The term is the exchange of oxygen and carbon dioxide between the organism at a cellular level.  The term  is the movement of air into and out of the lungs.   is the volume of gas inhaled or exhaled during one breath, which in adults in normally 500 to 600 mL.  is the amount of gas inhaled or exhaled in one minute. 

results from some respiratory diseases (e.g., emphysema) destroy and collapse the alveolar walls.  This results in the formation of fewer but larger alveoli.

is when oxygen levels are low.  is a state of decreased oxygen content in the arterial blood.

Hyperventilation causes an excess loss of CO2 which results in .

(This material will be covered later in the course) We have chemoreceptors located in the and which register the levels of in the body and is know as the .  The chemoreceptor within the registers and is the normal stimulus for respirations in a health person.  The nerve which leaves the spine at C4-5 controls the diaphragm.  The nerve inhibits the lungs and is responsible for what is known as .  When the lungs are full the nerve tells the medulla to stop the stimulus to inspiration.  Respiration works on a control system as described previously.

Interesting:  Our lungs hold 5,800 mL of air after taking one breath.  We exchange 500 to 600 mL per breath so this means that the lungs are never empty of air.  This is why, at a minimum, a cardiac patient without dyspnea should still be placed  on a NC at 4 LPM.  We are keeping the reserves within the lungs full with exchanges of 500 to 600 mL increments.  KEEP THE LUNGS TOPPED OFF.

What is gag reflex?  Triggered by touching the palate or pharynx. 

bulletSteps of a gag.
  1. Deep breath is taken.
  2. This raises the hyoid and larynx which opens the esophageal sphincter.
  3. Soft palate is elevated which closed the nares.
  4. Diaphragm and abdominal muscles contract forcefully.
  5. Stomach content expelled.
  6. If pt is unconscious or unable to protect airway, pulmonary aspiration may occur.

A&P changes is Pedi versus adult:

  1. Trachea in pedi is more .
  2. Larynx in pedi is located more and .
  3. The tongue in pedi is and takes up more space when comparably compared to an adult.
  4. The smallest opening that an ETT has to pass in an adult is the .
  5. The smallest opening that an ETT has to pass in a pedi is the .

Breathing terms:

  1. respirations indicates onset of respiratory arrest.
  2. is a slow respiratory rate. Examples; CVA, drug overdoses.
  3. Central neurogenic hyperventilation is rapid and regular breathing over 25 a minute.  Pt is trying to blow of CO2.
  4. is seen in brain deterioration.  Very ill patients. Fast to slow to absent breathing pattern.
  5. is normal breathing.
  6. is rapid, deep respirations results in hyperpnea.  Example; Anxiety, acid/base balance.
  7. is abnormally deep and very rapid.  Supports DKA present.
  8. rate more than 20 minute.  Examples; pain, fright, respiratory infection.

Oxygen flow:

bullet 6 to 10 LPM delivers 35 to 60%.
bullet at 1 to 6 LPM delivers 24 to 44%.
bullet no less than 10 LPM delivers 80 to 95%.
bullet delivers 16%.
bullet delivers 16%.
bullet at 15 LPM delivers 50 to 60%.
bullet delivers 21%.
bullet at 15 LPM or delivers 80 to 100%.

Body Positioning

bullet position is when the patient leans forward and supports their weight with the arms expended. 
bullet position also known as inline or neutral head position opens the upper airway.

Sings of Respiratory Distress.

bullet seen mostly in infants and children which allows the nares to become larger to allow more air in.
bullet allows the air more time to penetrate the respiratory system.  Form of self PEEPing.
bullet tugging is seen when their is a partial occlusion of the air passages.
bullet chest motion supports a flailed chest.
bulletTwo-Three is when the patient cannot finish a sentence without catching their breath.
bulletThe hallmark sign of dyspnea is an until proven otherwise.
bulletNormal breathing should be , and equal chest rise. 
bullet indicates an partial upper airway obstruction heard of inspiration.
bullet which is considered a lower airway constriction.
bullet occurs when upper airway is partially obstructed, usually by the tongue.
bullet is a rattling sound in the large airways associated with excessive mucus or other material.
bullet (also known as crackles) is a fine rattling sound which indicates fluid in the alveoli.
bullet is when the fingers and toes are contracted into flexion which indicates low CO2 levels.
bullet is the term for slow breathing.

Diagnostic Testing

Pulse Oximetry offers a rapid and fairly accurate means for assessing oxygen saturations.  The PulseOx probe is placed on the , or and measures the amount of oxygen bonded to the available hemoglobin.  95% and above is adequate saturations.  90% to 94% may indicate a nasal cannula.  Less than 90% usually indicates the need for a non-rebreather mask. 

bullet nail polish must be removed
bullet body temperature can constrict blood vessels to the probe.
bulletProbe elevated or than the heart can affect readings.
bulletIf carbon monoxide has saturated the hemoglobin the device will still register 100% saturation.

includes the disease of , and .  COPD is found in 25% of adults in the US.  50% mortality within 10 years of diagnosis.  COPD is caused by and environmental toxins. 

