Respiratory System Assessment

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Respiratory System Assessment

• Chemeketa Community College
• Paramedic Program

Peggy Andrews, Instructor
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A P Review- Upper Airway

• Nasal Cavity
• Oral Cavity
• Hyoid bone
• Pharynx
• Nasopharynx
• Oropharynx
• Hypopharynx
• vallecula

• Larynx
• Thyroid cartilage
• Cricoid cartilage
• Arytenoid cartilage
• Glottic opening
• Vocal cords
• Crithothyroid membrane

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A P Review- Lower Airway

• Trachea
• Carina
• Bronchi
• Left and right mainstem
• Secondary tertiary bronchi
• Bronchioles
• 22 divisions
• Respiratory bronchioles

• Alveoli
• 1 2 cell layers thick
• Lung parenchyma
• Pleura
• Visceral
• Parietal

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Respiratory cycle

• Depends on changes in pressure
• Inspiration active process
• Expiration passive process

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Pulmonary circulation

• Exchange of oxygen and carbon dioxide
• Right side of heart
• Pulmonary artery
• Deoxegynated blood
• Left side of heart
• Pulmonary vein
• Oxygenated blood

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Measuring oxygen carbon dioxide levels

• Partial pressure of gas
• Percentage of mixtures total pressure
• 21
• Diffusion
• Movement of gas from higher concentration lower
  concent.

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Oxygen concentration in blood

• Oxygen saturation (SpO2)
• PaO2
• 90 100 torr normal
• Hemoglobin molecule
• Carries 4 oxygen molecules
• Ventilation/perfusion mismatch
• Carbon dioxide concent. In blood

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What regulates respirations?

• Nervous impulses from the respiratory center
• Stretch receptors
• Hering-Breuer reflex
• Chemoreceptors
• Hypoxic Drive

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Respiratory rates

• Normal - 12 - 20
• Controlled by other factors
• Temperature - Emotion
• Drugs and medications - Hypoxia
• Pain - Acidosis
• Sleep
• Obstruction
• Tongue - most common
• Snoring, correct with positioning

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Foreign body

• May cause partial or complete obstruction
• Choking, gagging
• Stridor
• Dyspnea
• Aphonia
• Speechless
• Dysphonia
• Difficulty speaking
• Hoarseness

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• Total Lung Capacity
• 6 L
• Tidal Volume (Vt)
• 500 ml (5 7 ml/kg)
• Dead space volume
• 150 ml in adult male
• Minute volume
• Vt X RR

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Laryngeal spasm and edema

• Spasm
• Sudden movement/contraction
• Most frequently
• Trauma
• Aggressive intubation
• Post-extubation
• Especially if patient semi-conscious

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33 year old female rescued from a structure fire.
CAO x 3, RR38, SaO2 64, harsh stridor on insp.

• Edema
• Glottis
• Extremely narrowed
• Totally obstructed
• Most frequently
• Epiglottitis
• Bacterial infection
• Anaphylaxis

• Relieved by
• Aggressive ventilation
• Muscle relaxants
• Alternative Airway

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28 year old male, snowmobile intofarmers fence,
20 mph.

• Fractured larynx
• Airway patency dependent on muscle tone
• Increased resistance by decreased size
• Decreased muscle tone
• Laryngeal edema
• Ventilatory effort

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79 yo male, liquid diet, hiccups during
breakfast. Severely SOB

• SaO2 72 RA, Upper Resp. fluid audible
• Aspiration
• Significantly increases mortality - 25 die
• Obstructs airway
• Destroys delicate bronchiolar tissue
• Introduces pathogens
• Decreases ability to ventilate
• Commonly the beginning of the end ?

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Airway evaluation

• Rate
• 12-20?
• Regularity
• Steady pattern
• Irregular patterns are significant until proven
  otherwise

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Airway evaluation

• Effort
• Should be effortless at rest
• Changes may be subtle in rate or regularity
• Patients compensate by preferential posturing
• Upright sniffing
• Semi-fowlers
• Frequently avoid supine

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Some Important Patterns
Serious Illness/Terminal
DKA
Head injury/ICP
Resp Center Lesions
Paramedic Students
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Recognition of airway problems

• Respiratory distress
• Upper and lower obstruction
• Inadequate ventilation
• Impairment of respiratory muscles
• Impairment of nervous system

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Dyspnea may be result of or result in hypoxia

• Hypoxia
• Inadequate O2 at cells
• Hypoxemia
• Lack of O2 in arterial blood
• Anoxia
• No Os
• All therapies will fail if airway inadequate

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Visual Clues
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Another Sample Pt. What are the clues here?
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Our Lady (continued)

• .

