respiratory pt 1

Breathing patterns/lung sounds

100

Cheyne stokes

Gradualing increasing rete and followed by gradual decrease if reparations with periods of apnea; brainstem insult

200

Kussmaul

Deep and rapid respirations (DKA)

300

biot(ataxic)

Irregular pattern, rate, and depth of breathing with intermittent periods of apnea; results from increased ICP

400

Apneustic

Prolonged, gasping inhalation followed by extremely short, ineffective exhalation; associated with brainstem insult

500

Agonal

slow , shallow, irregular, or occasional gasping

ventilation/respiration

100

Hypoxia

Tissues and cells do not receive enough oxygen

200

signs of Inadequate breathing

• Breathing rate of less than 12 or more than 20

• Cyanosis

  • Position

  • Orthopnea

  • Chest rise and fall

  • Skin

  • Flared nostrils

  • Pursed lips

  • Retractions

  • Use of accessory muscles

  • Asymmetric chest wall movement

  • Quick breaths, long exhalation

  • Labored breathing

300

Internal factors affecting oxygenation and respiration

• Conditions that reduce surface area for gas exchange also decrease oxygen supply

• Hypoglycemia

  • Oxygen and glucose levels decrease

• Infection

  • Increases metabolic needs

  • Disrupts homeostasis

• Hormonal imbalances

  • May result in ketoacidosis

400

Abnormal lung sounds

• Weezing

• Cracked

• Diminished lung sounds

• Expiratory wheezing

• Pleural Rub

• Ronchi

• Stridor

500

Factors affecting ventilation

• Intrinsic factors: infection, allergic reactions, unresponsiveness

  • The tongue is the most common obstruction in an unresponsive pt

  • Factors may not be directly part of the respiratory system

• Extrinsic factors: trauma and foreign body airway obstruction

RSI

100

Contraindication

Cant get in BLS airway

200

do you need to sedate for a GCS of 3

YES

300

Indications

For pt who cant control secretions

400

Sequence-

Brain changer- Paralytic- TUBE- Sedation

500

Medications-

Brain Changer- Etomidate, Ketamine

 Paralytic- Depolarizing (Succ) or Non-depolarizing (Ronium)

 Sedation- Versed, Ketamine

interventions/vitals

100

ETCO2 detector types:

• Colorimetric

• Digital

• digital /waveform

200

Colorimetric capno

yellow good

purple bad

Reading after 6 to 8 positive pressure breaths

Replace with quantitative device as soon as possible

300

Waveform capnography phases

• Phase 1(A-B): initial stage of exhalation

• Phase 2(B-C): expiratory upslope

• Phase 3(C-D): expiratory or alveolar plateau

• Phase IV: inspiratory downstroke

400

Suctioning times

• Adult: 15 sec

• Child: 10 sec

• Infant: 5 sec

• Stoma 10 sec max

• All get 2 mins of ventilation after sectioning before suction again except stoma.

500

Contraindications CPAP

• Unable to follow verbal commands

• Respiratory arrest or agonal respirations

• Unable to speak

• Hypoventolation

• Hypotention

• Pneumothorax or chest trauma

• Closed head injury

• Facial trauma

• Cordiogenic shock

• Tracheostomy

• GI bleed, nausea, or vomiting

• Recent GI surgery

• Unable to sit up

• Unable to fit CPAP system

• Cannot tolerate mask

Other

100

DOPE

• Dislogment

• Obstruction

• Pneumothorax

• Equipment failure

200

pt for drug admin 6 rights

• Pt

• Dose

• Time

• drug

• Route

• documentation

300

ETCO2 detector types

• Colorimetric

• Digital

• digital /waveform

400

LEMON

• Look externally

  • The following can make intubation difficult

    • short , thick necks

    • Morbid obesity

    • Dental conditions

• Evaluate (3-3-2)

  • 3- mouth width of more than 3 fingers in best

  • 3- mandible length of 3 fingers is best

  • 2- distance from hyoid bone to thyroid notch of 2 fingers wide is best

• Mallampati

  • Note oropharyngeal structures visible in an upright, seated pt

    • Class one

      • Entire posterior pharynx is fully exposed

    • Class 4

      • Cant see anything

• Obstruction

  • Note anything that might interfere with visualization or ET tube placement

    • Foreign body

    • Obesity

    • Hematoma

    • masses

• Neck mobility

  • Sniffing position is ideal

500

Mallampati

• Note oropharyngeal structures visible in an upright, seated pt

  • Class 1

    • Entire posterior pharynx is fully exposed

  • Class 4

    • Cant see anything