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Respiratory SystemParamedic Anatomy Review
Upper Respiratory Tract: The sequence of Organs that comprise the upper
conducting pathway: Nasal cavity and sinuses
Pharynx
arynx
Trachea
Nasal Cavity:
The nasal cavities are separate from each other
!y the nasal septum"
#ascular mem!rane on the Nasal Septum
$ost nose !leeds in young people originate at
the anterior nasal septum
$ost nose !leeds in older people are from the
posterior nasal structures
The %ri!riform plate is the thin layer of !one thatseparates the !rain from the nasal cavity"
Lungs:
Right ung & lo!es
eft lung ' lo!es
Bronchioles:
Smallest airways
(alls consist entirely of smooth muscle )No
cartilage present*
+%onstriction increases resistance to air,ow
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Respiratory System Physiology:
Neurotoxic center/ 2xhaleA!nosic %enter
Respiratory System:
Automatic 1unction );ypoxic -rive* Primary -rive: 5ncrease in arterial %O'
Secondary )hypoxic* -rive: decrease in
arterial O'
Inspiration
Active process
Chest cavity expands
Intrathoracic pressure falls
Air flows in until pressure equalizes
*Needs to make PEEP Positive end
expiatory pressure!
Create " tor#m$ to maintain PEEP
xpiration
Passive process
Chest cavity size decreases
Intrathoracic pressure rises
Air flows out until pressure equalizes
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+ Normally we !reathe to remove %O'
from the !ody NOT to get oxygen in
34 %o' Required to !reath in to
simulate %hemoreceptors To stretch. put up hydrogen 5ons
COPD Pt:
;ypoxic -rive level changed
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pper Airway:
Trauma
2piglottis
1>AO
5n,ammation of tonsils
Lo#er Air#ay:
Trauma
O!structive lung disease
$ucus accumulation
Smooth $uscle spasm
Airway edema
Chest $all "mpairment:
Trauma
;emothorax
Pneumothorax
2mpyema
Pleural
5n,ammation
Neuromuscular diseases
Neurological Control:
>rainstem dysfunction/ %oning
Phrenic or spinal nerve dysfunction
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Sources O! Pulmonary "mpairment:-i@usion:
5nadequate 15O' )Smo?e 5nhalation*
%ar!on $onoxide '9B stronger thanOxygen )Remove from area 2$%A/P*
-iseased Alveoli: %anCt 2xpand As!estosis
%OP-
5nhalation 5nDury
%apillary >ed -isease: Atherosclerosis )No gas exchange.
hardening of artery* 5nterstitial Space -isease:
;igh Pressure Pulmonary 2dema
;igh Permea!ility Pulmonary 2dema
)Pressure on alveoli: at ,uid squeeEes more,uid*
Perfusion: 5nadequate !lood volume or
hemoglo!in
;emmorging
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;ead Trauma
%#A/ )Stro?e* Around Pons = $addule
-epressant drug Toxicity
Narcotics/ >radypena
Sedatives/ ;ypnotics
2thyl Alcohol
"nitial Assessment: Airway
Anticipate airway pro!lems with
-ecreased O%
;ead Trauma
$axillofacial Trauma
Nec? Trauma %hest Trauma
OP2N/%2AR/$A5NTA5N
Respiratory Soun%s:
Respiration Re&uires:
#entilation. the mechanical process ofmoving air or gases into and out of thelungs
Perfusion. or movement of !lood though
the lungs and capillaries
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-i@usion of gas !etween the lungs and the
!lood
'entilation:Tracheo!ronchial tree: involved inventilation !ut does not participate in gasexchange"
(as )*change:Ta?es place in therespiratory of the lungs. where gasdi@uses across the alveolar/capillarymem!rane as they are exchanged!etween the lungs and the !lood that,ows through the pulmonary capillaries"Regulation Of Respirations:
