Respiratory System &

Emergencies

Respiratory system

The respiratory system is the KEY component in patient care.

If you have an airway or breathing problem nothing else matters...

Respiratory system is

divided into two parts:

The upper airway & lower

airway

Structure & Function

Upper airway

From nose/mouth to epiglottis.

Filters air

Warms & humidifies air

provides sense of smell

Lower airway

From epiglottis to alveoli

Contains Larynx (vocal cords)

Exchange of oxygen (O2) & carbon dioxide (CO2)

Pharynx

Oropharynx and Nasopharynx

location of gag reflex for airway protection

Trachea

conducts air into lungs

hard - cartilage

Bronchi

connects trachea to each lung

angle difference

straight into right lung

sharp angle into left lung

Lungs

organ of respiration where exchange of O2 & CO2 take place

Each lung divided into lobes

location during ...

inspiration - the umbilicus

expiration - 4-5 intercostal space

Alveoli

smallest unit of respiratory system

microscopic sacks surrounded by capillaries

Gas exchange

Pleura

Parietal pleura

Visceral pleura

Diaphragm Has characteristics of both voluntary and

involuntary muscles

Dome-shaped

Divides thorax from abdomen

Contracts during inhalation

Relaxes during exhalation

Protective Structures

rib cage - protects from trauma

cilia - removes microscopic particles

pleura reduces friction

Breathing vs Respiration

NOT THE SAME

breathing = moves air in & out of system

respiration = supplies cells with O2 & removes CO2 - exchange at cellular level

Breathing Process: Inhalation

Diaphragm and intercostal muscles contract

Size of thoracic cavity increases

Pressure in the lungs decreases

Air travels to the lungs

Breathing Process: Exhalation

Diaphragm and intercostal muscles relax.

All dimensions of the thorax decrease.

Pressure in the lungs increases.

Air flows out of the lungs.

Exchange of Oxygen and Carbon Dioxide

Oxygen-rich air is delivered to alveoli.

Oxygen diffuses into the blood.

The body does not use all the inhaled oxygen.

Respiratory Center

located in brainstem

responds to CO2

controls rate & tidal volume

phrenic nerve makes the diaphragm work (neck injury can injure this nerve C3-5)

Signs of Adequate Respirations

Effortless

NTV

Normal rate

Regular rhythm

Normal LOC

Warm skin with normal color

Normal breath sounds bilaterally

Signs of Respiratory Distress (1 of 2)

Slower than 8 breaths/min or faster than 24 breaths/min

Irregular rhythm

Quality - labored

Accessory muscle use

Noisy or diminished breath sounds

Signs of Respiratory Distress (2 of 2)

Pale or blue skin

Cool, clammy skin

Dyspnea

Conversational dyspnea

Tripod position

Anxiety

Infant and Child Considerations

Structures less rigid

Airway smaller

Larger tongue

More dependence on diaphragm

Nasal flaring and seesaw respirations

Respiratory Emergencies

&

Dyspnea

Dyspnea

Shortness of breath (SOB) or difficulty breathing

Patient may not be alert enough to complain of shortness of breath

Terminology

Hypoxia - decreased/low oxygen

Anoxia - no oxygen

Wheezing - whistling sound

Rales - fluid sound (crackles)

Stridor - high pitched sound

Rhonchi - coarse gravelly sounds (similar to wheezing)

Causes of Poor Breathing

Pulmonary vessels become obstructed.

Alveoli are damaged.

Air passages are obstructed.

Blood flow to the lungs is obstructed.

Pleural space is filled.

Abnormal Respiratory Patterns

Apnea

Cheyne-Stokes

Central Nervous System Hyperventilation*

Ataxic

*Similar to Kussmal respirations in a diabetic patient

Upper or Lower Airway Infection

Infectious diseases may affect all parts of the airway.

Cause obstruction

Acute Pulmonary Edema

Fluid build-up in the lungs

Signs and symptoms

Dyspnea

Frothy pink sputum

Rales (crackles)

Recurrence high

History of chronic congestive heart failure

Chronic Obstructive Pulmonary Disease (COPD)

Emphysema or chronic bronchitis

Barrel chest

Labored breathing

Cyanosis

Can have sudden onset

Abnormal Breath sounds may be present Rhonchi, rales and wheezes

Acute Asthma

Spasm of the bronchioles

tachypnea

anxiety

wheezing

labored breathing

can have sudden onset

Spontaneous Pneumothorax

Accumulation of air in the pleural space

Caused by certain medical conditions

Dyspnea and sharp chest pain on one side

Absent or decreased breath sounds on one side

Pleural Effusion

Collection of fluid outside lung

Causes dyspnea

Caused by irritation, infection, or cancer

Decreased breath sounds

Eased if patient is sitting up

Pulmonary Embolus

Blood clot that winds up in lungs

Dyspnea

Hemoptysis

Cyanosis

Tachypnea

Plueritic chest pain

One sided chest pain

Can have sudden onset

Can have abnormal breath sounds

Pneumonia

History of URI (upper respiratory infection)

Fever

Productive cough

Slow onset

TX

High flow O2

High fowlers position

Rapid transport

Reassure patient

Support ventilations PRN

Hyperventilation

Response to illness (hyperventilation)

Response to emotional event (h. syndrome)

Anxiety

Dizziness

Clear lung sounds

Increased tidal volume

Numbness & tingling hands & feet

Carpal / Pedal spasms

RX

NO PAPER BAGS

Reassure patient

Give oxygen

Special Considerations

COPD in distress - High Flow O2

COPD in NO distress - low flow O2

2 LPM via nasal cannula

Due to hypoxic drive

Geriatric Needs

Aging alters respiratory system.

Older patients are at risk for lung diseases.

They may need ventilatory support.

Pediatric Needs

Asthma is common in childhood.

Cyanosis is a late finding.

Treatment is the same as for an adult.

THE END