Pulmonology
the process of inspiration
what is...
air flows in, the intercostal muscles contract and pull ribs up and outwards, lungs expand, diaphragm contracts and moves down and outward.
this causes the chest to expand creating a negative pressure in the lungs allowing air with O2 to move in to fill the space?
5 criteria of unstable angina
what is...
new onset
increrased duration
more tx to relive pain
oxxurs at rest
difference in quality of pain
the 5 CTAS levels
what are resuscitation, emergent, urgent, less urgent, non urgent.
signs and symptoms of chronic bronchitis
what is blue boater, wheezes, jcd, ankle edema, hepatic congestion, productive cough
how do central and peripheral receptors regulate ventilation?
the central receptors in the medulla detect increases in PaCO2 and decreased CSF pH , causing an increase in respirations and therefore a decrease in PaCO2
peripheral receptors in the carotid and aortic bodies detect increased PaCO2 and decreased PaO2, tells the brainstem to increase resps to increase elimination of CO2
beck's triad
what is a set of clinical signs that indicate cardiac tamponade
JVD, hypotension, and muffled heart sounds
the 5 ctas levels
what is...
rule #1: a minimum of two CTAS scores will be applied to each patient
Rule #2: the CTAS level reported to a receiving institution is the level at departure from the scene or if the patient's condition deteriorates after transport has been initiated.
Rule #3: when taking into consideration the patient's response to treatment, subsequent CTAS levels assigned must not be any greater than two levels below the pretreatment acuity.
Rule #4: For a patient who is VSA on arrival and who is resuscitated, the CTAS must stay as a CTAS 1
Rule #5: If paramedics receive a termination of resuscitation (TOR) order while managing a patient, the ctas levels assigned to the patient and documented on the ACR is based on the status of the patient on arrival and departure (if applicable) from the scene.
symptoms emphysema
pink puffer
barrel chest
clubbed nails
thin
prolonged expiration
retraction of accessory muscles
draw and label the tidal graph
draw it!
Pathophysiology of Emphysema
What is...
Exposure to noxious substances causes an immune response of inflammation. Immune response causes other immune cells to release chemicals which break down of elastin and collagen - Destruction of the walls of the alveoli (loss of elasticity). Alveoli can no longer stay open on exhalation. (Septa breakdown causes neighboring alveoli to grow larger decreasing the area for gas exchange which leads to hyperinflation of the chest) - Alveolar collapse on exhalation causes retention of co2 (air trapping) - Air trapping leads to an increases residual volume (air left inside the lungs after exhalation) - Leads to chronically increased levels of paco2 (co2 is a natural vasodilator, therefore increasing levels will cause vasodilation resulting in “pink skin”) and decreased levels of pao2 - The body attempts to compensate for lack of pao2 by creating more rbc (polycythemia)
Clinical manifestations of heart failure
what is dyspnea, orthopnea, PND, fatigue, dizziness, edema, crackles and JVD
dusky skin, weak peripheral pulses, chest pain, tachycardia, dysrhythmias, hypotension if severe/high normally, anxiety.
the 4 steps of assigning CTAS levels
conduct quick look
determine presenting complaints
apply first order modifiers
apply second order modifiers
symptoms of asthma
cough, wheezing, 1-2 word dypnea, hyperinflation of the chest and accessory muscle use,
persistent productive cough for minimum consecutive 3 months/year for 2 years
Pathophysiology of chronic bronchitis
what is...