-2P2N-S ON %O$PON2NTS:
4" Respiration Rate:The num!er of!reath a person !reaths in a minute
'" Nervous "mpulses !rom theRespiratory Center:$ain respiratorycenter lies in the $edulla O!longata in the!rainstem
&" Stretch Receptors:-uring inspiration.the lungs !ecome distended. activatingstretch receptors" These impulses send tothe !rainstem to inhi!it the medullary cells.decreasing inspiratory stimulus" Thus
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respiratory muscles relax allowing elasticlungs to recoil and expel air from the !ody"
6" Chemoreceptors:5nvoluntary
respiration controls central chemicalreceptors in the medulla and peripheralchemoreceptors in the carotid !odies andin the arch of the aorta" They arestimulated !y decreased oxygen andincreased car!on dioxide"
" +ypo*ic Drive:The mechanism that
increases respiratory stimulation when!lood oxygen falls and inhi!its respiratorystimulation when !lood oxygen clim!s"
Normal Respirations:
'esicular:ow pitched )soft* !reath
sounds that consist of a quiet" (ispy
inspiration phase with a shortened andsofter expiratory phase" They areheard over the periphery of the lungFeld"
Bronchovesicular:ouder )moreharsh*. !reath sounds consists of fullinspiratory phase with a shortened andsofter expiratory phase" They may !eheard throughout the full lung Feld andare often louder than tracheal !reathsounds"
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Bronchial:;ighest pitched )course*.
!reath sounds consists of a fullinspiratory and expiratory phase
usually !eing louder" They are normallyheard over the Trachea and arynx"
A,normal Respirations:
A,sent/no air entry
Diminishing: Are caused !y an
o!ese
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Course crac-les: Sound wet. low
pitched
.ine Crac-les: Sound dry. high
pitched
$hee/ing:%ontinuous. musical soundssimilar to a whistle sound" 5t results whenair moves though the partially o!structedairways" Their causes include asthma.
!ronchospasms. and foreign !odyo!struction" Iou may hear them without astethoscope or !y auscultating the chestduring any or all phases of the respiratorycycle" They often originate !y the small!ronchioles and Frst appear at the end ofexhalation" The closer to the end of
inspiration they appear. the worse yourpatientCs condition is"
Rhonchi:%ontinuous. rum!ling or rattlinglower pitched sound that has a snoringquality" They are heard in the larger
airway when large secretions.in,ammation. ,uid or other materials.o!struct airway" This is often found in thepatients su@ering from !ronchitis =pneumonia" Rhonchi usually appear in the
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early exhalation !ut may occur in earlyinspiration as well"
Stri%or:!ar? li?e sound that tends to !eaccentuated during inspiration when extrathoracic airways collapse due to lowerlumen pressure" They can often !e heardwithout a stethoscope" 5t is often a signcharacteristic of an upper airwayo!struction. Such as croup"
Pleural .riction Ru,:Are the squea?ingor grating sounds of the pleural liningsru!!ing together" They occur where thepleural layers are in,amed and have losttheir lu!rication" Pleural ru!s are common
in pneumonia and pleurisy )in,ammationof the pleura*" >ecause these sounds areheard whenever a patientCs chest wallmoves" They appear during the entirerespiratory cycle"
Respirations:
Apnea: Not !reathing" 5t is an ominous
Fndings and indictor of a seriouspro!lem with the airway. >reathing or!oth"
