Presentation 2: AIRWAY

Emergency Care

CLS 243 Dr.Bushra Bilal

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INTRODUCTION

These respiratory diseases include:

Infections such as pneumonia.

Obstructive disorders that obstruct airflow into and out of the lungs

such as asthma, bronchitis and emphysema.

Restrictive disorders are conditions that limit normal expansion of

the lungs such as pneumothorax, atelectasis and respiratory distress

syndrome

Cancers or exposure to Inhaled particles alter the pulmonary

function.

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GENERAL SYMPTOMS OF RESPIRATORY DISEASE

Hypoxia : Decreased levels of oxygen in the tissues

Hypoxemia : Decreased levels of oxygen in arterial blood

Hypercapnia : Increased levels of CO2 in the blood

Hypocapnia : Decreased levels of CO2 in the blood

Dyspnea : Difficulty breathing

Tachypnea : Rapid rate of breathing

Cyanosis : Bluish discoloration of skin and mucous

membranes due to poor oxygenation of the blood

Hemoptysis : Blood in the sputum

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SIGNS AND SYMPTOMS OF RESPIRATORY DISEASES

Cardinal Symptoms Cough Sputum Hemoptysis Dyspnea Wheezes Chest pain

Other presenting symptoms Apnea Hoarseness Stridor Snoring Fever Night sweating Weight loss

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a) Acute cough Acute bronchitis Pneumonia

b) Chronic cough (>2 weeks) Bronchial asthma Chronic bronchitis Lung cancer

c) Hemoptysis Lung cancer ( clots) Tuberculosis Pneumonia

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d) Dyspnea

Acute dyspnea (hours to days) Bronchial asthma Pneumonia

Chronic dyspnea (months to Years) Chronic bronchitis Emphysema

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e) Wheezes (Rhonchi) Bronchial asthma COPD

f) Chest pain Pneumonia Angina pectoris

g) Cyanosis (>5gm% of Hb deoxygenated)• Central (blue hands & tongue) COPD, Asthma, Pneumonia, • Peripheral (blue hands & red tongue) Cold weather

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RESPIRATORY INFECTIONS

Infections of the respiratory tract can occur in:

1. The upper respiratory tract or

2. The lower respiratory tract, or

3. Both.

Organisms capable of infecting respiratory structures include:

1. bacteria.

2. viruses:

3. fungi.

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THE COMMON COLD

The most common viral pathogens for the “common cold” are rhinovirus, parainfluenza virus, respiratory syncytial virus, adenovirus and corona virus.

• Manifestations of the common cold include:Rhinitis (Inflammation of the nasal mucosa)Sinusitis (Inflammation of the sinus mucosa)Pharyngitis (Inflammation of the pharynx and throat)HeadacheNasal discharge and congestion

DISEASES OF THE RESPIRATORY SYSTEM

• Chronic Bronchitis results from irritation of the bronchi and bronchioles. This causes more tissues to secrete excess mucous. In chronic bronchitis, the air passages clog with mucous. This causes a constant cough. This disease can result from cigarette smoking.

• Chronic Obstructive Pulmonary Disease (COPD) is a combination of asthma, emphysema, and chronic bronchitis. It usually results from exposure to cigarette smoke.

• Lung cancer It usually results from smoking or prolonged exposure to dangerous materials in the air.

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PNEUMONIA

• Pneumonia is an infection of the alveoli. Bacteria or viruses can cause it. Fluid collects in the alveoli. This means they cannot exchange oxygen and carbon dioxide efficiently.

Signs/symptoms:• High fever• Chills• Shortness of breath• Increased breathing rate• A worsening cough that may produce discolored or bloody

sputum (phlegm)• Sharp chest pains – caused by inflammation of the membrane

that lines the lungs.

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Treatment of pneumonia:

• Antibiotics if bacterial in origin.

• Oxygen therapy for hypoxemia.

• A vaccine for pneumococcal pneumonia is currently available and highly effective.

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TUBERCULOSIS

• The most common symptoms and signs of TB are:

•Fatigue •fever• weight loss•coughing•hemoptysis•night sweats

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CHRONIC OBSTRUCTIVE PULMONARY DISEASE( COPD)

• It is a chronic, progressive disorder characterized by airway obstruction and little/no reversibility.

Comprises of:• chronic bronchitis• emphysema• asthma

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Chronic Bronchitis:

It is defined clinically as cough, productive of sputum, on most days for 3 months of 2 successive years.

Emphysema:

Is defined histologically as enlargement of the air spaces distal to the terminal bronchioles, with destruction of the alveolar walls

Asthma:

Characterized by recurrent episodes of dyspnea, cough(often nocturnal) and wheeze caused by reversible airway obstruction

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Chronic bronchitis EmphysemaMild Dyspnea Dyspnea that may be

severe

Productive cough Dry or no cough

Cyanosis common Cyanosis rare

Respiratory infection common

Infrequent infections

Onset usually after 40 years of age

Onset usually after 50 years of age

History of cigarette smoking

History of cigarette smoking

Cor pulmonale common Cor pulmonale in terminal stages

Comparison of Symptoms for Chronic Bronchitis and Emphysema

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CATEGORIES OF COPD• Type A - “Pink Puffer”- predominantly emphysema• Type B - “Blue Bloaters- predominantly chronic bronchitis.

Investigations:• ABG• CXR to exclude infection and pneumothorax• FBC, U&E, ECG• blood cultures( if pyrexial)

Management:• Controlled oxygen therapy• Nabulized bronchodilators e.g. albuterol (ventolin)• Antibiotics if evidence of infection (amoxicillin)

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EMPHYSEMA

• Emphysema is a respiratory disease that is characterized by destruction and permanent enlargement of terminal bronchioles and alveolar air sacs

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Signs and symptoms of emphysema• barrel-chest appearance• non productive cough• severe exertional dyspnea• pink skin color(pink puffer)• wheezing and ronchi• pursed-lip breathing(prolonged inspiration)

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ASTHMA

It is characterized by recurrent episodes of dyspnoea, cough and wheeze caused by reversible airways obstruction.

Contributing factors:

Bronchial muscle contraction, mucosal swelling/inflammation, increased mucosal production

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Manifestations of asthma :

Coughing, wheezing Difficulty breathing Rapid, shallow breathing Increased respiratory rate Excess mucus production Significant anxiety Hyper inflated chest Hyper resonant percussion note

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Common Asthma causes:• Animals (pet hair or dander) • Dust • Changes in weather (most often cold weather) • Chemicals in the air or in food • Exercise • Mold • Pollen • Respiratory infections, such as the common cold • Strong emotions (stress) • Tobacco smoke

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Management: Beta 2 receptor agonist(Salbutamol) Corticosteroids Aminophylline (decreases bronchoconstriction) Anticholinergics(e.g. Ipratropium) may decrease muscle spasm

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Manifestations of chronic bronchitis:• Productive, chronic cough• Production of purulent sputum• Frequent acute respiratory infections• Dyspnea, shortness of breath, wheezing, fatigue• Hypoxia, cyanosis• Fluid accumulation (edema) in later stages

BRONCHITIS

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• Chronic inflammation and swelling of the peripheral airways• Excessive mucus production and accumulation• Partial or total mucus plugging• Hyperinflation of alveoli (air-trapping)• Smooth muscle constriction of bronchial airways

(bronchospasm)

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