This raises the hyoid and larynx which opens the esophageal sphincter.
Soft palate is elevated which closed the nares.
Diaphragm and abdominal muscles contract forcefully.
Stomach content expelled.
If pt is unconscious or unable to protect airway, pulmonary aspiration
A&P changes is Pedi versus adult:
Trachea in pedi is more .
Larynx in pedi is located more and .
The tongue in pedi is and takes up more space when comparably compared to an adult.
The smallest opening that an ETT has to pass in an adult is the
The smallest opening that an ETT has to pass in a pedi is the
respirations indicates onset of respiratory arrest.
is a slow respiratory rate. Examples; CVA, drug overdoses.
Central neurogenic hyperventilation is rapid and regular breathing over
25 a minute. Pt is trying to blow of CO2.
is seen in brain deterioration. Very ill patients. Fast to slow
to absent breathing pattern.
is normal breathing.
is rapid, deep respirations results in hyperpnea. Example;
Anxiety, acid/base balance.
is abnormally deep and very rapid. Supports DKA present.
rate more than 20 minute. Examples; pain, fright, respiratory
6 to 10 LPM delivers 35 to 60%.
at 1 to 6 LPM delivers 24 to 44%.
no less than 10 LPM delivers 80 to 95%.
at 15 LPM delivers 50 to 60%.
at 15 LPM or delivers 80 to 100%.
position is when the patient leans forward and supports their
weight with the arms expended.
position also known as inline or neutral head position opens the
Sings of Respiratory Distress.
seen mostly in infants and children which allows the nares to
become larger to allow more air in.
allows the air more time to penetrate the respiratory system.
Form of self PEEPing.
tugging is seen when their is a partial occlusion of the air
chest motion supports a flailed chest.
Two-Three is when the patient cannot finish a sentence without catching
The hallmark sign of dyspnea is an until proven otherwise.
Normal breathing should be , and equal chest rise.
indicates an partial upper airway obstruction heard of
which is considered a lower airway constriction.
occurs when upper airway is partially obstructed, usually by the
is a rattling sound in the large airways associated with excessive
mucus or other material.
(also known as crackles) is a fine rattling sound which indicates
fluid in the alveoli.
is when the fingers and toes are contracted into flexion which
indicates low CO2 levels.
is the term for slow breathing.
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
nail polish must be removed
body temperature can constrict blood vessels to the probe.
Probe elevated or than the heart can affect readings.
If 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
History of recent weight loss and increase dyspnea.
Typically a cough is present - most common in morning.
Sleeps with many pillows.
Sits in tripod.
Pink in color.
20 pack/year history (Take the number of cigarette packs smoked per
day. Multiply the number by the years smoking)
Well developed accessory muscles.
of the fingers due to lack of O2 over a long period of time.
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
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.
Pt presents ill.
History of and/or chills
productive cough and may expel yellow to brown sputum.
Pleuritic chest pain
Viral 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.
cherry skin and lips is a
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.
Common types of clots; air, fat, amniotic fluid, blood clots
Signs; Sudden unexplained dyspnea. Rapid death.
Deep Vein Thrombosis (DVT) is an indication of possible risk for PE.
Check 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.
Care: 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
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.