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Bra%ypnea: Slow. regular respirations
with a rate that is slower than 4'!reaths per minute"
)upena: Normal. Regular fullrespirations with a rate ,uctuating!etween 4'/'9 !reaths per minute.with the expiratory phase that lasts &/6 times longer than the inspiratoryphase"
Tachypnea:1ast. rapid respirationswith a rate that exceeds '9 !reathsper minute"
Dyspnea:-iJcult !reathing. with
sensation of shortness of !reath"
Orthopnea: -yspnea while laying
supine
Paro*ysmal Nocturnal Dyspnea:
Short attac?s of dyspnea that occurs at
night and interrupt sleep"
Agonal:Shallow. slow or infrequent
!reathing" 5nactive of !rain anoxia"
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Normal Respiration Rates:
Age Lo# Rate +igh Rat
Ne# Born0"n!ant 123 yrs4
56 76
To%%ler 1308yrs4
89 96
Preschooler150 yrs4
88 59
School age17038 yrs4
3; 56
A%olescent13503; yrs4
38 87
A%ult 1
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controls and respiratory al?alosis is oftenseen"
Cheyne Sto-es: Progressively deeperand faster respirations alternating withslow and shallow !reathing possi!ly apneaat the end of expiration" This pattern istypically seen in older patients withterminal illness or !rain inDury" )%ushingCs*Kussmauls: -eep. slow OR rapid 0ASP5N0that results as a corrective measureagainst such conditions as dia!etic?etoacidosis that produce meta!olicacidosis
PR)S)NT PROBL)=S:
A!dominal
%hest Pain
2lectrocution
5nhalation of toxic gases: e"g" %ar!on
-ioxide
$aDor
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BLS Respiratory RAT)S 1A%ult4:
Assist 'entilation if !reathing isdeemed inadequateL i"e" respiratoryrates M/49 or respiratory rates M'/&9 !pm
Breathing Appearsshallow. patientis cyanosed or decreased OA"
PA4
AB(:
P+: Normal: >50>90
+omeostasis
CO8: 1Aci%otic4: Normal: 509
Respiratory+CO5: 1Al-alytic4: Normal: 88087
=eta,olic
Partial Pressure o! O*ygen an%
Car,on Dio*i%e
PCO8: Al#ays the Opposite to P+
Norm: 509?
PAO8: ;60366?
Bu@ering: +omeostasis
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Respiratory System:
Tachypnearadypnea: Orthopedic
Signs of Respiratory -istress:
Nasal 1laring )Opening up Airway as
much as possi!le* Tracheal Tugging
Reactions
Accessory $uscle use
se of a!dominal muscle on exhalation
Tripod Positioning
SniJng position/ angle
Respiratory Assessment:%yanosis )ate. unrelia!le sign of
;ypoxia*OBI02NAT2 5mmediately 2specially if:
-ecreased O% )Frst Sign*
Possi!le Shoc?
Possi!le severe ;emorrhage
%hest Pain
%hest Trauma
Respiratory -istress or -yspnea
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;x of any ?ind of ;ypoxia
+elp!ul Respiratory Terminology
;ypoxia: 5nadequate Oxygen at the
cellular level
;ypoxemia: -eFciency of oxygen in
the arterial !lood
Anoxia: lac? of Oxygen
Respiratory Patterns:
Agonal: pattern of gasping followed !y
apnea
Ataxic Respirations: %luster. !reathing
or irregular characteriEed !y a series ofinspirations = expirations )lesions in
the medulla*
>iotCs: irregular respirations
characteriEed !y varying depths of
apnea" )this pattern lac?s repetitive
such as cheyne/sto?es* sually
indicates 5%P changes or head inDuries"
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%heyne/Sto?es: Regular periodic
pattern of !reathing with equal
intervals of apnea" 1ollowed !y
crescendo/ascendo sequence of
respirations. also seen in cortical head
inDuries or dysfunction. or possi!ly
sleep patterns in some adults" Kussmauls: A!normally deep pattern of
respirations with sighing sequences.
