Respiratory System-Review Patho

8/9/2019 Respiratory System-Review Patho

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Respiratory SystemParamedic Anatomy Review

Upper Respiratory Tract: The sequence of Organs that comprise the upper

conducting pathway: Nasal cavity and sinuses

Pharynx

arynx

Trachea

Nasal Cavity:

The nasal cavities are separate from each other

!y the nasal septum"

#ascular mem!rane on the Nasal Septum

$ost nose !leeds in young people originate at

the anterior nasal septum

$ost nose !leeds in older people are from the

posterior nasal structures

The %ri!riform plate is the thin layer of !one thatseparates the !rain from the nasal cavity"

Lungs:

Right ung & lo!es

eft lung ' lo!es

Bronchioles:

Smallest airways

(alls consist entirely of smooth muscle )No

cartilage present*

+%onstriction increases resistance to air,ow


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3/100

Respiratory System Physiology:

Neurotoxic center/ 2xhaleA!nosic %enter

Respiratory System:

Automatic 1unction );ypoxic -rive* Primary -rive: 5ncrease in arterial %O'

Secondary )hypoxic* -rive: decrease in

arterial O'

Inspiration

Active process

Chest cavity expands

Intrathoracic pressure falls

Air flows in until pressure equalizes

*Needs to make PEEP Positive end

expiatory pressure!

Create " tor#m$ to maintain PEEP

xpiration

Passive process

Chest cavity size decreases

Intrathoracic pressure rises

Air flows out until pressure equalizes


4/100

+ Normally we !reathe to remove %O'

from the !ody NOT to get oxygen in

34 %o' Required to !reath in to

simulate %hemoreceptors To stretch. put up hydrogen 5ons

COPD Pt:

;ypoxic -rive level changed


5/100

pper Airway:

Trauma

2piglottis

1>AO

5n,ammation of tonsils

Lo#er Air#ay:

Trauma

O!structive lung disease

$ucus accumulation

Smooth $uscle spasm

Airway edema

Chest $all "mpairment:

Trauma

;emothorax

Pneumothorax

2mpyema

Pleural

5n,ammation

Neuromuscular diseases

Neurological Control:

>rainstem dysfunction/ %oning

Phrenic or spinal nerve dysfunction


6/100

Sources O! Pulmonary "mpairment:-i@usion:

5nadequate 15O' )Smo?e 5nhalation*

%ar!on $onoxide '9B stronger thanOxygen )Remove from area 2$%A/P*

-iseased Alveoli: %anCt 2xpand As!estosis

%OP-

5nhalation 5nDury

%apillary >ed -isease: Atherosclerosis )No gas exchange.

hardening of artery* 5nterstitial Space -isease:

;igh Pressure Pulmonary 2dema

;igh Permea!ility Pulmonary 2dema

)Pressure on alveoli: at ,uid squeeEes more,uid*

Perfusion: 5nadequate !lood volume or

hemoglo!in

;emmorging


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8/100

;ead Trauma

%#A/ )Stro?e* Around Pons = $addule

-epressant drug Toxicity

Narcotics/ >radypena

Sedatives/ ;ypnotics

2thyl Alcohol

"nitial Assessment: Airway

Anticipate airway pro!lems with

-ecreased O%

;ead Trauma

$axillofacial Trauma

Nec? Trauma %hest Trauma

OP2N/%2AR/$A5NTA5N

Respiratory Soun%s:

Respiration Re&uires:

#entilation. the mechanical process ofmoving air or gases into and out of thelungs

Perfusion. or movement of !lood though

the lungs and capillaries


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-i@usion of gas !etween the lungs and the

!lood

'entilation:Tracheo!ronchial tree: involved inventilation !ut does not participate in gasexchange"

(as )*change:Ta?es place in therespiratory of the lungs. where gasdi@uses across the alveolar/capillarymem!rane as they are exchanged!etween the lungs and the !lood that,ows through the pulmonary capillaries"Regulation Of Respirations:

-2P2N-S ON %O$PON2NTS:

4" Respiration Rate:The num!er of!reath a person !reaths in a minute

'" Nervous "mpulses !rom theRespiratory Center:$ain respiratorycenter lies in the $edulla O!longata in the!rainstem

&" Stretch Receptors:-uring inspiration.the lungs !ecome distended. activatingstretch receptors" These impulses send tothe !rainstem to inhi!it the medullary cells.decreasing inspiratory stimulus" Thus


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respiratory muscles relax allowing elasticlungs to recoil and expel air from the !ody"

6" Chemoreceptors:5nvoluntary

respiration controls central chemicalreceptors in the medulla and peripheralchemoreceptors in the carotid !odies andin the arch of the aorta" They arestimulated !y decreased oxygen andincreased car!on dioxide"

" +ypo*ic Drive:The mechanism that

increases respiratory stimulation when!lood oxygen falls and inhi!its respiratorystimulation when !lood oxygen clim!s"

Normal Respirations:

'esicular:ow pitched )soft* !reath

sounds that consist of a quiet" (ispy

inspiration phase with a shortened andsofter expiratory phase" They areheard over the periphery of the lungFeld"

Bronchovesicular:ouder )moreharsh*. !reath sounds consists of fullinspiratory phase with a shortened andsofter expiratory phase" They may !eheard throughout the full lung Feld andare often louder than tracheal !reathsounds"


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Bronchial:;ighest pitched )course*.

!reath sounds consists of a fullinspiratory and expiratory phase

usually !eing louder" They are normallyheard over the Trachea and arynx"

A,normal Respirations:

A,sent/no air entry

Diminishing: Are caused !y an

o!ese


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Course crac-les: Sound wet. low

pitched

.ine Crac-les: Sound dry. high

pitched

$hee/ing:%ontinuous. musical soundssimilar to a whistle sound" 5t results whenair moves though the partially o!structedairways" Their causes include asthma.

