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RespiratorySystem
1
1.1
IntroductiontoRespiratorySystem
Definitions
Mainfunctionofrespiratorysystemexchangegasesbetweenbodyandatmosphere Generallyspeaking:respiratoryrefersto2processes: o Externalrespiration: AbsorptionofOxygen&removalofcarbondioxidefrombodyasawhole o Internalrespiration: UseofOxygenandproductionofcarbondioxidebycellsinbody Totallungcapacity o 6000ml:ForceddeepbreatheVolumeofairinlungafteraforcefulinspiration Tidalvolume o 500ml:Normalbreathingvolumeofairinspire/expireduringeachrespiratorycycle o Normalbreathing1220breathesperminute) Deadairspace o 150ml:Airremaininginpassages Minutevolume o Amountofairthatmovesinandoutofthelungsperminute o TidalVolumexrespiratoryrate(1220bpm)=minutevolume o VT or tidal volume is the amount of air the lungs breathe in one breath, o VE or minute volume is the number of breaths o RR (respiratory rate or f=frequency) breathed in one minute times the tidal volume. o Thus VT x RR = VE. 350ml x 12 breaths per minute = 4,2 L/min.
AnatomyofRespiratorySystem
Maincomponents: ThoracicCage Airpassages Lungs Anddiaphragmdeficiency Upperrespiratorysystem(upperairway): Nose Nasalcavity Mouth Pharynx(throat) o (comprisedof:Nasopharynx,Oropharynx) Lowerrespiratorysystem(lowerairway): Larynx Trachea Lungs Mainbronchi Bronchioles Alveoli(TerminalAirSacs)
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RespiratorySystem
2.1 Nose
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RespiratorySystem
2.2 NasalCavity
2.3
Conditioninwhichadrugcanandshouldbegiven
2.3.2 Oropharynx
Pipethatleadtostomach
2.4 Larynx
Belowthelarynxistracheawhichissemirigidtube+12.5cminlength SupportbyCshapedringofcartilagepreventitfromcollapsingwhenairmovesin/outoflungs
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2.6
RespiratorySystem
ConsistsofBonesandsofttissue Bonesare: Ribs: 12oneachside(12pairs) Sternum(Breastbone): anteriortowhichtheribsjoin Spine: posteriortowhichoppositeendofeachribjoins Softtissue: consistsofintercostalmuscles
2.7 Lungs
2.8
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2.8.1 Bronchioles
RespiratorySystem
Smallestbronchialtubesreferredtoasbronchioles
2.8.2 Alveoli(TerminalAirSacs)
2.9 Pleura
2.9.1
Doublelayerofsmoothandslipperytissuecoveringeachlung Pleurahelpsusbreath
VisceralPleura
Innerlayerofpleura Coversoutside(anterior)oflungs
2.9.2 ParietalPleura
Outerlayerofpleura Coversinsideofthoraciccavity
2.9.3 ParietalFluid
Fluidinspacebetweenvisceralandparietalpleural Preventsfrictionfromoccurring
2.10 Diaphragm
Domeshapedmuscleseparatesthoracicandabdominalstructures Mainmusclesconcernedwithbreathing
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RespiratorySystem
3
3.1
Breathing
Introductiontobreathing
Breathinginiscontractingofdiaphragm Breathingoutisrelaxedstateofdiaphragm(conversely) Respirationcontrolledbybrainstem o Informationtransmittedviaspinalcordtomusclesofrespiration:diaphragm,intercostalmuscles Contractionofdiaphragmandintercostalmusclesleadtoinhalationconverselyrelaxationofthose musclesleadstoexhalation Contractionofdiaphragmcontrolledbyphrenicnervewhichoriginatesatcervical3,4,5(C4C5) Automaticstimulustobreatheisinitiatedbycontrolcentreinbrainstemcontinuallymonitorslevels ofcarbondioxideandph.inblood o Stimulusbreatheisinitiatedbyrecognitionofhighcarbondioxidelevelsbychemoreceptors o Chemoreceptorsarefoundinaorticandcarotidbodies
Characteristicsofnormalbreathing
3.2
3.3
3.4
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4
4.1
GaseousExchange
Introductiontogaseousexchange
Atmosphericairmixtureofgases o Resultisdifferentonabsorptionandexcretionbybody
Inspiredair ExpiredAir Oxygen 21.00% 17.00% CarbonDioxide 0.04% 4.00% Nitrogen 79.00% 79.00% 4%(47%)of21%oxygeninhaledisretainedbythebody o WhileamountofcarbondioxideEXPIREDis100timeGREATERthancarbondioxideinhaled Expiredairdiffersfromatmosphericaircontainslessoxygenandmorecarbondioxide o Butwarmedtobodytemperatureandmoistenedbywatervapour
4.2 Inspiration
5.1
AirwayObstructions
Lowerairwayobstructionscanbecausebyinfection,foreignbodies,asthma,chronicbronchitisand emphysema
Asthma