usually indicated -KA )-ia!etic* )'8/
&9*
Nervous System )@ect on
'entilation:
=e%ulla: Stimulation to initiate
ventilationPhrenic: 5nnervation of the
diaphragm
Spinal Nerves at Thoracic Levels:
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5nnervation of intercostal muscles
+ering0Breuer Ree*:
Prevents overin,ation
=)D"CAL R)SP"RATOR PAT+OLO(")S:
Pleurisy:
5n,ammation of pleura caused !y
friction ru! ayers of Pleura ru!!ing together
%ommonly associated with another
respiratory disease5nfection
ayers Ru! together
Presentation O! Pleurisy:
Sharp. sudden and intermittent chest
pain with related dyspnea Possi!ly referred to the shoulder
$ay or with respirations
Pleural Gfriction ru!H may !e audi!le
$ay have e@usion )1luid* or !e dry
Pulmonary )m,olism:
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9.999 deathslood:
-oes not pass Alveoli
-oes not exchange gases
A disorder of perfusion
2m!olis if mo!ile
1racture opens up fat. vessel gets into
venous system causing P2
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%om!ination of factors increase
pro!a!ility of occurrence:
;ypercoagula!ility: ;igher ris? ofclotting
Platelet Aggregation/ thic?en !lood
-eep #ein Stasis )possi!ility of !lood
clots due to deeper veins with poor
!lood ,ow*2m!olus usually originates in lower
extremities or pelvis
#: mismatch )%anCt Perfuse well*
AB(:
Acidotic %O'
P; )Acidic*R"S .ACTOR:
#ein stasis or -#T )enlarged Trachea
#eins*
Recent surgery or trauma
ong !one fractures )lower*Oral %ontraception
Pregnancy
Smo?ing
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%ancerC
ong ,ights
+Polycythemia: 5ncrease in Red >lood
%ells
Anemia due to poor perfusion
Training lower partial pressure in
certain states
Training: Anticoagula!ility given
Other Causes: Air
Amniotic 1luid )mom can lea?
,uid into vascular*
1at Particles )long !one fracture*
Particles from su!stance A!use
#enous %atheter
Signs Symptoms O! P):
RAP5- ONS2T
-ISPN2A
TA%;I%AR-5A
TA%;IPN2A
12#2R )SO$2T5$2S*
2P5SO-5% )S;O(2RS*
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2#5-2N%2 OR ;5STORI O1
T;RO$>OP;2>5TS )Plaque*
%ONS5-2R 2ARI (;2N NO OT;2R%AR-5OR2SP5RTORI 15TS
#:
')R LAR() )=BOL"
Preceded !y sloc?age right heart failure Shoc?
%ardiac Arrest
ARDS:
A con%ition that results in severe
illness or inEury an% associates
#ith a high mortality rate 5ncreased permea!ility
Pulmonary 2dema
Surfactant -estruction
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Atelectasis
-ecreased compliance
;ypoxemia )severe ;ypoxemia*
>lood O' low
ADULT R)SP"RTOR D"STR)SS
SNDRO=):
AKA: NON/%ardiogenic Pulmonary
edema A %omplication Of:
Severe Trauma
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Suction
=)CAN"CAL ')NTALT"ON:
P22P
)C( =onitoring:Treat nder lying %auses:
$ay require #asopressors for shoc?
%/PAP
>/PAP
Splint Alveoli P22P #entilation
PN)U=ON"A:
1ifth leading cause of death in S
0roup of speciFc infections
Ris? 1actors
%igarette smo?ing
2xposure to %old 2xtremes of age
Ioung
Old
PN)U=ON"A:
"nammation o! Bronchioles an%
AlveoliProducts of in,ammation )secretions.
pus* add to respiration diJculty
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(as )*change is impaire%
(or? of !reathing increased
=ay Lea% to:
AtelectasisSepsis
# mismatch
;ypoxemia
Presentation O! Pneumonia:
Shortness of !reath. -yspnea
1ever. %hills
Pleuritic %hest Pain. Tachycardia
%ough
0reenrown Sputum$ay have crac?les. rhonchi.