!ronchospasms. and foreign !odyo!struction" Iou may hear them without astethoscope or !y auscultating the chestduring any or all phases of the respiratorycycle" They often originate !y the small!ronchioles and Frst appear at the end ofexhalation" The closer to the end of

inspiration they appear. the worse yourpatientCs condition is"

Rhonchi:%ontinuous. rum!ling or rattlinglower pitched sound that has a snoringquality" They are heard in the larger

airway when large secretions.in,ammation. ,uid or other materials.o!struct airway" This is often found in thepatients su@ering from !ronchitis =pneumonia" Rhonchi usually appear in the


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early exhalation !ut may occur in earlyinspiration as well"

Stri%or:!ar? li?e sound that tends to !eaccentuated during inspiration when extrathoracic airways collapse due to lowerlumen pressure" They can often !e heardwithout a stethoscope" 5t is often a signcharacteristic of an upper airwayo!struction. Such as croup"

Pleural .riction Ru,:Are the squea?ingor grating sounds of the pleural liningsru!!ing together" They occur where thepleural layers are in,amed and have losttheir lu!rication" Pleural ru!s are common

in pneumonia and pleurisy )in,ammationof the pleura*" >ecause these sounds areheard whenever a patientCs chest wallmoves" They appear during the entirerespiratory cycle"

Respirations:

Apnea: Not !reathing" 5t is an ominous

Fndings and indictor of a seriouspro!lem with the airway. >reathing or!oth"


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Bra%ypnea: Slow. regular respirations

with a rate that is slower than 4'!reaths per minute"

)upena: Normal. Regular fullrespirations with a rate ,uctuating!etween 4'/'9 !reaths per minute.with the expiratory phase that lasts &/6 times longer than the inspiratoryphase"

Tachypnea:1ast. rapid respirationswith a rate that exceeds '9 !reathsper minute"

Dyspnea:-iJcult !reathing. with

sensation of shortness of !reath"

Orthopnea: -yspnea while laying

supine

Paro*ysmal Nocturnal Dyspnea:

Short attac?s of dyspnea that occurs at

night and interrupt sleep"

Agonal:Shallow. slow or infrequent

!reathing" 5nactive of !rain anoxia"


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Normal Respiration Rates:

Age Lo# Rate +igh Rat

Ne# Born0"n!ant 123 yrs4

56 76

To%%ler 1308yrs4

89 96

Preschooler150 yrs4

88 59

School age17038 yrs4

3; 56

A%olescent13503; yrs4

38 87

A%ult 1


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controls and respiratory al?alosis is oftenseen"

Cheyne Sto-es: Progressively deeperand faster respirations alternating withslow and shallow !reathing possi!ly apneaat the end of expiration" This pattern istypically seen in older patients withterminal illness or !rain inDury" )%ushingCs*Kussmauls: -eep. slow OR rapid 0ASP5N0that results as a corrective measureagainst such conditions as dia!etic?etoacidosis that produce meta!olicacidosis

PR)S)NT PROBL)=S:

A!dominal

%hest Pain

2lectrocution

5nhalation of toxic gases: e"g" %ar!on

-ioxide

$aDor


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BLS Respiratory RAT)S 1A%ult4:

Assist 'entilation if !reathing isdeemed inadequateL i"e" respiratoryrates M/49 or respiratory rates M'/&9 !pm

Breathing Appearsshallow. patientis cyanosed or decreased OA"

PA4

AB(:

P+: Normal: >50>90

+omeostasis

CO8: 1Aci%otic4: Normal: 509

Respiratory+CO5: 1Al-alytic4: Normal: 88087

=eta,olic

Partial Pressure o! O*ygen an%

Car,on Dio*i%e

PCO8: Al#ays the Opposite to P+

Norm: 509?

PAO8: ;60366?

Bu@ering: +omeostasis


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Respiratory System:

Tachypnearadypnea: Orthopedic

Signs of Respiratory -istress:

Nasal 1laring )Opening up Airway as

much as possi!le* Tracheal Tugging

Reactions

Accessory $uscle use

se of a!dominal muscle on exhalation

Tripod Positioning

SniJng position/ angle

Respiratory Assessment:%yanosis )ate. unrelia!le sign of

;ypoxia*OBI02NAT2 5mmediately 2specially if:

-ecreased O% )Frst Sign*

Possi!le Shoc?

Possi!le severe ;emorrhage

%hest Pain

%hest Trauma

Respiratory -istress or -yspnea


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;x of any ?ind of ;ypoxia

+elp!ul Respiratory Terminology

;ypoxia: 5nadequate Oxygen at the

cellular level

;ypoxemia: -eFciency of oxygen in

the arterial !lood

Anoxia: lac? of Oxygen

Respiratory Patterns:

Agonal: pattern of gasping followed !y

apnea

Ataxic Respirations: %luster. !reathing

or irregular characteriEed !y a series ofinspirations = expirations )lesions in

the medulla*

>iotCs: irregular respirations

characteriEed !y varying depths of

apnea" )this pattern lac?s repetitive

such as cheyne/sto?es* sually

indicates 5%P changes or head inDuries"


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%heyne/Sto?es: Regular periodic

pattern of !reathing with equal

intervals of apnea" 1ollowed !y

crescendo/ascendo sequence of

respirations. also seen in cortical head

inDuries or dysfunction. or possi!ly

sleep patterns in some adults" Kussmauls: A!normally deep pattern of

respirations with sighing sequences.

usually indicated -KA )-ia!etic* )'8/

&9*

Nervous System )@ect on

'entilation:

=e%ulla: Stimulation to initiate

ventilationPhrenic: 5nnervation of the

diaphragm

Spinal Nerves at Thoracic Levels:


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5nnervation of intercostal muscles

+ering0Breuer Ree*:

Prevents overin,ation

=)D"CAL R)SP"RATOR PAT+OLO(")S:

Pleurisy:

5n,ammation of pleura caused !y

friction ru! ayers of Pleura ru!!ing together

%ommonly associated with another

respiratory disease5nfection

ayers Ru! together

Presentation O! Pleurisy:

Sharp. sudden and intermittent chest

pain with related dyspnea Possi!ly referred to the shoulder

$ay or with respirations

Pleural Gfriction ru!H may !e audi!le

$ay have e@usion )1luid* or !e dry

Pulmonary )m,olism:


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9.999 deathslood:

-oes not pass Alveoli

-oes not exchange gases

A disorder of perfusion

2m!olis if mo!ile

1racture opens up fat. vessel gets into

venous system causing P2


23/100

%om!ination of factors increase

pro!a!ility of occurrence:

;ypercoagula!ility: ;igher ris? ofclotting

Platelet Aggregation/ thic?en !lood

-eep #ein Stasis )possi!ility of !lood

clots due to deeper veins with poor

!lood ,ow*2m!olus usually originates in lower

extremities or pelvis

#: mismatch )%anCt Perfuse well*

AB(:

Acidotic %O'

P; )Acidic*R"S .ACTOR:

#ein stasis or -#T )enlarged Trachea

#eins*

Recent surgery or trauma

ong !one fractures )lower*Oral %ontraception

Pregnancy

Smo?ing


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%ancerC

ong ,ights

+Polycythemia: 5ncrease in Red >lood

%ells

Anemia due to poor perfusion

Training lower partial pressure in

certain states

Training: Anticoagula!ility given

Other Causes: Air

Amniotic 1luid )mom can lea?

,uid into vascular*

1at Particles )long !one fracture*

Particles from su!stance A!use

#enous %atheter

Signs Symptoms O! P):

RAP5- ONS2T

-ISPN2A

TA%;I%AR-5A

TA%;IPN2A

12#2R )SO$2T5$2S*

2P5SO-5% )S;O(2RS*


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2#5-2N%2 OR ;5STORI O1

T;RO$>OP;2>5TS )Plaque*

%ONS5-2R 2ARI (;2N NO OT;2R%AR-5OR2SP5RTORI 15TS

#:

')R LAR() )=BOL"

Preceded !y sloc?age right heart failure Shoc?

%ardiac Arrest

ARDS:

A con%ition that results in severe

illness or inEury an% associates

#ith a high mortality rate 5ncreased permea!ility

Pulmonary 2dema

Surfactant -estruction


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Atelectasis

-ecreased compliance

;ypoxemia )severe ;ypoxemia*

>lood O' low

ADULT R)SP"RTOR D"STR)SS

SNDRO=):

AKA: NON/%ardiogenic Pulmonary

edema A %omplication Of:

Severe Trauma


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Suction

=)CAN"CAL ')NTALT"ON:

P22P

)C( =onitoring:Treat nder lying %auses:

$ay require #asopressors for shoc?

%/PAP

>/PAP

Splint Alveoli P22P #entilation

PN)U=ON"A:

1ifth leading cause of death in S

0roup of speciFc infections

Ris? 1actors

%igarette smo?ing

2xposure to %old 2xtremes of age

Ioung

Old

PN)U=ON"A:

"nammation o! Bronchioles an%

AlveoliProducts of in,ammation )secretions.

pus* add to respiration diJculty


28/100

(as )*change is impaire%

(or? of !reathing increased

=ay Lea% to:

AtelectasisSepsis

# mismatch

;ypoxemia

Presentation O! Pneumonia:

Shortness of !reath. -yspnea

1ever. %hills

Pleuritic %hest Pain. Tachycardia

%ough

0reenrown Sputum$ay have crac?les. rhonchi.

wheeEing in peripheral lung Felds%onsolidation

2gophony

=anagement O! Pneumonia:

Treatment mostly !ased on symptoms:

O'

Rarely is intu!ation required

5# Access = rehydration


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30/100

Allergens

-rugs

Occupational ;aEards

(eneral Pathophysiology:

SpeciFc pathophysiology varies !y

disease

O!struction in >ronchioles Smooth muscle spasm )!eta9

$ucus accumulation )0o!let cells get

irritated and mucus* 5n,ammation

O!struction may !e reversi!le or

irreversi!le O!struction results in air trapping

>ronchioles usually dilate on

5NSP5RAT5ON -ilation allows air to enter even in

presence or Go!structionH >ronchioles tend to %ONSTR5%T on

expiration


31/100

Air !ecomes trapped distal to

o!struction

%yanotic late sign )very ill* Ph"

Acidotic %O'

C+RON"C OBSTRUCT"')

PULO=NAR D"S)AS): )mphysema

Chronic Bronchitis Sometimes Asthma

)mphysema:

Adelectics: loss of elastic recoil with

alveoli


32/100

Smo?ers 49B more li?ely to die od

%OP- than non/smo?ers

)nvironmental .actors Alpha/ 4 antitrypsin deFciency

+ere%itary

9.999 to 499.99 cases

$ost people of Northern 2uropean

-escent

0eriatrics -isease

PAT+OP+S"OLO(:

-ecreased surface area leads to

decreased gas exchange with !lood

oss of pulmonary capillaries =

;ypercarnia eads to: 5ncreased resistance to !lood ,ow

which leads to: Pulmonary ;TN

Right ;eart 1ailure )%or Pulmonale*

oss of elastic recoil leads to increase

in residual volume and %O' retention Air trapping


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;yperin,ation

;ypercapnia Pulmonary

#asoconstriction #arrel

%hest* -ecreased ung sounds< heart )siEe of

surface area increased ;yperresonant chest

5P PRS5N0: Air Trapping to increase

P22P levels )exhalation* Alerted !lood gases

Normal or decreased PaO'

2levated %O'

%lu!!ed Fngers

Still perfusing

%yanosis is a late sign of diseaseP"N PU..)RG

Treatment:

BLS:

#entilate


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O' mas?

