Pulmonary System and Respiratory Disorders

1. Pulmonary System and Respiratory Disorders

2. Upper Respiratory Tract • Nasal passages • Paranasal sinuses • Pharynx • Nasopharynx • Oropharynx • Larynx • Function • Warming • Humidifying • Filtering air

3. Lower Respiratory Tract • Trachea • Lungs • Right = 3 lobes • Left = 2 lobes • Bronchi • Bronchioles • Terminal alveoli

4. Respiration (simultaneous) • Ventilation • Air moves through respiratory tract • Oxygenation • Exchange of gases in the alveolar-capillary beds

5. Inspiration • Diaphragm and intercostal muscles contract • Thoracic cavity expands = negative pressure = movement of air into lungs • Alveolar pressure= atmospheric pressure = intercostal stretch receptors fire • Inspiration ceases

6. Expiration • Elastic recoil of thoracic cage = passive expiration

7. Respiration Rates • Unlabored = 12 to 20 /minute • Newborn – 30 to 60 • Infant – 25 to 40 • Toddler – 20 to 30 • Young children – 20 to 25 • Older children – 15 to 20 • Dyspnea = difficulty breathing • Apnea = absence • Obstructive sleep apnea • Tachypnea = >24 /minute “rapid breathing” • Pulmonary embolism • Enlarged liver or spleen

8. Respiration Rates • Hyperpnea = tachypnea with large breaths = hyperventilation • Anxiety • Diabetic ketoacidosis (DKA) • Bradypnea = <12 /minute = “slow breathing” • Well conditioned athletes • Electrolyte imbalance • Hypopnea = “shallow, slow breaths” • Rib fracture

9. Respiration Patterns

10. Normal x-ray

11. Asthma • Chronic inflammatory disease • Intermittent acute bronchospasms • Affects 25 million people in the US, 300 million worldwide • Causes epithelial cell damage and fibrous changes in bronchioles = reduction in airflow • Sighs and symptoms • Dyspnea (difficulty breathing) • Coughing • Wheezing • Chest tightness • Prolonged expiration • Panting speech • Posture – leaning forward to assist breathing • Cyanosis (blue/gray skin coloring) • Seizure – severe cases

12. Asthma • Causes • Allergens • Respiratory infections • Cold/dry air • Drugs • Emotional states • Treatment • Long-acting albuterol inhaler (often combined with corticosteroids) • Short-acting albuterol inhaler • Policies and Procedures • Have a written action plan for each patient with asthma

13. Asthma • Action plan should include: • Physician’s name and contact information • Long-term and quick relief medications (names and doses) • Personal best peak expiratory flow rate (PEFR) • Physician’s instructions for managing patient’s acute asthma attack • Rescue inhaler (number of puffs/dose, time between doses, number of doses) • Nebulizer • Supplemental oxygen • Criteria for seeking EMS • RTP criteria (return to play)

14. Asthma • Managing an acute asthma attack • Patient in seated position • Instruct patient to take deep breaths • Exhale through pursed lips (increases pressure throughout airway) • Attempt to calm emotionally • Take PEFR (peak exp. flow rate) • Administer short-acting ß2 agonists (inhaler) • If prescribed and indicated • Takes 5 to 15 minutes to act • Takes up to 3 doses in a 1 hour period • Take PEFR again • Recovery should occur gradually in about 1 hour • Pulse oximeter can monitor oxygen saturation • Administer supplemental oxygen SpO2 < 92% • Treat as emergency if little to no recovery

15. Asthma • Severe attack may cause: • Pneumothorax (collapsed lung) • Acute right heart failure • Hypoxemia (low O2 level in blood) • Metabolic collapse (muscles cannot function) • Signs and symptoms • Use of accessory muscles to breath • Cyanosis • Confusion • Sweating • Poor air movement

16. Exercise-Induced Bronchospasm • AKA exercise-induced asthma • Affects 15% of population • Occurs 5 to 10 minutes into exercise • Becomes progressively worse with activity • Spontaneous recovery occurs 30 to 60 of rest after ceasing activity • Does not produce chronic inflammation in the bronchioles • Sign and symptoms • Unusual dyspnea (difficulty breathing) • Central chest pain or tightness during exercise • Coughing after strenuous exercise

17. Exercise-Induced Bronchospasm • Factors that exacerbate • Allergens • Infection • Pollution • Cool or dry air mouth breathing • Prevention • Preventive medication • Environmental precautions • Prolonged warm up (60 minutes) • 10 to 15 minutes at 50%, MHR • Rest 15 minutes prior to activity • Treatment • Same as an asthma attack

18. Pleurisy • AKA pleuritis or pleuritic pain • Any inflammation of the pleura that causes pain

19. Upper Respiratory Infections • Common signs and symptoms • Rhinitis (nose inflammation) • Rhinorrhea (runny nose) • Sore throat • Nonproductive cough • Sneeze • Headache • Malaise (feeling run down, low energy) • Chills • Low grade fever • Laryngitis (inflammation of the larynx) • Duration • 7 to 10 days

20. Upper Respiratory Infections • Complications • Ear infections • Sinus infections • May include tooth pain • Facial or sinus pressure and pain • Nasal congestion or discharge • Foul breath • Virus • Contagious • Active for at least 8 days following initial infection • Communicability highest in first 72 hours • Prevention • Avoid contact with persons exhibiting sx/sy of URI • Frequent hand washing • 20 seconds or sing the “happy birthday” song

21. Upper Respiratory Infections • Treatment • Rest • Fluids • Nutrition • OTC’s • Caution patients from “stacking” meds • Do not use aspirin with anyone 18 and younger • Reye’s syndrome = altered mental state and severe vomiting • “neck rule” (symptoms above neck = ok to exercise) • Hold an additional 24 hours after sx/sy have ceased • Physician referral after 10 days • Antibiotics only work if bacterial

