2. Respiratory Emergencies
A Comprehensive Look

3. Respiratory system
Provided for the passage of O2 to enter
Necessary for energy production and for
CO2 to exit
Waste product of body’s metabolism.

4. Upper airway
Mouth and nose to larynx
Nasopharynx: Tonsils, uvula
Oropharynx: Tongue

5. Uvula
composed of connective tissue containing a number of racemose glands, and some muscular fibers

6. Lower Airway
Below the larynx to the alveoli

7. Pharynx
Muscular tube
Extends vertically from back of the soft palate to superior aspect of the esophagus
Allows air to flow in and out of the respiratory tract and food to pass into the digestive tract

8. Larynx
Joins the pharynx with the trachea
Consists of the thyroid and cricoid cartilage, glottic opening, vocal cords, cricothyroid membrane.

9. Trachea:
10 to 12 centimeter long tube that connects the larynx to the two mainstem bronchi.
Lined with respiratory epithelium containing cilia and mucous producing cells.
Mucous traps particles that the upper airway did not filter.
Cilia move the trapped particles up into the mouth where it is expelled or swallowed.

10. Bronchi:
At the carina bifurcates into the right a left mainstem bronchi.
Alveoli
Bronchioles divide into the alveolar ducts and terminates into the alveoli
Comprise the key functional unit of the respiratory system
Contain an alveolar membrane that is only 2 cells thick
Most CO2 and O2 exchange takes place
Become thinner as they expand
Surface area totals more than 20 square meters, enough to cover half a tennis court
The hollow structure resists collapse due to the presence of a surfactant, a chemical that decreases their surface tension and makes it easier for them to expand.
Carina

12. Atelectasis
Aveolar collapse
Lung Parenchyma
Parenchyma: Principal or essential parts of an organ
Organized into the lobes
Right lung has three lobes where as the left lung has only two as it shares thoracic space with the heart.

13. Pleura
Membranous connective tissue that covers the lungs
Visceral: Envelopes the lungs and does not contain nerve tissue
Parietal: Lines the Thoracic cavity and contains nerve fibers

14. RESPIRATION AND VENTILATION
Ventilation: The mechanical process that moves air into and out of the lungs
Pulmonary or external respiration: Alveoli
Cellular or internal respiration occurs in the peripheral capillaries It is the exchange of respiratory gases between the RBCs and various body tissues
Cellular respiration in the peripheral tissue produces CO2 which is picked up by the blood in the capillaries and transports it as bicarbonate ions through the venous system to the lungs.

15. RESPIRATORY CYCLE
Nothing within the lung parenchyma makes it contract or expand
Ventilation depends upon changes of pressure within the thoracic cavity
Begins when the lungs have achieved a normal expiration and the pressure inside the thoracic cavity is equal to the atmospheric pressure
Respiratory centers in the brain communicate with the diaphragm by way of the phrenic nerve, signaling it to contract. This initiates the respiratory cycle
Then……….

16. Thorax increases; pressure within decreases; becomes lower than atmospheric pressure; with the negative pressure, air rushes in; the alveoli inflate with the lungs, becoming thinner allowing oxygen and CO2 to diffuse across their membranes.
When the pressure in the thoracic cavity is again that of the atmospheric pressure, the alveoli are maximally inflated.

17. Pulmonary expansion stimulates microscopic stretch receptors in the bronchi and bronchioles that signal the respiratory center by way of the vegus nerve to inhibit respiration and the influx of air stops.
At the end of respiration:
Respiratory muscles relax
Size of the chest cavity decreases
Elastic lungs recoil forcing air out of the lungs (expiration)

18. Expiration is passive
Respiration is active process using energy

19. Use of Accessory muscles:
Strap muscles of the neck, and abdominal muscles to augment efforts to expand the thoracic cavity

20. Pulmonary Circulation
During each cardiac cycle, the heart pumps just as much blood to the lungs as it does to the peripheral tissues.
Bronchial arteries that branch from the aorta supply most of their blood.
Bronchial veins return blood from the lungs to the superior vena cava.

21. Hypoventilation: Reduction in breathing rate and depth

22. Pneumothorax: Air or gas in the pleural cavity
Hemothorax: Accumulation of blood or fluid containing blood in the pleural cavity
Pulmonary embolism: Blood clot that travels to the pulmonary circulation and hinders oxygenation of blood

23. Hypoxic Drive
The body constantly monitors the PaO2 and the pH.
COPD
Chronically elevated PaCO2
Body no longer uses PaCO2 levels to stimulate breathing
Hypoxic drive increases respiratory stimulation when PaO2 level falls and inhibits respiratory stimulation when PaO2 levels increase.

24. Hypoxemia: Decreases partial pressure of oxygen in the blood

25. Respiratory Acidosis: Retention of CO2 can result from impaired ventilation due to problems occurring in either the lungs or in the respiratory center of the brain.
Respiratory Alkalosis results from increased respiration and excessive elimination of CO2.