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Auscultation techniques

• Air movement at mouth and nose
• Bilateral lung fields equal

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Palpation techniques

• Air movement at mouth and nose
• Chest wall
• Paradoxical motion
• Retractions

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Bag-valve-mask

• Resistance/changing compliance with BVM
  ventilations

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Pulsus paradoxis

• Systolic BP drops greater than 10 mmHg with
  inspiration
• Seen in Pericardial tamponade

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History

• Evolution
• Sudden
• Gradual over time
• Known cause or trigger
• Duration
• Constant
• Recurrent
• Ease - What makes it better?
• Exacerbate Aggravation of symptoms
• Associate - other symptoms (productive cough, etc)

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History

• Interventions
• Evaluations/admissions to hospital
• Medications (include compliance and dose)
• Ever intubated???

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History

• Modified form of respiration
• Protective reflexes
• Cough - forceful, spastic exhalation aids in
  clearing bronchi and bronchioles
• Sneeze - clears nasopharynx
• Gag reflex - spastic pharyngeal and esophageal
  reflex
• Sighing
• Increases opening of alveoli
• Normally sigh _at_ 1/min.
• Hiccough
• Intermittent spastic closure of glottis

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Inadequate ventilation

• When body cant compensate for increased oxygen
  demand or maintain O2/CO2 balance.
• Many causes
• Infection
• Trauma
• Brainstem injury
• Noxious or hypoxic atmosphere
• Renal failure
• Multiple symptoms
• Altered response
• Respiratory rate changes

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Supplemental oxygen therapy

• Supplemental oxygen therapy
• Increases O2 to cells
• O2 increases patients ability to compensate
• Delivery method continually reassessed

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Oxygen source

• Compressed gas
• Common sizes and volumes
• D 400L
• E 625L
• M 3450L

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Calculating Tank Life

• Page 386
• Tank Size Factor
• 0.16 D Tank
• 0.28 E Tank
• 1.56 M Tank

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Regulators

• High pressure
• Transfer gas from tank to tank
• Cascade System
• Therapy regulators
• Pressure stepped down
• Delivery via adjustable low pressure

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Delivery Devices

• Nasal cannula
• Optimal delivery 40 at 6 Lpm
• Indications
• Low to moderate enrichment
• Long term therapy
• Contraindications
• Poor respiratory effort
• Severe hypoxia
• Apnea
• Mouth breathing

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Delivery Devices

• Nasal cannula
• Advantages
• Well tolerated
• Easy to communicate
• Disadvantages
• Doesnt deliver high volume/high concentration
• Not guaranteed

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Delivery Devices

• Simple face mask
• Indications
• Moderate to high oxygen concentration
• 40-60 at 10 Lpm
• Advantages
• Higher oxygen concentrations
• Disadvantages
• Beyond 10 LPM does not enhance oxygen content.

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Delivery Devices

• Partial rebreather
• Indications
• Contraindications
• Apnea
• Poor respiratory effort
• Advantages
• Higher concentrations
• Disadvantages
• Beyond 10 LPM does not enhance content.

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Delivery Devices

• Non-rebreather mask
• Mask side ports
• One-way disc
• Reservoir bag attached
• 80-95 at 15 Lpm
• Indications
• Highest O2 content (Non PPV)
• Contraindications
• Apnea
• Poor effort

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Delivery Devices

• Venturi mask
• Mask with interchangeable adapters
• Side ports for room air
• Highly specific content. O2
• Oxygen humidifiers
• Sterile water reservoir for humidifying oxygen
• Long term admin.
• Desirable for Croup/Epiglottitis/Bronchiolitis
• Tracheostomy
• Stoma

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Summary

• Respiratory Assessment concepts
• Scenarios
• Oxygen Delivery Method Review