wheeEing in peripheral lung Felds%onsolidation
2gophony
=anagement O! Pneumonia:
Treatment mostly !ased on symptoms:
O'
Rarely is intu!ation required
5# Access = rehydration
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Allergens
-rugs
Occupational ;aEards
(eneral Pathophysiology:
SpeciFc pathophysiology varies !y
disease
O!struction in >ronchioles Smooth muscle spasm )!eta9
$ucus accumulation )0o!let cells get
irritated and mucus* 5n,ammation
O!struction may !e reversi!le or
irreversi!le O!struction results in air trapping
>ronchioles usually dilate on
5NSP5RAT5ON -ilation allows air to enter even in
presence or Go!structionH >ronchioles tend to %ONSTR5%T on
expiration
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Air !ecomes trapped distal to
o!struction
%yanotic late sign )very ill* Ph"
Acidotic %O'
C+RON"C OBSTRUCT"')
PULO=NAR D"S)AS): )mphysema
Chronic Bronchitis Sometimes Asthma
)mphysema:
Adelectics: loss of elastic recoil with
alveoli
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Smo?ers 49B more li?ely to die od
%OP- than non/smo?ers
)nvironmental .actors Alpha/ 4 antitrypsin deFciency
+ere%itary
9.999 to 499.99 cases
$ost people of Northern 2uropean
-escent
0eriatrics -isease
PAT+OP+S"OLO(:
-ecreased surface area leads to
decreased gas exchange with !lood
oss of pulmonary capillaries =
;ypercarnia eads to: 5ncreased resistance to !lood ,ow
which leads to: Pulmonary ;TN
Right ;eart 1ailure )%or Pulmonale*
oss of elastic recoil leads to increase
in residual volume and %O' retention Air trapping
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;yperin,ation
;ypercapnia Pulmonary
#asoconstriction #arrel
%hest* -ecreased ung sounds< heart )siEe of
surface area increased ;yperresonant chest
5P PRS5N0: Air Trapping to increase
P22P levels )exhalation* Alerted !lood gases
Normal or decreased PaO'
2levated %O'
%lu!!ed Fngers
Still perfusing
%yanosis is a late sign of diseaseP"N PU..)RG
Treatment:
BLS:
#entilate
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O' mas?
%ardiac $onitor 5rregular )P#%*
$onitor >reathing
Chronic Bronchitis:5ncreased mucus production for more
then & months for ' consecutive years"
Recurrent productive cough
)tiology:
Smo?ing 2nvironmental irritants
Pathophysiology:
$ucus plugging
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creating more causing Polycythemia
)not getting oxygenated !y Alveoli*
;ypercar!ia leads to pulmonaryvascular constriction: increased right
ventricular which leads Right sided
heart failure which can lead to
enlargement of right side )%or
Pulmonale*
S"(NS S=PTO=S
5ncreasing dyspnea on exertion
1requent colds of increasing duration
Productive cough
(eight 0ain. edema )right hear failure*
>luish/red s?in )polycythemia*: -2 TO
NOBI02NAT2- >OO-
Rales. Rhonci. (heeEing
;eadache. drowsiness )increase in%O'*
nintelligence
Over weight due to SO>
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P5TT5N0 2-2$A
Personality %hange
;yperocar!ia
;ypoxia
1luid >ac?s up. 5nferior and Superior
!ecome semi/permea!le. !lood lea?s
out into interstitial spaceTreatment: + Anti!iotics
CANOS"S "S AN )ARL COURS) O.
