Pulmonary - SALA

what are the lobes of the lungs? Right—>Left/Top—>Bottom

Right: Superior Lobe, Middle Lobe, Inferior Lobe

Left: Superior Lobe, Cardiac Notch, Inferior

layers of the lung pleura? outermost to innermost

parietal pleura - attaches to chest wall (parietal: lines body cavity walls that house organs)

visceral pleura - covers the lungs (visceral: lines organs)

pleural space - space between that contains serous fluid (reduces friction between membranes)

What is the path of the respiratory tract?

Oropharynx, Nasopharynx, Pharynx, Epiglottis, Larynx, Trachea, Carina, Bronchi, Bronchioles, Alveoli, Capillaries

How we breathe?

Negative Pressure System!!!

Inhalation: diaphragm contracts, pulls down the pleura = negative pressure

negative pressure = air flows into lungs

Exhalation: diaphragm relaxes, pushing back up the pleura = pushes air out

Why do we breathe? 2 reasons

1.) Carbonic Drive: high CO2 levels in the blood

a.) higher acidity due to lots of CO2, signals phrenic nerve to trigger diaphragm to contract

b.) phrenic nerve located at C3, C4, C5 —> controls diaphragm

2.) Hypoxic Drive: low O2 levels in the blood

a.) COPD patients who have high levels of CO2

^^ body is so used to high CO2, body says fugg it and now its low O2

3 breathing vocab (how air moves)

Ventilation: physical movement of air (controlled by diaphragm)

Respiration: gas exchange of CO2 and O2 at the alveoli

Oxygenation: loading of oxygen onto hemoglobin in red blood cells

Signs of pulmonary distress:

tripoding, universal choking sign, nasal flaring, head bobbing

Primary assessment, what to do:

A(irway) —> anything to take out or put in?

B(reathing) —>ELPASSCO

C(irculation) —> PEST

Indications, contraindications, sizing, insertion of an OPA:

Indication: patient is unable to maintain their own airway AND is unresponsive

Contraindication: Recent seizure activity OR the patient has an intact gag reflex

Sizing: corner of mouth to angle of jaw

Insertion: cross finger technique, OPA upside down, encounter resistance = flip OPA correctly

Indication, contraindication, sizing, insertion of NPA

Indication: patient is unable to maintain their own airway

Contraindication: major facial/nasal trauma

Sizing: tip of nose to angle of the jaw

Insertion: lube NPA, NPA into RIGHT nostril w/ bevel facing septum

Lung sounds, description, disease

Wheezing - high-pitched whistle - Asthma

Rhonchi - low pitched rumble due to fluid - pneumonia

Rales - crackles from alveoli filled with fluid being popped open - pulmondary edema

Stridor - high pitched sound upon inhalation - FBAO

Where to listen for lung sounds

Midclavicular

Basal

Midaxillary

What is pneumothorax? What are the symptoms of pneumothroax?

it is pressure build-up in the thoracic cavity

JVD, Tracheal Deviation, Accessory Muscle use

what is cyanosis?

bluish discoloration of skin due to lack of O2

what is pallor?

unhealthy pale appearance due to lack of blood flow to an area

secondary assessments

get a full medical history

take vitals:

breaths = 12-20

SPO2 = 95%+

Chronic lung condition/chronic smoker = 90%

Administer interventions = CHECK VITALS AFTER

What are agonal respirations?

When someone is not getting enough oxygen = is gasping for air

This is a brainstem reflex

What are Cheyne Stokes Respiration?

Repeating cycles of rapid breathing followed by periods of apnea

Sign of intracranial pressure

part of the brain that pushes on area of brain that tells you to breathe more and faster

what are kussmaul respirations?

deep labored breathing pattern that indicates body or organs have become too acidic

This is often a response to diabetic ketoacidosis (when the body tries to get rid of large amounts of CO2)

What is Eupnea?

normal breathing

What is Dyspnea?

difficulty breathing

What is apnea?

absence of breathing

what is tachypnea?

rapid breathing

what is bradypnea?

slow breathing

what is orthopnea

Shortness of breath that occurs while lying flat and is relieved by sitting or standing

what is COPD and what are the 3 symptoms?

A group of diseases that cause airflow blockage and breathing related problems

Dyspnea, sputum production, chronic cought

What are the 2 types of COPD? and Describe them

Chronic Bronchitis: Chronic inflmmation of the bronchi + productive cough for 3 months in 2 successsive years

Emphysema: Formation of bleb like structure due to destruction of alveoli + loss of alveolar integrity and elasticity

What are 4 symptoms of chronic bronchitis, and what to do

cyanosis

often overweight

Overproduction of mucus causes productive cough

Mucus coats bronchi/bronchioles causing wheezing

administer O2/albuterol if indicated

What are 5 symptoms of emphysema and what to do?

breathing through pursed lips

often older and thin

difficulty exhaling/air trapping

barrel chested

accessory muscle use

administer O2/albuterol if indicated

What is asthma?