%ardiac $onitor 5rregular )P#%*

$onitor >reathing

Chronic Bronchitis:5ncreased mucus production for more

then & months for ' consecutive years"

Recurrent productive cough

)tiology:

Smo?ing 2nvironmental irritants

Pathophysiology:

$ucus plugging


35/100

creating more causing Polycythemia

)not getting oxygenated !y Alveoli*

;ypercar!ia leads to pulmonaryvascular constriction: increased right

ventricular which leads Right sided

heart failure which can lead to

enlargement of right side )%or

Pulmonale*

S"(NS S=PTO=S

5ncreasing dyspnea on exertion

1requent colds of increasing duration

Productive cough

(eight 0ain. edema )right hear failure*

>luish/red s?in )polycythemia*: -2 TO

NOBI02NAT2- >OO-

Rales. Rhonci. (heeEing

;eadache. drowsiness )increase in%O'*

nintelligence

Over weight due to SO>


36/100

P5TT5N0 2-2$A

Personality %hange

;yperocar!ia

;ypoxia

1luid >ac?s up. 5nferior and Superior

!ecome semi/permea!le. !lood lea?s

out into interstitial spaceTreatment: + Anti!iotics

CANOS"S "S AN )ARL COURS) O.

D"S)AS)

BLU) BLOAT)RGG

COPD Assessment .in%ings:

Chronic Con%ition Acute

)piso%e

SS o! #or- o! ,reathing

an%Hor hypo*emia

se of accessory muscles

5ncreased expiratory e@ortTachycardia

%yanosis

(heeEing. Rhonli


37/100

-ecreased ung Sounds

Thin. red


38/100

Un%erstan% Di@erenceG

ARDS: 1S)')R) ACUT)

R)SP"RTOR .A"LUR)4


39/100

Respiratory .ailure:

5na!ility of the lungs to meet meta!olic

demands of the !ody%anCt ta?e in enough O' = %ant

eliminate enough %O' fast enough

#entilation 1ailure: 5m!alance !etween

load on the lungs and the a!ility of the

!ellows to compensate1ailure of Oxygenation: PaO' M89

mmhg

1ailure to #entilation: Pa%O' U9

mmhg

ARDS:

ea?y Alveolar capillaries

Plasma ,uid and eu?ocytes lea? into

the airspace

Shunt

;ypoxemiaCAUS)S O. ARDS:

Pneumonia

Aspiration of 0astric contents


40/100

Pulmonary %ontusion

Near/-owning

5nhalation 5nDury )%O/Smo?e*

Reperfusion Pulmonary 2dema

After ung Transplant or

Pulmonary 2m!olectomy

5ND"R)CT LUN( "NIUR:

Non/Pulmonary sepsis

Severe trauma with S;O%K

%ardiopulmonary >ypass

Acute Pancreatitis

-rug Reaction )ARA/%*

1AT. Amniotic 1luid

2m!olism. !ypass

PAT+OP+S"OLO(:

"ncrease alveolar permea,ility %ue

to %irect neutrophil0me%iate%

inEury to the alveolar epithelium

Al#ays en%s in some !orm o!!ulminating )%ema

)n% result:


41/100

Severe +POF)="A

BLS T+)ARP+T"C (OALS:

=aintain Reasona,ly O*ygen

Delivery

."ND ."F PR"=AR CAUS)

T+ORAC"C TRAU=A:

Second leading cause of trauma

deaths after head inDuries

%auses of a!out 49/'9Q of all auma

death

$any deaths due to thoracic trauma

are preventa!lePR)')NT"ON STRAT)(")S:

0un Safety 2ducation

Sports Training = Protective

2quipment

Seat >elts = Air >ag se

=echanism O! "nEury

>lunt 5nDury

-eceleration

%ompression


42/100

Penetrating "nEury

Both

Anatomical "nEuries:

Thoracic %age )S?eletal*

%ardiovascular )ethal -ysrhythmia*

Pleural and Pulmonary $ediastinal

-iaphragmatic

2spogheal

Penetrating %ardiac )0rave TOR*

Often Results in:

;ypovolemia

Pulmonary #


43/100

+o# $hy %o #e ventilateJ

Per!usion 'entilation

(eneral Pathophysiology:

"mpairment to Car%iac Output

>lood loss

5ncreased intrapleural pressure

)Pnemo*

>lood in Pericardial Sac

$yocardial #alve -amage

#ascular -isruption

"mpairments in 'entilation:

%hest excursion compromise:

Pain

Air in pleural sac

Asymmetrical movement

>leeding in Pleural Space 5ne@ective -iaphragm contraction "mpairment in (as )*change: Atelectasis Pulmonary %ontusion Respiratory Tract disruption "nitial )*am %irecte% to#ar%s

Li!e Threatening "nEuries:


44/100

Open Pneumothorax 1lail %hest Tension Pneumothorax $assive ;emothorax %ardiac Tamponade Con%itions: Apnea Respiratory -istress

ASS)SS=)NT ."ND"N(S:

$ental Status )decreased* Pulse )A!sent. >rady. Tachy* >P )Narrow PP. ;yperP in

inspiration

#entilation rate = e@ort )Tachy. or

>rady. a!ored. retractions* S?in )-iaphoresis. pallor. %yanosis. open

inDury. ecchymosis*

Nec? )Tracheal position. S

emphysema. #-. Open 5nDury*

%hest )contusions. tenderness.