D"S)AS)
BLU) BLOAT)RGG
COPD Assessment .in%ings:
Chronic Con%ition Acute
)piso%e
SS o! #or- o! ,reathing
an%Hor hypo*emia
se of accessory muscles
5ncreased expiratory e@ortTachycardia
%yanosis
(heeEing. Rhonli
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-ecreased ung Sounds
Thin. red
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Un%erstan% Di@erenceG
ARDS: 1S)')R) ACUT)
R)SP"RTOR .A"LUR)4
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Respiratory .ailure:
5na!ility of the lungs to meet meta!olic
demands of the !ody%anCt ta?e in enough O' = %ant
eliminate enough %O' fast enough
#entilation 1ailure: 5m!alance !etween
load on the lungs and the a!ility of the
!ellows to compensate1ailure of Oxygenation: PaO' M89
mmhg
1ailure to #entilation: Pa%O' U9
mmhg
ARDS:
ea?y Alveolar capillaries
Plasma ,uid and eu?ocytes lea? into
the airspace
Shunt
;ypoxemiaCAUS)S O. ARDS:
Pneumonia
Aspiration of 0astric contents
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Pulmonary %ontusion
Near/-owning
5nhalation 5nDury )%O/Smo?e*
Reperfusion Pulmonary 2dema
After ung Transplant or
Pulmonary 2m!olectomy
5ND"R)CT LUN( "NIUR:
Non/Pulmonary sepsis
Severe trauma with S;O%K
%ardiopulmonary >ypass
Acute Pancreatitis
-rug Reaction )ARA/%*
1AT. Amniotic 1luid
2m!olism. !ypass
PAT+OP+S"OLO(:
"ncrease alveolar permea,ility %ue
to %irect neutrophil0me%iate%
inEury to the alveolar epithelium
Al#ays en%s in some !orm o!!ulminating )%ema
)n% result:
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Severe +POF)="A
BLS T+)ARP+T"C (OALS:
=aintain Reasona,ly O*ygen
Delivery
."ND ."F PR"=AR CAUS)
T+ORAC"C TRAU=A:
Second leading cause of trauma
deaths after head inDuries
%auses of a!out 49/'9Q of all auma
death
$any deaths due to thoracic trauma
are preventa!lePR)')NT"ON STRAT)(")S:
0un Safety 2ducation
Sports Training = Protective
2quipment
Seat >elts = Air >ag se
=echanism O! "nEury
>lunt 5nDury
-eceleration
%ompression
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Penetrating "nEury
Both
Anatomical "nEuries:
Thoracic %age )S?eletal*
%ardiovascular )ethal -ysrhythmia*
Pleural and Pulmonary $ediastinal
-iaphragmatic
2spogheal
Penetrating %ardiac )0rave TOR*
Often Results in:
;ypovolemia
Pulmonary #
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+o# $hy %o #e ventilateJ
Per!usion 'entilation
(eneral Pathophysiology:
"mpairment to Car%iac Output
>lood loss
5ncreased intrapleural pressure
)Pnemo*
>lood in Pericardial Sac
$yocardial #alve -amage
#ascular -isruption
"mpairments in 'entilation:
%hest excursion compromise:
Pain
Air in pleural sac
Asymmetrical movement
>leeding in Pleural Space 5ne@ective -iaphragm contraction "mpairment in (as )*change: Atelectasis Pulmonary %ontusion Respiratory Tract disruption "nitial )*am %irecte% to#ar%s
Li!e Threatening "nEuries:
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Open Pneumothorax 1lail %hest Tension Pneumothorax $assive ;emothorax %ardiac Tamponade Con%itions: Apnea Respiratory -istress
ASS)SS=)NT ."ND"N(S:
$ental Status )decreased* Pulse )A!sent. >rady. Tachy* >P )Narrow PP. ;yperP in
inspiration
#entilation rate = e@ort )Tachy. or
>rady. a!ored. retractions* S?in )-iaphoresis. pallor. %yanosis. open
inDury. ecchymosis*
Nec? )Tracheal position. S
emphysema. #-. Open 5nDury*
%hest )contusions. tenderness.
asymmetry. a!sent or decreased lung
sounds. a!normal percussion. open
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inDury. impaled o!Dect. crepitus.
hemoptysis )coughing up of !lood*
;eart Sounds )muVed. distant.
regurgitant murmur*
pper A!domen )%ontusion. open
inDury*
2%0 )ST segment a!normalities.
dysrhythmias*
+istory: -yspnea Pain Past hx of %ardiovascular disease Restraint device used
5tem
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2specially common in 2lderly )falls*
Ri!s form rings
Possi!le !rea? in ' places )th*
$ost commonly th/th
Poor Protection
1ractures of the 4stand 'ndrequire
high force
1requently have inDury to aorta or
!ronchi Occur in 9Q of patients with
Tracheo/>ronchial rupture W
Su!cutaneous emphysema*
$ay inDure Su!clavian arterylood in rine*
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Short = Stoc?y
ateral 5mpact $#%
ASS)SS=)NT ."ND"N(S:
ocaliEed pain. tenderness
5ncrease on palpation or when
Patient:
%oughs
$oves
>reaths
Splinted Respirations )0uarding.