is defined as loss of of the alveoli.  As a result of less alveolar tissue the pulmonary capillary beds decrease leading to pulmonary hypertension which results into right sided heart failure which is termed which means when the patient inhales the BP drops and then they exhale it returns.  Due to the loss of elasticity the emphysema patient will purse their lips to create a positive pressure in the lungs to move air trapped in the dead spaces.  This lip pursing is a form of self PEEPing (Positive end-expiratory pressure).  As a result of less alveoli the body produces more RBC to inundate the available alveoli to pick up the slack.  This results in a pink skin color.  Also this patient is working very hard to exchange gasses with more rapid breathing.  As a result we call these patient .

bulletHistory of recent weight loss and increase dyspnea.
bulletTypically a cough is present - most common in morning.
bulletSkinny patient.
bulletSleeps with many pillows.
bulletSits in tripod.
bulletPink in color.
bullet20 pack/year history (Take the number of cigarette packs smoked per day.  Multiply the number by the years smoking)
bulletWell developed accessory muscles.
bullet of the fingers due to lack of O2 over a long period of time.
bullet chest as intercostal muscles overdevelop.

is defined as having bronchitis for at least 2 months per year for or more consecutive years.  History of most common.  Smoking irritates the lining of the lungs resulting is excess production.  The patient is able to deliver oxygen to the alveoli but has trouble exhaling through the mucus.  (Like a milk shake we can suck the milk shake through the straw but it is harder to blow air into the milk shake.). Due to the lack of exhalation a buildup of CO2 in the blood slows metabolism and the patient gains weight.  Also they turn blue as a result of the higher than normal CO2 levels.  This is why we call these patients

is the same disease process as a patient with occasional asthma but the Chronic Asthma patient has more occurrences due to triggers.

Asthma is a common respiratory illness what affects many people. Asthma is defined as a narrowing if the airways. 50% of patients who die from asthma do so before they can reach the hospital.  Think of asthma as not one attack but rather two attacks.  The first asthma attack is cause by a which irritates the lungs  (Dust, temperature, humidity, perfumes, allergies, exercise, foods, stress, medications).  This results in a bronchocontriction resulting in a narrowing of the airways which results in a drying of the airways as well.  As a result of the drying of the mucus linings over the next few hours will develop resulting in once again another narrowing of the airways.  This is why most asthma patients will have two inhalers or one inhaler with a combination of drugs.  One inhaler is albuterol or another class drug to bronchodilate.  The other inhaler is a steroid to keep down edema. 

Almost all patients who die from an asthma attach have mucus plugs in the airway.  Percussion is important to perform by cupping your hand and clapping the back to move the mucus.

is a severe asthma attack that cannot be broken by conventional means.  Prepare for immediate ETT placement.

is an infection of the lungs and a common medical problem.  Pneumonia is among the leading causes of death for the elderly and AIDS patients. Bacterial and viral are the most common.  As the infection evolves and inflammation collects in the alveoli. 

bulletPt presents ill.
bulletHistory of and/or chills
bullet productive cough and may expel yellow to brown sputum.
bulletPleuritic chest pain
bulletViral and fungal pneumonia present differently; no fever, no cough, no chest pains, just tires with sore throat and n/v. (walking pneumonia)

(Covered in Toxicology and Overdose Lecture) Carbon Monoxide is , tasteless and colorless produced from incomplete burning of fossil fuels.  CO binds to hemoglobin times stronger than O2. 

bulletcherry skin and lips is a sign

chamber is needed.

is a blood clot (thrombus) that lodges in the pulmonary arteries affecting blood flow. 50,000 US deaths per year but many survive at a 10 to 1 ratio.   Causes; long bone fractures release fat into circulation, recent , childbirth, birth control mixed with or without , prolonged immobilization like travel.  A-fib and sickle cell also can increase the occurrence of a PE.

bulletCommon types of clots; air, fat, amniotic fluid, blood clots
bulletSigns;  Sudden unexplained dyspnea.  Rapid death.
bulletDeep Vein Thrombosis (DVT) is an indication of possible risk for PE.
bulletCheck for DVT.  In over 50% of PE's DVT signs are present which includes warm swollen extremities with a thick cord palpated along the medial thigh and pain on palpation or when extending the calf. 
bulletCare: ABC, limited care option in field except for transport to the appropriate level of care.

is defined as a pneumothorax that occurs in the absence of blunt or penetrating .  Spontaneous pneumothorax is a common occurrence; 18/100,000.  50% of patients will have a re-occurrence within 2 years of the first.  Most common type of patients who experience a spontaneous pneumothorax are people who .  Smoking leads to blebs (weakened lung tissue).  Also people with lots of lung which results in scaring/thinning of the lungs.  Tall white males are prone to thin lung tissue.  Most spontaneous pneumothorax's will self seal.

is rapid breathing, chest pain, , and anxiety.  Never treat hyperventilation syndrome until all other cause for rapid breathing have been ruled out.  Hyperventilating blows off too much CO2 resulting in lightheaded, numbness, spasms. 

bulletCare; reassurance.
bulletCare; Place on simple face mask at 2 LPM.

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