asymmetry. a!sent or decreased lung

sounds. a!normal percussion. open


45/100

inDury. impaled o!Dect. crepitus.

hemoptysis )coughing up of !lood*

;eart Sounds )muVed. distant.

regurgitant murmur*

pper A!domen )%ontusion. open

inDury*

2%0 )ST segment a!normalities.

dysrhythmias*

+istory: -yspnea Pain Past hx of %ardiovascular disease Restraint device used

5tem


46/100

2specially common in 2lderly )falls*

Ri!s form rings

Possi!le !rea? in ' places )th*

$ost commonly th/th

Poor Protection

1ractures of the 4stand 'ndrequire

high force

1requently have inDury to aorta or

!ronchi Occur in 9Q of patients with

Tracheo/>ronchial rupture W

Su!cutaneous emphysema*

$ay inDure Su!clavian arterylood in rine*


47/100

Short = Stoc?y

ateral 5mpact $#%


ocaliEed pain. tenderness

5ncrease on palpation or when

Patient:

%oughs

$oves

>reaths

Splinted Respirations )0uarding.

short tidal volume* )Pillow Splint:

%leansing !reathing. long as

possi!le resp"*

5nsta!ility in chest wall. %repitus-eformity and discoloration

Associated with Pneumo =

;emothorax

=ANA()=)NT:

;igh %onc" O'

Positive Pressure #entilation %/PAP

Splint using Pillow or swath

2ncourage Pt" to !reath deeply

;elps prevent Atelectasis


48/100

Analgesics for isolated trauma

)$orph"*

Non/circumferential splinting)5solate to that Region*

=onitor )l%erly pt COPD

patients Closely:

>ro?en Ri!s can cause

decompensation

Pt" will fail to !reath deeply and

cough. resulting in poor clearance of

secretions

sually Non/2mergent Transport

ST)RNAL .RACTUR):ncommon. /Q in !lunt chest

trauma

arge traumatic force

-irect !low to front of chest !y

-eceleration:

Steering wheel

-ash!oard

Other o!Dect


49/100

'Q/6Q mortality due to

associated trauma:

-isruption of thoracic aortaTracheal or >ronchial tear

)Su!cutaneous 2mphysema*

-iaphragm Rupture

$yocardial Trauma

;igh 5ncidence of myocardial

%ontusion. %ardiac Tamponade or

pulmonary contusionASS)SS=)NT ."ND"N(S:

ocaliEed Pain

Tenderness over sternal

%repitusTachypnea. -yspnea painful

2%0 changes with associated

$yocardial %ontusion

;x


50/100

;igh %oncentration O' )4'/4. Q

SO'*

Assist ventilations with >#$ asneeded

5# NS


51/100

Also results from:

1alls from heights

5ndustrial Accidents

Assault

>irth Trauma

$OR2 %O$$ON 5N O-2R PT"

$ortality rates '9/69Q due to

associated inDuries

$ortality increased with: Seven or more ri!s fractured

Three or more associated inDuries

Shoc?

;ead 5nDuries

CONS)U)NC)S O. .LA"L

C+)ST:

Respiratory .ailure %ue to:

Pulmonary %ontusion

5ntrathoracic 5nDury

5nadequate diaphragm movement

PARADOF"CAL =O')=)NT:

$ust large to compromise

ventilation

5ncreased wor? of !reathing


52/100

PA"NM Decrease% Chest

e*pansion:

eading to decreased ventilation;ypoxic. ;ypoperfused

Contusion o! Lung:

-ecreased lung compliance

5ntra/alveolar/capillary hemorrhage

Decrease% 'entilation

;ypercapnea %o' increase;ypoxia

ASS)SS)=)NT ."ND"N(S:

%hest wall contusion

Respiratory -istress

Pleuritic %hest Pain

Splinting e@ected side %repitus

Tachypnea. Tachycardia

Paradoxical $ovement )possi!le*

=ANA()=)NT:

Suspect Spinal 5nDuries

2sta!lish Airway ;igh %onc" O'

Assist ventilation with >#$


53/100

Treat hypoxia from underlying

contusion

Promote full lung expansion %onsider need for 5ntu!ation and

P22P

AN5B2TI Reduces. Pain. Tidal

#olume 5ncrease

$echanically Sta!iliEe %hest (all

)uestiona!le value* )>ul?

dressings. %ravats*

5# of R


54/100

2$2R02NT TRANSPORT:

TRA$A %2NT2R

S"=PL) Pneumothora*:

Pleural wall

"nci%ence:

49/&9Q in !lunt chest trauma

almost 499Q with penetrating chest

trauma

$or!idity = $ortality depends on:2xtent of atelectasis

Associated 5nDuries

CAUS)S:

%ommonly a fx ri! lacerates lung

Paper !ag e@ect

$ay Occur spontaneously in tall.

thin. young males following:

2xertions

%oughing

Air Travel

Spontaneous may occur #ith=ar!ans Syn%rome 1)longate%

Lungs4PAT+OP+SOLO(:


55/100

Air enters pleural space causing

partial lung collapse

Small tear self/seal arger tears may progress

Usually #ell tolerate% in the

young +ealthy

Severe compromise can occur in

the el%erly or patients #ithpulmonary %isease

Degree o! %istress %epen%s on

amount spee% o! collapseASS)SS=)NT ."ND"N(S:

Tachypnea. tachycardia

-iJculty !reathing or respiratory

distress

Pleuritic Pain )chest pain that is not

cardiac pain*

$ay !e referred to shoulder or arm

pain on a@ected side

Decrease% or a,sent ,reath

soun%s:


56/100

Not al#ays relia,le

5f pt" is standing. assess apices Frst

5f supine assess anteriorly Frst

Patients with $ultiple ri! fractures

may splint inDured side !y not

!reathing deeply=ANA()=)NT:

2sta!lish airway.