Often people who smoke - Smoking causes the bronchi to be exposed to several irritants and chemicals. Leads to cilia breakdown (cilia expels mucous) - Irritants and chemicals cause hypertrophy and hyperplasia of the bronchial mucosa glands located in the main bronchi and the goblet cells (goblet cells secrete mucous) in the smaller airways. This causes an increased mucous production in both locations (easy for AW obstruction to occur) - Chronic bronchitis usually causes hypoxemia and hypercarbia. This occurs because of narrowed airways due to secretions. Narrowed airways decreased the air flow down to the alveoli (alveoli hypoventilation). Therefore, more co2 left in the airways during exhalation (air trapping). - Chronic bronchitis patients have a decreased vital capacity (amount of inspired air in a normal breath). This leads to hypoxemia which then results in the body creating more RBC without o2 (cyanosis)
pathophysiology of cardiogenic shock
what is a severe form of heart failure in which the heart is unable to pump enough blood to meet the body's metabolic needs. it leads to inadequate tissue perfusion, despite the body's maximal compensatory efforts.
most commonly due to left ventricular dysfunction, often from a large MI where >40% of the LV is damaged.
the impaired contractracility or mechanical obstruction (MI/valve failure/PE) causes decreased stroke volume which leads to decreased cardiac output.
as CO drops tissue perfusion decreases causing organ hypoxia. body compensates with increased heart rate (catecholamines), increased preload (fluid retention), and increased afterload (vasoconstriction), to maintain BP. however they only very temporality improve BP before increasing the heart's workload too much and worsening oxygen demand and ischemia.
if left unchecked the cycle worsens, poor perfusion of the coronary arteries further impairs the heart, the failing heart cannot perfuse itself, causing progressive damage. and eventually compensation fails and multi-organ failure ensues.
first order modifiers (1&2)
What is?
Oxygen saturation
Hemodynamic stability
GCS
Temperature
(2)
Pain
Bleeding
MOI
2nd order modifiers
what are blood pressure, blood glucose, dehydration and mental health
pathophysiology of asthma (both stages)!!
what is...
stage 1:
Foreign body in the environment enters the airways and causes a hyperreactive response - Dendritic cells located in the epithelial cells, lung mucosa, oro and nasopharynx detects the foreign body. (dendritic cells are an antigen detecting cell of the immune system, the main function is to process antigen and bring it to the surface for the t cells) - The foreign body causes a release of histamine throughout the lungs - Histamine binds to the bronchiole walls causing mild mucous production, mild bronchospasm and, mild bronchial edema. (wheezing) - The release of histamine also causes the release of IGE antibodies. IGE immune cells are used by the immune system to isolate pathogens and destroy them. - The presence of IGE antibodies causes mast cells to release histamine to fight the effects of the asthma attack. - The mast cells also release goblet cells. Goblet cells are responsible for mucous production and mast cells for broncho constriction.
Stage 2:
6-8 hours later the increased mucous production has caused epithelial cell injury resulting in decreased mucociliary function. Now widespread mucous production due to inability to cough it up - Interleukin 5 is released (is PRO inflammatory mediator and releases cytokines and leukotrienes). Cytokines and leukotrienes cause an accumulation of WBC due to the immune response - The WBC mediators damage the bronchial mucosal lining causing an increased vascular permeability and increase immune cell response from the blood stream - Causes dehydration due to fluid shift and more mucous in a/w
heart failure management at home.. what do each do?
what is vasodilators - mostly ace inhibitors that reduce the load on the myocardium by dilating/enlarging blood vessels.
diuretic agents- decrease extracellular fluid volume by counteracting fluid retention, subsequently decreasing preload - Inhibits reabsorption of sodium in the kidney.
Inotropic agents - increase the strength of contraction of cardiac muscle, thereby.
some presenting complaints from all 5 categories that would indicate a CTAS 1
what are...
cardiac: cardiac arrest, pre-arrest, rosc, stemi, chest pain w cardiac features w sings of shock.
environmental: burns >25% BSA, chemical burn>25% BSA
mental health: violent/homicidal behavior, bizarre behavior (uncontrolled).
Neurologic: active seizure, unconscious (GCS 3-9)
Obstetrics/gynecology: pregnancy>20 weeks - presenting fetal parts, prolapsed cord. Vaginal bleeding in the 3rd trimester.