chronic inflammation and narrowing of airway

what happens during asthma, caused by? symptoms? treatment?

airway constrict and fills with mucus

can be caused by allergies, airborne irritants, infections or exercise

wheezing, chest tightness, dyspnea, breathlessness, and coughing

treat with albuterol

symptoms of pneumonia and what populations are at risk?

fever, coughing, chills, chest pain, difficulty breathing, rhonchi

pediatric, geriatric and immunocompromised populations

symptoms of COVID/Flue/RSV

wide range: asymptomatic to dsypnea/chest pain

patients often have flu-like symptoms, fever, loss of taste and smell

what is a pulmonary embolism?

forms when a blood clot blocks off the pulmonary arteries (embolis)

what are the symptoms of pulmonary embolism?

sudden onset pinpoint chest pain**** that may radiate to shoulder/back, shortness of breath, low SpO2

pain may worsen when taing a deep breath

what are the risk factors for blood clots?

DICERS

Diabetes, immobilization, cancer/chemo, estrogen, recent surgery, smoking

what is pulmonary edema?

excess fluid in the alveoli

what is pulmonary edema a result of?

a left sided CHF, wherein fluid backflows into lungs due to left ventricle failure

what are the symptoms of pulmonary edema

rales, orthopnea, dyspnea, shortness of breath, anxiety/restlessness, paroxysmal, nocturnal dyspnea

how to treat a pulmonary edema

sit them upright, O2, ALS

what is flail chest

3 ribs broken, in 2 or more places, on 1 side of the chest

symptoms of flail chest

paradoxical chest movement, palpitation of chest there would be crepitus

treatment of flail chest

BVM acting as an internal splint, call ALS, rapid transport

what is a sucking chest wound

an injury that allows air to enter the pleural cavity, when patient inhales, air gets sucked into the hold in chest, causing further accumulation of air in the pleural cavity

what can a sucking chest wound lead to?

pneumothorax

MOI of sucking chest wound?

gunshots, stabbing

symptoms of a sucking chest would

bubbling at injury site, hissing/sucking, sounds when breathing

how to treat a sucking chest wound

use semi-occlusive dressing and treat for SHOCK (PHART) LOOK FOR EXIT WOUND

what is pneumothorax

air accumulation in pleural space, causing the lung on the afflicted side to collapse

symptoms of pneumothorax

absent lung sounds on affected side, sharp pain that worsens upon inhalation, JVD, tracheal deviation

treatments for pneumothorax

call ALS, rapid transport, BVM

what are the types of pneumothorax

spontaneous pneumothorax, tension pneumothorax, hemopneumothorax

what is spontaneous pneumothorax

occurs suddenly due to rupture of blebs, allowing air from lungs to flow into pleural space

what is tension pneumothorax

when air built up in the pleural space begins to put pressure on the vasculature of the heart

what is hemopneumothorax

when air AND BLOOD enter the pleural space

what are 2 pediatric pulmongenic emergencies

croup and epiglottitis

what is croup

viral infection of upper airway

what are the symptoms of croup and how to treat

barking cough, fever, runny nose

treatment: ALS, humidified O2

what is epiglottitis

bacterial infection of the epiglottis

what are the symptoms of epiglottitis and how to treat

drooling, difficulty swallowing, stridor

ALS, humidified O2

what are panic attacks

sudden episodes of intense fear that causes severe physical reaction

symptoms of panic attacks

feeling of impending doom, headache, hyperventilation, nausea, sweating, tachycardia

what to do when you encounter a panic attack

keep calm, expect longer scene times, do what you can to make them more comfortable

BOX breathing!!! “breathe with me”

What can you do during a pulmonary distress

High concentration O2, ALS, Treatment (albuterol, ipratroprium, epi), DONT DELAY TRANSPORT

Albuterol: Indication, contraindication, route, dose, max dose, mechanism, side effects, considerations

Wheezing with dyspnea, no contraindication, inhaled via nebulizer, 1 ampule(2.5mg/3mL), 3 ampules, bronchodilator,

tachycardia, headache, anxiety

epinephrine for a critical asthma attack with med control approval

Ipratroprium bromide: indication, contraindication, route, dose, max dose, mechanism, side effects, considerations

Wheezing with dyspnea, none, inhaled via nebulizer, 1 ampule (0.5mg/2.5mL), 3 ampules, anticholinergic bronchodilator

dry mouth, blurred vision

Pregnancy

What does CPAP stand for?

Continuous positive airway pressure

What does CPAP do?

increases alveolar recruitment, it keeps the end airway open

increases intrathoracic pressure

CPAP: indications, contraindications, how to use

pulmonary edema with severe dyspnea, acute respiratory distress w/ difficulty oxygenating

AMS/unable to follow commands, SBP <90, respiratory arrest, active vomiting

Set up with a good seal, use 5-10 cm H20, set to 10 Lpm, delivers 901pm to pt

what is pneumonia caused by

infection of the lungs, inflammation of alveoli, causes alveoli to fill up with fluid or pus