Trend #itals -onCt leave patient alone

;igh %onc" O'

Assist with >#$

-ecreased or rapid respirations

5nadequate Tidal #olume )T#*

5# or S


57/100

Larger the hole the more li-ely

air #ill enter through there than

the Trachea 5f trauma pt" does not ventilate well

with an open airway. loo? for hole

$ay!e su!tle

A!rasion with deep punctures

Pathophysiology:

Results of penetrating trauma

Profound hypoventilation may occur

Allows communication !etween

pleural space = Atmosphere

Prevents development of negative

intrapleural pressure

Results in 5psilateral lung collapse

)One Side*

5na!ility to ventilate a@ected lung

'H mismatch:

Shunting;ypoventilation

;ypoxia

arge functional dead space


58/100

;ypotensive during venous return/

%O/Reduce/ Reduced >P


Opening in the chest wall

Suc?ing sound on inhalation

Tachycardia

Tachypnea

Respiratory -istress S emphysema

-ecreased ung sounds on a@ected

side=ANA()=)NT:

%over chest opening with occlusive

dressing )A%S/ Asherman %hest

Seal*

;igh %O'

Assist with positive pressure

ventilations

$onitor for progression of tension

Pneumothorax

5# with R


59/100


60/100

Reduction in %ardiac Output/

#enous return reduced

5ncreased intrathroxic pressure -eformed #ena %ava reducing

preload

Positive pressure !uilding more =

more

789 mm/ suppose to !e

Pressure on heart

-eviated trachea

Starling aw: greater stretch.

greater elastic recoil

Pressure on superior. inferior. aorta

#- ;ypotensive/ >P

ASS)SS)=)NT ."ND"N(S: 0 1=OST

L")L4

Severe -yspnea/ 2xtreme resp"

distress

Restlessness. anxiety. agitation


61/100

A!sent


62/100

;igh O'

Positive pressure ventilation with

>#$ Needle thoracostomy

5v of Re careful not ?in? or !end needle

5f availa!le attach one way valve


63/100

+emothora*:

PAT+OP+S"OLO(:

>lood in Pleural space

$ost common as a result of maDor

chest trauma to the chest wall

Present in 79/9Q of penetrating

and maDor non/penetrating trauma

cases

Associated with Pneumothorax

Ri! fractures are frequent causes

>lood vessels ruptures

>lood in 4999cc/&999cc

1lat Nec? #eins

+Kinematics ;igher

2ach can hold up to &999cc of !lood

ife/threatening often requiring

chest tu!e and or< surgery

5f associated with 0reat< #essel or

cardiac inDury:

9Q die immediately

'Q die to 49 minutes

'Q may live &9 minutes or longer


64/100

>OO- OSS R2STS 5N:

;ypovolemia

-ecreased ventilation a@ected lung

Accumulation of !lood in Pleural

Space

Penetrating or !lunt trauma

%hest wall vessels

5ntercostal vessel

$yocardium $ASS5#2 hemothorax indicates

great vessel or cardiac inDury

5ntercostal Artery can !leed

50cc/min

Results in %ollapse lung Accumulation of !lood eventually

producing a tension hemothorax

shifting the mediastinum producing:

#entilation impairment

%ardiovascular collapse



65/100

Tachypnea or Respiratory

Distress

Shoc? Rapid. wea? pulse

;ypotensive. Narrow PP

Restlessness. Anxiety

%ool. Pale. %lammy S?in

Thirst

Pleuritic %hest Pain -ecreased ung sounds

%ollapsed nec? veins

-ullness on Percussion

=ANA(A)=)NT:

)sta,lish Air#ay

;igh %onc" O' Assist ventilations with >#$

$AST in Profound ;ypotension

Needle Thoracostmy if tension =

una!le to di@erate from Tension

Pneumothorax 5#s B' with R


66/100

2$2R02NT TRANSPORT to TRA$A

%2NT2R

PUL=ONAR CONTUS"ON: PAT+OP+S"OLO(:

Blunt Trauma to the Chest

Rapid deceleration forces cause

lung to stri?e chest wall

;igh energy shoc? wave from

explosion

ow velocity as with 5ce pac?

$OST Trauma from !lunt thoracic

trauma:

&9/7Q of !lunt trauma

$ortality 46/'9Q Ri! fx in many !ut not all cases

Alveolar rupture with hemorrhage 7

2dema

5ncreased capillary mem!rane

permea!ility arge vascular shunt develop

0as exchange distur!ances

;ypoxemia


67/100

;ypercar!ia


Tachypnea or Respiratory distress

Tachycardia

2vidence of !lunt chest trauma

%ough and


68/100

(reat 'essel inEury until proven

other#ise

=OCARD"AL CONTUS"ON:$ost common !lunt trauma to heart

sually due to Steering wheel

SigniFcant cause of mor!idity and

$ortality in the !lunt trauma patient

PAT+OP+S"OLO(:

Behaves li-e an Acute ="

;emorrhage with 2dema

%ellular inDury

#ascular damage

;emopericardium may occur from

acerated epicardium or endocardium

)!lood Pericardium Sac*

$ay produce Arrhythmias )2ctopic

1oceye. extra !eats*

$ay cause unresponsive ;ypotension

to ,uid and drug therapyASS)SS=)NT ."ND"N(S:


69/100

%ardiac Arrhythmias following !lunt

chest trauma

Angina/li?e pain unresponsive toNitroglycerin

Precordial discomfort indepence of

respiratory movement

Pericardial friction ru! )late*

2%0 %hanges:

Persistent Tachycardia

ST elevation. T wave 5nversion

R>>>

Atrial 1lutter. Atrial 1i!rillation

P#%Cs

PA%Cs =ANA()=)NT:

)sta,lish Air#ay

;igh %onc" O'

5# R


70/100

Consi%er vasopressors !or

hypotension

)mergent Transport0 Trauma

Pericar%ial Tampona%e:

Usually associate% #ith

Penetrating trauma

Rare #ith Blunt trauma

Occurs in 'Q of chest trauma

0S( have greater mor!ity than

sta! wounds

ower $ortality rate if isolated

TamponadePAT+OP+S"OLO(:

Space normally lle% #ith 5606

ml stra#0colore% ui%

u!rication

ymphatic -ischarge

5mmunologic protection of the heart

RAP5- A%%$AT5ON O1 >OO- 5N

the 5N2AST5% P2R5%AR-5$


71/100

;eart is compressed decreased !lood

entering heart:

-ecreased diastolic expansion andFlling

;inders venous return / preload

$yocardial Perfusion decreased due to:

Pressure e@ects on walls of heart

-ecreased diastolic pressures

5schemic dysfunction may result in

inDury

Removal of as little as '9ml may

increase %O drastically

Stro?e #olume/ eft ventricle/ eDection

fractionX 89/Q of stro?e volume

.lui% aroun% cant pump as #ell

S"(NS S=PTO=S:

B)C TR"AD:

Resistant +ypotension Q Boles no

change

"ncrease% Central 'enous

Pressure: Bloo% thats %raining


72/100

get collecte% an% causes I'D

1Disten%e% nec-Harm veins in

presence o! %ecrease% arterial BP4 Small uiet +eart 1Decrease%

+eart Soun%s4 Narro# PP

.lui% goes into lungs

+y%rostatic Osmatic pressure ui%

#ill go into Alveoli %ue to pressuresemi0permea,le

Pulsus Paradoxus:

Radial pulse !ecomes wea? or

disappears when patient inhales/

49mm systolic5ncreased intrathoracic pressure on

inhalation causes !lood to !e trapped

in lungs temporarily

P2A/ 2T;A -ISR;I$T$A

O%=ANA()=)NT:

Secure Airway

;igh %ON%" O' $as?


73/100

Pericardiocentesis

Out of hospital primarily reserved for

%ardiac ArrestRapid Transport

5#Cs of Rlunt %hest Trauma


74/100

4Q of all !lunt chest trauma deaths

4 in 8 people who die in $#% has

Aortic RuptureQ die instantaneously

49/4Q survive to hospital

4lood enters media through a mall

intima tear/Thinned layer may rupture-escending Aorta at the 5sthmus distal

to left su!calvian artery most common

site of rupture/ igamentum ArterisomASS)SS=)NT ."ND"N(S:

Retrosternal or interscapular Pain

Pain in lower !ac? or one leg: not

getting perfused well

Respiratory -istress


75/100

Asymmetrical arm >PCs

pper 2xtremity hypertension with

-ecreased 1emoral Pulses or A!sent

1emoral Pulses

-ysphagia )Swollen*

=ANA()=)NT:

2sta!lish Airway;igh %onc" $as?

%/SP5N2

$aintain $inimal >P in dissection

5# R


76/100

>ac?ward ,ow of !lood out of right

heart into vessels of upper chest and

!ac?#-

%apillaries rupture


Purplish0re%%ish %iscoloration o!:

;ead

Nec? Shoulders

>lood shot. protruding eyes

#-

Sternal 1acture or central ,ail

Shoc? when pressure released

=ANA()=)NT:

Airway with %/spine control

Assist in #entilation

Spinal Sta!iliEations

"' o! LR

$onitor 2K0

$AST in severely ;ypotensive pts"

Rapid Transport


77/100

%onsider 2arly Sodium >icar!onate in

Arrest );%O&*

Diaphragmatic Rupture:Usually %ue to ,lunt trauma ,ut

may occur #ith penetrating

trauma

Usually li!e threatening

Li-ely to ,e associate% #ith other

severe inEuries

I'D

A,%ominal Contents in Pleural

SpacePAT+OP+S"OLO(:

Compression to a,%omen results

in increase% intra0a,%ominal

Pressure:

A!dominal contents rupture through

diaphragm into chest

>owel O!struction and strangulation

Restriction of lung expansion

$ediastinal shift


78/100

9Q occur on the left side due to

protection of right side !y liver

ASS)SS=)NT ."ND"N(S:Decrease% Breath Soun%s

sually unilateral

-ullness on percussion

-yspnea or Respiratory -istress

Scaphoid A!domen )hollow

appearance*sually impossi!le to hear !owl sounds

=ANA()=)NT:

)sta,lish Air#ay

Assist #entilations with ;igh %onc" O'

5# of R

$onitor 2K0

N0 tu!e if possi!le

Avoid

$AST

Trendelen!rug Position

Diaphragmatic Penetration:Suspect intra0a,%ominal trauma

#ith any inEury ,elo# 9th "CS


79/100

Suspect "ntrathoraic trauma #ith

any a,%ominal inEury a,ove

Um,ilicus)sophageal "nEury:

Rare >lunt Trauma

%an perforate Spontaneously

#iolent emesis

%arcinoma )Tears*

ASS)SS=)NT ."ND"N(:Pain. local tenderness

;oarseness. -ysphagia

Resp" -istress

Resistance of nec? on passive motion

$ediastinal esophageal perfection

$ediastinal emphysema


80/100

2$2R02NT TRANSPORT

TRAC+)OBRON"CAL RUPTUR):

Uncommon inEury

ess than &Q of chest trauma

Occurs with Penetrating trauma or

!lunt

;igh $or!ity rate

$ay involve fracture or upper ri!s

osing air into pleural space

Carina splint common

PAT+OP+S"OLO(:

$aDority )9Q* occur near %arina

YRapid movement of air into the Pleural

Space%ontinuous ,ow of air ,ow from needle

of decompressed chestASS)SS)=)NT ."ND"N(S:

Respiratory Distress:

-yspnea

Tachypnea

O!vious S 2mphysema

;emoptysis

>right Red colour


81/100

Signs of Tension Pneumothorax

unresponsive to needle decompression

=ANA()=)NT:)sta,lish Air#ay an% 'entilations

%onsider 2arly intu!ation

$ay!e life saving

2$2R02NT TRANSPORT

"NTRODUCT"ON TO CARD"OLO(:

CARD"O'ASCULAR D"S)AS):

Single greatest cause of death and

disa!ility in the S

5ncludes heart disease and #ascular

-isease

' $illion People diagnosed with as

A%S


82/100

Almost half of these )'9.99* will

sudden and within the Frst hour of

onset of symptoms99.99 people will su@er a stro?e each

year in the S

Nearly Z of these will die


83/100

AT+)ROSCL)ROS"S:

Pla&ue accumulation #ithin the

lumen o! the artery resulting in:

-ecreased umen inner diameter

5ncrease #ascular resistance

Potential for Throm!us or 2m!olus

formation

ASSO%5AT2- (5T;:

;TN

STROK2

AN05NA. ;2ART ATTA%K

R2NA 1A5R2

R"S .ACTOR:

Age

1amily ;istory

;ypertension

;ypercholesterolemia

$ale

Smo?ing

-ia!etes


84/100

CONTRUBT"N( .ACTORS:

-iet

O!esity

Oral %ontraceptives

Sedentary ifestyle

Personality Type)=S ROL):

Original #as the nee% !or rapi% response

to i%enti!y emergency care o! victims o!

Su%%en car%iac %eath 1parame%ics have

,een prove to ma-e %i@erence in survival

an% Acute =yocar%ial "n!ractionM

Contri,utions to ,eing reconi/e% in acute

coronary syn%romes

Loo-ing !or ST )levation in 5 or more

lea%s Car%iac Artery is then Splinte% or

Stente%

Bypass )R Department

$ea- 's Strong Chain o!

Survival:


85/100

Outcome is lo# #ith %elaye% CPR

(oo% &uality CPR is (OOD

"! #e %ont have goo% CPR

then #e can per!use heart

#ith +emoglo,in

TO su,stance 'entricular

.i,ulation 1Rhythm4

$ith ventricular .i,ulation

there is no rhythmic reaction

on pulse

Li!e:

'0.i,

Pulseless '0Tach


86/100

P)A0 Pulseless

Pulseless '0Tach

Asystoli 1.lat line4

Anatomy Physiology:

$hen heart must con%ucts

rst

.unctionally sypthom

Autocontratility: #e cancontract our o#n

Pulmonary )%ema: LC+.:

Con%uctive SST)=:

SA0NOD): 1PAC)=A)R4

760366 ,pm 1RA0 Anterior

in!erior #all o! Atrium4

A' NOD): 96076 BP=

P)R-inEie .i,ers: 86096,pm

Per-inEe system

A' IUNCT"ON0 IunctinalRhythm


87/100

Loo- !or (AP IUCT"ONS


88/100

Parietal - pericardial sac

Pericardial fluid


89/100

Bloo% .lo#:


90/100

CONDUCT"ON O. PAT+$A O. T+)

+)ART:

(Mitral

valve)


91/100

CARD"AC CCL):


92/100

D"ASTOL"C SSTOL"C

P)R"P+)RAL 'ASCULAR SST)=

')NOUS R)TURN:

SK22TA $S%2 P$P:

$uscular contraction squeeEes

adDacent veins causing a mil?ing action

#alves prevent opposite ,ow

R)SP"RTOR =O')=)NTS:

-iaphragm contraction exerts pressurein a!domen and decreases pressure in

thoracic cavity


93/100

>lood moves to area of lower pressure

in thorax

')NOUS R)TURN:%onstriction of #eins

Sympathetic stimulation causes

contraction of the smooth muscles

walls of veins

0ravity


94/100


95/100

Negative )@ects on 'enous

Return:

5ncreased intrathoracic Pressure

P22P


96/100

ART)R"AL R)S"STANC) 1A!terloa%4BP:

%ardiac Output B Systemic #ascular

Resistance

)Sto?e #olume x ;eart Rate* B

Systemic #ascular Resistance

StarlingCs aw: The 0reater the

Stretch the greater the recoil

SST)="C 'ASCULAR R)S"STANC):

'asoconstriction:

Sympathetic NS e@ects

$edications )prescription. non/

prescription. recreational* Renin/Angiotensin/Aldosterone

$echanism

Atherosclerosis

Anatomical Dea% Space: Airways thatdo not involve gas exchange


97/100

Physiological Dea% Space: Anatomical

dead space = the Alveoli that are no

longer wor?ing

Coronary Circulation:

sually thought of as & arteries

eft )$ain* %oronary Artery

eft %ircum,ex Artery

eft Anterior -escending Artery


98/100


99/100

S&: 2xtra ;eart Sound hear after an

S'. compati!le with ;eart failure.

extra sound of heart opening and

closing

S6: 2xtra Sound hear late in diastolia

instead of following S&. comes !efore

S4" Sometime failure !ut not always"

Thrill: paplapa!le murmur over a

localiEed o!struction felt on pads of

Fngers. can !e found on Radial.

Athroscrosis*

>ruit: ;ear high pitch of ,uid going

through localiEed o!structions

)Auscultate*

Right =" 8?

Le!t ;6?

=" S"(NS S=PTO=S:

Ia# pain


100/100

Chest Pain

Diaphertic

Pale

Dyspnea

76 an% a,ove age

Normtensive0+ypertensive

Respiratory System-Review Patho

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