26. MEASURES OF RESPIRATORY FUNCTION
Respiratory rate:
Adults 12 to 20
Children 18 to 24
Infants 40 to 60
Eupnea: Normal Respiration
Fever Increases
Emotion Increases
Pain Increases
Hypoxia Increases
Acidosis Increases
Stimulant Drugs Increases
Depressant Drugs Decreases
Sleep Decreases

27. Total Lung Capacity
Total amount of air contained in the lung at the end of the maximal respiration 6L
Tidal Volume
Average volume of gas inhaled or exhaled in one respiratory cycle
500 mL (5 to 7 cc/kg)
Dead Space Volume
The amount of gas in the tidal volume that remains in the air
passageways unavailable for gas exchange.
Anatomic dead space includes the trachea and bronchi
Physiologic dead space from COPD, obstruction or atelactesis
150 ml

28. Minute Volume
Amount of gas moved in and out of the respiratory tract in one minute
Vmin = VT x Respiratory Rate
Alveolar Minute Volume
Amount of gas that reaches the alveoli for gas exchange in one minute
VA-min = (VT – VD) X Respiratory rate

29. RESPIRATORY PROBLEMS
Dyspnea: An abnormality of breathing rate, pattern, or effort
Hypoxia: Oxygen deficiency
Anoxia: The absence or near-absence of oxygen

30. Modified forms of respiration
Coughing: forceful exhalation of a large volume of air form the lungs, expelling foreign materials from the lungs
Sneezing: Sudden forceful exhalation from the nose. Nasal irritation
Hiccoughing: Sudden inspiration; caused by spasmodic contraction of the diaphragm with spasmodic closure of the glottis. No physiologic purpose. Occasionally been associated with MI on the inferior (diaphragmatic) surface of the heart
Sighing: Slow, deep, involuntary inspiration followed by a prolonged expiration; hyperventilates the lungs and reexpands atlectatic alveoli; occurs once a minute
Grunting: Forceful expiration; occurs against a partially closed epiglottis; usually an indication of respiratory distress.

31. Accessory Respiratory Muscles:
Intercostal
Suprasternal
Supraclavicular
Subcostal retractions
Abdominal muscles
In Infants
Nasal flaring
Grunting

32. COPD
Purse their lips

33. Pulsus Paradoxus
Comparison of blood pressure between that of
inspiration and that of exhalation
A drop in blood pressure greater than 10 torr
Drop in blood pressure during inspiration
Drop is due to increased pressure in the thoracic cavity that impairs the inability of the
ventricles to fill.

34. ABNORMAL RESPIRATORY PATTERNS
Kusssmaul’s Respirations
Deep, slow or rapid, gasping breathing,
Commonly found in diabetic ketoacidosis
Cheyne-Stokes Respirations
Progressively deeper, faster breathing alternating gradually with shallow, slower breathing.
Indicates brain-stem injury
Biot’s Respirations
Irregular pattern of rate and depth with sudden, periodic episodes of apnea
Indicates increased intracranial pressure

35. Central Neurogenic hyperventilation
Deep, rapid respirations
Indicates increased intracranial pressure

36. Agonal Respirations
Shallow, slow, or infrequent breathing
Indicates brain anoxia

37. Rales: Fine, bubbling sound; on inspiration; fluid in smaller bronchioles
Rhonchi; Course, rattling noise on inspiration; associated with inflammation, mucous or fluid in the bronchioles
Stridor: Harsh, high-pitched heard on inhalation; laryngeal edema or constriction
Snoring: Partial obstruction of the upper airway by the tongue
Gurgling: Accumulation of blood, vomitus, or other secretions in the upper airway

38. Tension Pnuemothorax
Any tear in the lung parenchyma can cause a pneumothorax.
Tension: Large pneumothorax that affects other structures in the chest
Progressively worsening compliance when bagging
Diminished unilateral breath sounds
Hypoxia with hypotension
Distended neck veins
Marked increase in pressure can prevent ventricles from adequately filling decreasing cardiac output
Tracheal deviation

39. Tachypnea/Bradypnea
Respiratory effort: How hard a patient has to work to breathe
Orthopnea: Difficulty breathing while lying supine

40. Hypothermia
Combines the mechanisms of convection, radiation, and evaporation
Accounts for a large proportion of the body’s heat loss
Heat is transferred to from the lungs to inspired air by convection and radiation
Evaporation in the lungs humidifies the inspired air.
During expiration, warm humidified air is released into the environment, creating heat loss

41. Respiratory Shock
Respiratory system is not able to bring oxygen into the alveoli and remove CO2
Blood leaves the pulmonary circulation without adequate oxygen and with an excess of
CO2
The cells become hypoxic while the bloodstream becomes acidic

42. RESPIRATORY CONTROL
Respiratory centers within the brainstem control respiration
Inspiration and expiration occur automatically and are triggered by impulses generated in the respiratory center of the medulla oblongata during normal respiration
The medullary respiratory system contains chemoreceptors that respond to changes in the CO2 and pH levels in the CSF
CO2 rapidly diffuses across the blood-brain barrier in to the CSF while H+ and bicarbonate ions do not.

43. Two Respiratory Centers in the Pons
Apneustic
Located in the lower pons
Acts as a shut-off switch to inspiration
If non-functional, prolonged inspiration interrupted by occasional expiration
Pneumotaxic Center
Located in the upper pons
Moderates the activity of the apneustic center and provide fine tuning
Medulla Oblongata
CO2 receptors
Internal Carotid Arteries
CO2, O2 and B/P receptors
Aorta
Lungs
Stretch receptors

44. Pons
Modifies rate and depth of breathing
Medulla Oblongata
Sets basic rate and depth of breathing

46. Nasal Canulae
4 to 6 liters per minute
22 to 44% oxygen
Non-rebreather
10 to 15 liters per minute
80 to 100% oxygen

47. Inhaler: Bronchodilator
Inhaler: Stimulation of the Sympathetic Nervous System
One metered dose

48. Inhaler
purse lips around inhaler
depress inhaler as patient inhales deeply
Patient hold their breath for a few seconds

49. Inhaler: Breathing difficulties with history of COPD/Asthma
The patient is not responsive enough
The maximum dose has been taken