conditions in the anatomy of the airway
  • disease processes
  • traumatic conditions
  • abnormalities in the pulmonary vessels
• Dyspneic patients may have:

  • gas exchange obstructed b/c fluid in lungs/infection/collapsed alveoli (atelectasis)
  • damaged alveoli -> cannot transport gases properly across their own walls
  • obstructed air passages b/c muscle spasm/mucus/weakened airway walls
  • obstructed blood flow to lungs by blood clots
  • excess fluid or air in pleural space -> lungs cannot properly expand
• Patients often have dyspnea or hypoxia with:

  • pulmonary edema - fluid buildup in lungs commonly b/c of CHF
  • hay fever (allergic rhinitis) - allergic response to airborne allergens
  • pleural effusion - fluid collection between lungs and chest wall that may compress the lung
  • obstruction of the airway
  • hyperventilation syndrome - occurs in the absence of physical problems and commonly associated with panic attacks
  • environmental/industrial exposure
  • drug overdose
  • carbon monoxide poisoning
• Dyspnea is common with cardiopulmonary diseases.
• Air hunger


  feeling of "not getting enough air" + strong need to breathe
• chest tightness


  uncomfortable feeling in the chest commonly reported by patients with asthma
• Besides shortness of breath, a patient with dyspnea may report the sensation of chest tightness and air hunger.
• Infectious diseases causing dyspnea may affect all parts of the airway.
• Inadequate oxygen to the tissues is a problem of oxygenation.
• Some forms of obstruction cause dyspnea:

  • mucus and secretions obstructing airflow in major passages -> colds, diphtheria
  • swelling of soft tissues in upper airways -> epiglottitis, croup
  • impaired exchange of gases in alveoli -> pneumonia
• Acidosis


  Buildup of excess acid in the blood or body tissues
• Adventitious breath sounds


  Abnormal breath sounds such as wheezing, stridor, thonchs, and crackles
• Alkalosis


  Buildup of excess base (lack of acids) in the body fluids
• Allergen


  Substance that causes an allergic reaction
• Anaphylaxis


  Extreme, life-threatening, systemic allergic reaction that may include shock and respiratory failure
• Asthma


  Acute spasm of the smaller air passages, called bronchioles, associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages
• Atelectasis


  Collapse of the alveolar air spaces of the lungs
• Bronchial breath sounds


  Normal breath sounds made by air moving through the bronchi
• Bronchitis


  Acute or chronic inflammation of the lung that may damage lung tissue, usually associated with cough and production of sputum and, depending on its cause, sometimes fever
• Carbon dioxide retention


  Condition characterized by a chronically high blood level of carbon dioxide in which the respiratory center no longer responds to high blood levels of carbon dioxide
• Carbon monoxide


  Odorless, colorless, tasteless, and highly poisonous gas that results from incomplete oxidation of carbon in combustion
• Chronic bronchitis


  Irritation of the major lung passageways from long-term exposure to infectious disease or irritants such as smoke
• Chronic obstructive pulmonary disease (COPD)

  Lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible
• Continuous positive airway pressure (CPAP)


  Method of ventilation used primarily in the treatment of critically ill patients with respiratory distress; can prevent the need for endotracheal intubation
• COVID-19


  Respiratory disease caused by the virus SARS-CoV-2. The virus is a coronavirus, similar to the one that causes the common cold
• Crackles


  Cracking, rattling breath sounds that signal fluid in the air spaces of the lungs
• Diphtheria


  Infectious disease in which a pseudomembrane forms, lining the pharynx, this lining can severely obstruct the passage of air into the larynx
• Dyspnea


  Shortness of breath
• Embolus


  Blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage of blood flow
• Rhonchi


  Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways
• Small-volume nebulizer


  Respiratory device that holds liquid medicine that is turned into a fine mist. The patient inhales the medication into the airways and lungs as a treatment for conditions such as asthma