22. Acute Bronchitis • Lower respiratory infection • Viral most common • Typically preceded by URI • Productive cough • Wheezing • Treatment • OTC’s • Rest • Hydration • Possibly short-acting inhaler • RTP • “neck rule” • Gradual return

23. Pneumonia • Lower respiratory infection • Bacterial, viral or fungal • Signs and symptoms • Productive cough • Dyspnea • Pleuritic chest pain • Fever • Myalgia • Malaise • Tachypnea • Tachycardia • Crackles with auscultation • Dullness with percussion

24. Pneumonia • Treatment • Refer to physician • OTC’s • Antibiotics • Rest • Fluids • Supplemental oxygen • RTP • Similar to that of acute bronchitis, however, would be longer

25. Influenza • AKA flu • Occur in fall, peaking in the winter, lasting into spring • Three recognized strains – A, B, and C • A = most commonly associated with large outbreaks • Transmitted • Person to person through respiratory secretions • Incubation period of 2 days • Treatment • Antiviral – occasionally (administered at first sign of symptoms) • OTC’s • RTP • “neck rule” • Gradual increase of intensity and duration

26. Tuberculosis • Pulmonary tuberculosis (TB) • Highly contagious • Develops granular tumors in the infected tissue • May be dormant for years before causing active disease • Suspend from activity and refer to a physician

27. Tuberculosis • Signs and symptoms • Fatigue • Fever >100° • Chills • Night sweats • Weight loss • Cough • Hemoptysis • Chest pain • SOB • Wheezing • Crackles or wheezing with auscultation • Enlarged and tender lymph nodes • Clubbing of fingers and toes • Bold = key symptoms

29. Chronic Obstructive Pulmonary Disease (COPD) • Examples • Chronic bronchitis • Hypoxemia • Cyanosis • Productive cough (greater in mornings and evenings) • Cough > 3 months for 2 consecutive years with no other explanation • Emphysema • Complication of chronic pulmonary disease and smoking • Damage is irreversible and prognosis is poor • Cystic fibrosis • Inherited • Damage to lungs and digestive system • No cure • Some may live into 40’s or 50’s, commonly to 20’s and 30’s

30. Atelectasis • Not a disease but a complication • Collapse of a lung segment’s alveoli • Common – more than 200,000 cases per year • RTP – depends on amount of damage

31. Drowning/near drowning • Inhaled water physically damages lung tissue • Leads to atelectasis • Reflex spasm of larynx – die from asphyxia • Time of immersion and temperature of water determines extent of damage for a near drowning victim • Neurological complications • Renal complications • Rapid, progressive respiratory failure can occur 12 to 24 hours after rescue • Always perform life saving strategies • Always transport

32. Pneumothorax • Pneumothorax AKA “collapsed lung • Air in the pleural space • Negative pressure that holds lungs inflated is lost • Lung retracts toward bronchial tree • Symptoms and symptoms • Decreased or absent breath sounds • Acute pleuritic chest pain • Dyspnea • Hyperpnea • Crepitus

33. Pneumothorax • Management • Splint by hugging a pillow • Calm the patient to control coughing or gasping for air • Monitor vital signs • Seal any open wounds • Transport • RTP • May occur within days of discharge • If other injuries permit

34. Hemothorax • Blood enters the pleural cavity • Splashing may be heard on auscultation in the lower lobes with changes in posture • Blood and air = hemopneumothorax

35. Flail Chest Injury • Results from multiple anterior or posterior rib fractures • Affected region collapses on inspiration • Affected region bulges on expiration • Medical emergency • Often accompanied by pneumothorax

36. Pediatric Concerns • Asthma • Cystic fibrosis • Neuromuscular diseases • May affect respiratory muscles and neural control of breathing • Scoliosis • May impair inflation of one or both lungs • Pertussis “whooping cough” • Highly contagious • Asymptomatic incubation period (7 to 21 days) • Catarrhal stage – 1 to 2 weeks, resembles a simple URI • Most contagious period • Paroxysmal state • Whooping cough appears and increases over a week • 6 to 10 weeks • Convalescent stage • Gradual cessation of cough over 2 to 3 weeks

37. Therapeutic Interventions • Supplemental Oxygen (possible sickle cell distress) • Assemble tank and regulator • Hand-tighten the regulator • Check tank pressure – turn valve stem one complete turn • 500 psi = 25% full = refill • Select appropriate delivery device (bag, mask etc.) • Attach oxygen tubing from device to regulator • Adjust oxygen flow rate to appropriate setting • Apply device to patient • When finished, remove device from patient FIRST • Turn off oxygen • Relieve the pressure in the regulator

38. Therapeutic Intervention • Metered Dose Inhaler • Remove dust cap and shake inhaler before each use • Inspect mouthpiece for contamination or foreign objects • Breathe out through mouth, exhaling as completely as possible • Hold inhaler upright with mouthpiece in mouth, lips closed tightly around mouthpiece • Breathe in slowly while pressing down on the cartridge • Hold breath as long as possible • Release pressure while still holding breath • Remove mouthpiece • Wait for container to repressurize, shake and repeat steps 3-8 when more than one inhalation is indicated • Rinse mouth with water • Clean inhaler every few days

39. Therapeutic Interventions • Nebulizer • Pour appropriate amount of medication into machine cup • Attach hose and mouthpiece (or mask) to medicine cup • Turn the nebulizer on • Instruct patient to put mouthpiece in mouth and form a tight seal with lips • Instruct patient to breathe in and out slowly through the mouth • Continue until medicine is gone • 15 to 20 minutes • Turn the nebulizer off • Rinse cup and mouthpiece • Instruct patient to rinse out mouth