oxygenation

acapella

respiratory therapy tool used to help clear mucus from the lungs, by combining positive expiratory pressure with airway vibrations to mobilize secretions and improve lung function.

ventilation

the function of the respiratory system is to obtain oxygen from atmospheric air, transport this air through the respiratory tract into the alveoli, and ultimately diffuse oxygen into the blood to carry oxygen to all the cells of the body

eupnea

breathing within the normal respiratory rates

bronchial sounds

loud high pitched sounds heard over the trachea 

bronchovesicular sounds

medium in loudness and pitch are heard on each side of the sternum and between the scapulae

vesicular sounds

soft, low-pitched sounds that are heard over the peripheral lung fields, best heard during inhalation and at the beginning of exhalation, patent airway

hypoxemia

decreased level of oxygen in the blood, early signs retractions

hypoxia

hypoxemia may result in decreased delivery of oxygen to the tissues

dyspnea

shortness of breath

cyanosis

a bluish discoloration of the skin and mucous membranes, late sign of hypoxia

hyperventilation 

rapid and deep inhalation and exhalation of air from the lungs 

hypoventilation 

an abnormally slow respiratory rate leads to inadequate oxygen delivery to the lungs as well as an increase in retention of CO2

orthopnea 

difficult breathing in the supine position

kussmaul breathing

occurs in the presence of metabolic acidosis and results in very deep and rapid breathing, increase the elimination of affecting acid-base balance. 

Cheyne-stokes respirations

exhibit as deep, rapid breathing and slow, shallow breathing with periods of apnea, seen in individuals with heart failure, increased intracranial pressure (ICP) and drug overdoses 

blot respiration

seen in individuals with CNS disorders, these present as shallow breathing with periods of apnea

respiratory acidosis

decreased levels of oxygen result in levels of co2 increasing resulting in vasodilatation of vessels

stridor

high pitch sound within the trachea and larynx that suggest narrowing of the tracheal passage sounds like screeching or squeaking due to upper airway obstruction 

fine crackles

high pitched short duration, sound like pops/cracks of a fire, due to presence of fluids in the lungs

coarse crackles

low pitched long duration sounds like blowing through a straw under water due to presence of secretions

wheezes

Continuous high pitch musical, whistling sound like a ballon due to narrowing of the airway

rhonchi

continuous low pitched low sounds like rumbling, rattling or snoring due to partial blockage of airway passage can usually improve with coughing

atelectasis

collapse of all or part of a lung affecting the exchange of oxygen and carbon dioxide

pleural friction rub

associated with pleural inflammation and occurs when inflamed pleural surfaces slide across one another

arterial blood gases (ABGs)

provide a direct indication of oxygen and carbon dioxide exchange and the acid-base balance within the blood 

hypercarbia-hypercapnia

increase in blood levels of Co2 to above 45mmHg

hypocapnia-hypocarbia

decrease in blood levels of co2 to below 35mmhg

peak expiratory flow rate (PEFR)

used to monitor the ability of an individual to exhale a specific volume of air related to the individuals age, sex, height, and weight 

upper respiratory tract

nasl cavity, paranasal sinuses, pharynx, nasopharynx, oropharynx, laryngopharynx, larynx

lower respiratory tract

trachea, lungs, bronchi, bronchioles, alveolar duts, alveoli

the CNS

the brainstem controls ventilation through rate and depth of breathing from the feedback of blood gas sensors 

pneumothorax

lung collapse caused by the collection of free air within the pleural space (decreased or absent breath sounds on affected lobe) chest pain, shortness of breath, asymmetrical chest wall movement, cyanosis

tension pneumothorax

is life threatening, caused by trauma, it increases intrapleural pressure, compressing mediastinal structures and requires urgent treatment with needle decompression or chest tube insertion 

sickle cell disease 

impairs the transport of oxygen though the blood and can cause a variety of complications, including organ failure 

sputum

clear/white- normal, green/yellow- infected, pink frothy-pulmonary edema, blood tinged- trauma or pulmonary embolus, chocolate brown-lung abscess

purse lip breathing 

used by patients with chronic PC02 retention to increase expiratory time to expel more PCO2

sputum specimen

needs to be from lungs, best done first thing in the morning, should be obtained before antibiotic therapy 

arterial blood gas test

measures the levels of oxygen, carbon dioxide, and the acidity of arterial blood, provides oxygenation, ventilation, and acid base balance 

PH

7.35-7.45 below 7.35 is acidosis and above 7.45 is alkalosis

PaCo2 (carbon dioxide)

35-45 mmHg

PaO2 (lungs)

75-100mmHg

HCO3 kidney

24-28 mEg/L

SaO2 (oxygen saturation)

95-100%

bronchoscopy

invasive procedure that allows direct visualization of the lungs, go into the trachea and the bronchi to visualize the airways NPO for 6-8 hrs prior

Ambu mag -bag valve mask

provides 100% Fio2 for the patient

thoracentesis

performed to drain excessive pleural fluid from between the pleural linings

huffing

inhale normally and then exhale as hard as you can using short deep breaths

chest physiotherapy 

sticking sections of the back with cupped hands to loosen secretions in specific regions of the lungs 

prone face down

used to assist the lungs in better circulating oxygen, increases oxygen saturation levels and decreases the need for intubation specially useful for treating pts with covid 19 

endotracheal tube

inserted to the nose or mouth into the tracheal used to maintain open airway in patients with decreased consciousness and to ventilate

tracheostomy tube

inserted to through wall of trachea used to maintain airway in patients with upper airway during expiration to prevent airway obstruction 

CPAP

used in sleep apnea patients to keep a positive pressure in the airways during expiration to prevent airway obstruction

nasal canula

delivers 2-6 L/min , provides 24-45% oxygen, we breath 21% oxygen regularly, every liter goes up by 4 1L 24%, 2L 28%, 3L 32% and so on

oxymizer and vapotherm

oxymizer increases oxygen inhalation with an additional reservoir, while vapotherms warm, filter, and increase positive end-expiratory pressure, commonly used in NICUs

simple mask 

covers the mouth and nose, provides 40-50% oxygen 5-8L/min 

nonrebreather mask

contains a one way valve and attached reservoir, preventing exhaled gases from mixing with oxygen and can deliver levels of 60% or higher flow rate of 10-15L/min can deliver up to 100%Fio2

venturi mask

delivers specific flow rates of 24-50% oxygen with an adjustable jet adapter for precise oxygen deliver 

high flow oxygen therapy with humidification \

used to reduce WOB, improve gas exchange, 100% oxygenation

oxygen

medical oxygen is nearly 100% pure oxygen, it is used to increase the oxygen level in the blood, particularly for patients who have difficulty breathing or require supplemental oxygen for their condition 

medical air

mixture of gases, primarily composed of 78%nitrogen, 21%oxygen and trace amounts of other gases, often used fir patients who don’t need supplemental oxygen but require mechanical ventilation, humidification or aerosol tretments.

chest tube 

treat conditions in which air or fluid enters the pleural cavity, causing lung collapse, allows the lungs to expand properly, remains in place typically for 2-5 days 

oxygen %

if the patients oxygen is low we start them at the highest percentage of oxygen an ween them off slowly, except for COPD patients were we start them low and go up as needed