short tidal volume* )Pillow Splint:
%leansing !reathing. long as
possi!le resp"*
5nsta!ility in chest wall. %repitus-eformity and discoloration
Associated with Pneumo =
;emothorax
=ANA()=)NT:
;igh %onc" O'
Positive Pressure #entilation %/PAP
Splint using Pillow or swath
2ncourage Pt" to !reath deeply
;elps prevent Atelectasis
8/9/2019 Respiratory System-Review Patho
48/100
Analgesics for isolated trauma
)$orph"*
Non/circumferential splinting)5solate to that Region*
=onitor )l%erly pt COPD
patients Closely:
>ro?en Ri!s can cause
decompensation
Pt" will fail to !reath deeply and
cough. resulting in poor clearance of
secretions
sually Non/2mergent Transport
ST)RNAL .RACTUR):ncommon. /Q in !lunt chest
trauma
arge traumatic force
-irect !low to front of chest !y
-eceleration:
Steering wheel
-ash!oard
Other o!Dect
8/9/2019 Respiratory System-Review Patho
49/100
'Q/6Q mortality due to
associated trauma:
-isruption of thoracic aortaTracheal or >ronchial tear
)Su!cutaneous 2mphysema*
-iaphragm Rupture
$yocardial Trauma
;igh 5ncidence of myocardial
%ontusion. %ardiac Tamponade or
pulmonary contusionASS)SS=)NT ."ND"N(S:
ocaliEed Pain
Tenderness over sternal
%repitusTachypnea. -yspnea painful
2%0 changes with associated
$yocardial %ontusion
;x
8/9/2019 Respiratory System-Review Patho
50/100
;igh %oncentration O' )4'/4. Q
SO'*
Assist ventilations with >#$ asneeded
5# NS
8/9/2019 Respiratory System-Review Patho
51/100
Also results from:
1alls from heights
5ndustrial Accidents
Assault
>irth Trauma
$OR2 %O$$ON 5N O-2R PT"
$ortality rates '9/69Q due to
associated inDuries
$ortality increased with: Seven or more ri!s fractured
Three or more associated inDuries
Shoc?
;ead 5nDuries
CONS)U)NC)S O. .LA"L
C+)ST:
Respiratory .ailure %ue to:
Pulmonary %ontusion
5ntrathoracic 5nDury
5nadequate diaphragm movement
PARADOF"CAL =O')=)NT:
$ust large to compromise
ventilation
5ncreased wor? of !reathing
8/9/2019 Respiratory System-Review Patho
52/100
PA"NM Decrease% Chest
e*pansion:
eading to decreased ventilation;ypoxic. ;ypoperfused
Contusion o! Lung:
-ecreased lung compliance
5ntra/alveolar/capillary hemorrhage
Decrease% 'entilation
;ypercapnea %o' increase;ypoxia
ASS)SS)=)NT ."ND"N(S:
%hest wall contusion
Respiratory -istress
Pleuritic %hest Pain
Splinting e@ected side %repitus
Tachypnea. Tachycardia
Paradoxical $ovement )possi!le*
=ANA()=)NT:
Suspect Spinal 5nDuries
2sta!lish Airway ;igh %onc" O'
Assist ventilation with >#$
8/9/2019 Respiratory System-Review Patho
53/100
Treat hypoxia from underlying
contusion
Promote full lung expansion %onsider need for 5ntu!ation and
P22P
AN5B2TI Reduces. Pain. Tidal
#olume 5ncrease
$echanically Sta!iliEe %hest (all
)uestiona!le value* )>ul?
dressings. %ravats*
5# of R
8/9/2019 Respiratory System-Review Patho
54/100
2$2R02NT TRANSPORT:
TRA$A %2NT2R
S"=PL) Pneumothora*:
Pleural wall
"nci%ence:
49/&9Q in !lunt chest trauma
almost 499Q with penetrating chest
trauma
$or!idity = $ortality depends on:2xtent of atelectasis
Associated 5nDuries
CAUS)S:
%ommonly a fx ri! lacerates lung
Paper !ag e@ect
$ay Occur spontaneously in tall.