Twopredisposingfactorsareallergiesandstress Condition:airwaybecomesnarrowduetovariouscausessuchas: o Bronchospasm o Swelling o Mucousplugging AboveisthePATHOPHYSIOLOGY Pt.canshowsignsofallthreecauses/symptoms Sometimesnarrowingofairwaysmaygetbetterbyitselforwithspecifictreatment Narrowingofairwaypt.needstoworkhardertobreathein/out.Pt.willcomplainofdyspnea (difficultybreathing)andshortnessofbreath. Airpassingthroughnarrowpassagescausemedicalsounds o SoundcalledWHEEZING Whenairwaysbecomeseverelynarrowthereisalmostnoairmovementin/outwheezingwill stop o ThisiscalledSILENTASTHMATICUS (NEEDIMMEDIATEASSISTANCE)
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5.1.1 ClinicalpictureofAsthma
RespiratorySystem
Difficultyinexpiration(breathingOUTistheproblem) o Pursedlips o Signsofcyanosis o Difficultinspeech o Cough BarrelChest o Hyperresonant(highpitchedsound) o Wheezingthensilentchest o Tachypnea(fastbreathing) Accessorymuscleuse o Pt.willbesittinginthetripodposition o Usingstomachmusclestobreath o Usingneckmusclestobreath DecreasedLOC(lackofconsciousness) o Agitation o Restlessness Tachycardia(heartbeatsover120bpm)
TreatmentandManagement
5.1.2
Aimisto: o Oxygenate o Bronchodilate o Stopreaction History: o Howlonghastheattacklasted o Whatmedicationwastaken Airway:Mostimportant o MAINTAINAIRWAY Breathing: o Nebulisedoxygen o Backupearly(ifneeded) Partialrebreathermask Nebulizer(+40%@46L/min) Partialrebreathermask Circulation: o Monitorgradeoftachycardia(fastheartbeatabove120bpm) Assess: o Severity o VitalsincludingHGT Reassesspt.continuously: o TransportASAP o RememberBackupearly(ifneeded)!!!!!!!!!!!
Anaphylaxis
5.2
5.2.1
Donotsufferfromasthmamaysuffersevereallergicreaction Allergensubstancepeoplearesensitivetomaycauseallergicreactionoranaphylaxis
Signsandsymptoms
Airwayswelling Dilationofbloodvessels
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5.2.2
RespiratorySystem
Hypotension(lowbloodpressure) Widespreaditching
TreatmentandManagement
5.3
SameasAsthma
PulmonaryOedema
5.3.1
5.3.2
5.4
5.4.1
5.5
5.5.1
Dyspnea(difficultybreathing) Barrelchest
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5.5.2
RespiratorySystem
Hypoxia(pt.notnormallycyanoticpinkpuffer) Respiratoryfailure
TreatmentandManagement
5.6
Surfaceoflungisdisruptedairescapesintopleuralspaceeffectselasticityoflungtissue Pneumothoraxmostcommonlycausebytraumacanalsobecausebymedicalcondition Mayoccurinpt.withchroniclunginfection&pt.bornwithweakareasinlungs Asthmaandemphysemapt.highriskofspontaneouspneumothorax o Occurringwhenweakenedpotionoflungruptureswhilstcoughing Causesdecreaseinsurfaceareaavailableforgaseousexchange Resultsinloweroxygenintakeandcarbondioxidereleasefromblood NORMALpersonstimulustobreathecontrolledbyincreaseincarbondioxidelevelsinblood Emphysemapatientsrelyondecreasedlevelsonoxygenasstimulustobreathe o Forthisreasonemphysemapt.needtobecloselymonitoredwhenapplyinghighconcentrations ofoxygenpt.maylosestimulustobreatheandbecomeepneic. o NEVERwithholdoxygenfromthesept.
Signsandsymptoms
5.6.1
5.6.2
5.7
5.7.1
ABC Oxygen
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RespiratorySystem
ChestInjuries
6.2
6.2.1
6.3
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6.3.1 SignsandSymptoms
RespiratorySystem
6.3.2
6.4
6.4.1
Mostcommoninjuriesfoundintraumasituation
SignsandSymptoms
6.4.2
6.5
6.5.1
Paradoxicalmovement Createsflailsegmentwhichproduceparadoxicalbreathing
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6.5.2
Oninhalationflailsectionmovesinwards Onexhalationflailsectionmovesoutwards
RespiratorySystem
TreatmentandManagement
6.6
ABC Oxygen AssistwithventilationwithBVMifneeded(b/p/mbelow6) Beawareofpossibledamagetounderlyingstructures/organs VitalSigns SecondarySurvey Encouragept.tobreathenormally Splintinjuredsideusingpt.armorhandforsupport Transport Callforbackup(ifneeded)
ContusionoftheLung
6.7
6.7.1
6.7.2
6.8
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RespiratorySystem
6.8.1
6.8.2
Decreasedorabsentairentryoninjuredside Reducedchestmovement Trachealdeviation Distendedneckveins Hyperresonant(highpitchednoisewheezingsound) Centralandperipheralcyanosis Tachycardia Hypotensionor(Reducesbloodpressure) Coldandclammyskin Subcutaneousemphysema
TreatmentandManagement
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RespiratorySystem
AirwayManagement
OneortwopersonBVMVentilationNOCOMPRESSION Advancedairway 1Ventilation Adult 1Breath Child 1Breath Infant 1Breath Child: 3secondsages5,6,7 5Secondsages12,13,14 Infants:ONEmonthandolder
7.2.1 BVM
7.2.2
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