Presentation 2: AIRWAY Emergency Care CLS 243 Dr.Bushra Bilal

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. 2

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 CO 2 in the blood  Hypocapnia : Decreased levels of CO 2 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 3

SIGNS AND SYMPTOMS OF RESPIRATORY DISEASES Cardinal Symptoms  Cough  Sputum  Hemoptysis  Dyspnea  Wheezes  Chest pain 4 Other presenting symptoms  Apnea  Hoarseness  Stridor  Snoring  Fever  Night sweating  Weight loss

a) Acute cough  Acute bronchitis  Pneumonia b) Chronic cough (>2 weeks)  Bronchial asthma  Chronic bronchitis  Lung cancer c) Hemoptysis  Lung cancer ( clots)  Tuberculosis  Pneumonia 5

d) Dyspnea Acute dyspnea (hours to days)  Bronchial asthma  Pneumonia Chronic dyspnea (months to Years)  Chronic bronchitis  Emphysema 6

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 7

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. 8

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)  Headache  Nasal discharge and congestion 9

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.

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. 11

Treatment of pneumonia: Antibiotics if bacterial in origin. Oxygen therapy for hypoxemia. A vaccine for pneumococcal pneumonia is currently available and highly effective. 12

TUBERCULOSIS The most common symptoms and signs of TB are: Fatigue fever weight loss coughing hemoptysis night sweats 13

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 14

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 15

16 Chronic bronchitisEmphysema Mild DyspneaDyspnea that may be severe Productive coughDry or no cough Cyanosis commonCyanosis rare Respiratory infection commonInfrequent infections Onset usually after 40 years of age Onset usually after 50 years of age History of cigarette smoking Cor pulmonale commonCor pulmonale in terminal stages Comparison of Symptoms for Chronic Bronchitis and Emphysema Comparison of Symptoms for Chronic Bronchitis and Emphysema

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) 17

EMPHYSEMA Emphysema is a respiratory disease that is characterized by destruction and permanent enlargement of terminal bronchioles and alveolar air sacs 18

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) 19

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 20

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 21

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 22

Management:  Beta 2 receptor agonist(Salbutamol)  Corticosteroids  Aminophylline (decreases bronchoconstriction)  Anticholinergics(e.g. Ipratropium) may decrease muscle spasm 23

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 24 BRONCHITIS

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) 25

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