thin. young males following:
2xertions
%oughing
Air Travel
Spontaneous may occur #ith=ar!ans Syn%rome 1)longate%
Lungs4PAT+OP+SOLO(:
8/9/2019 Respiratory System-Review Patho
55/100
Air enters pleural space causing
partial lung collapse
Small tear self/seal arger tears may progress
Usually #ell tolerate% in the
young +ealthy
Severe compromise can occur in
the el%erly or patients #ithpulmonary %isease
Degree o! %istress %epen%s on
amount spee% o! collapseASS)SS=)NT ."ND"N(S:
Tachypnea. tachycardia
-iJculty !reathing or respiratory
distress
Pleuritic Pain )chest pain that is not
cardiac pain*
$ay !e referred to shoulder or arm
pain on a@ected side
Decrease% or a,sent ,reath
soun%s:
8/9/2019 Respiratory System-Review Patho
56/100
Not al#ays relia,le
5f pt" is standing. assess apices Frst
5f supine assess anteriorly Frst
Patients with $ultiple ri! fractures
may splint inDured side !y not
!reathing deeply=ANA()=)NT:
2sta!lish airway.
Trend #itals -onCt leave patient alone
;igh %onc" O'
Assist with >#$
-ecreased or rapid respirations
5nadequate Tidal #olume )T#*
5# or S
8/9/2019 Respiratory System-Review Patho
57/100
Larger the hole the more li-ely
air #ill enter through there than
the Trachea 5f trauma pt" does not ventilate well
with an open airway. loo? for hole
$ay!e su!tle
A!rasion with deep punctures
Pathophysiology:
Results of penetrating trauma
Profound hypoventilation may occur
Allows communication !etween
pleural space = Atmosphere
Prevents development of negative
intrapleural pressure
Results in 5psilateral lung collapse
)One Side*
5na!ility to ventilate a@ected lung
'H mismatch:
Shunting;ypoventilation
;ypoxia
arge functional dead space
8/9/2019 Respiratory System-Review Patho
58/100
;ypotensive during venous return/
%O/Reduce/ Reduced >P
ASS)SS=)NT ."ND"N(S:
Opening in the chest wall
Suc?ing sound on inhalation
Tachycardia
Tachypnea
Respiratory -istress S emphysema
-ecreased ung sounds on a@ected
side=ANA()=)NT:
%over chest opening with occlusive
dressing )A%S/ Asherman %hest
Seal*
;igh %O'
Assist with positive pressure
ventilations
$onitor for progression of tension
Pneumothorax
5# with R
8/9/2019 Respiratory System-Review Patho
59/100
8/9/2019 Respiratory System-Review Patho
60/100
Reduction in %ardiac Output/
#enous return reduced
5ncreased intrathroxic pressure -eformed #ena %ava reducing
preload
Positive pressure !uilding more =
more
789 mm/ suppose to !e
Pressure on heart
-eviated trachea
Starling aw: greater stretch.
greater elastic recoil
Pressure on superior. inferior. aorta
#- ;ypotensive/ >P
ASS)SS)=)NT ."ND"N(S: 0 1=OST
L")L4
Severe -yspnea/ 2xtreme resp"
distress
Restlessness. anxiety. agitation
8/9/2019 Respiratory System-Review Patho
61/100
A!sent
8/9/2019 Respiratory System-Review Patho
62/100
;igh O'
Positive pressure ventilation with
>#$ Needle thoracostomy
5v of Re careful not ?in? or !end needle
5f availa!le attach one way valve
8/9/2019 Respiratory System-Review Patho
63/100
+emothora*:
PAT+OP+S"OLO(:
>lood in Pleural space
$ost common as a result of maDor
chest trauma to the chest wall
Present in 79/9Q of penetrating
and maDor non/penetrating trauma
cases
Associated with Pneumothorax
Ri! fractures are frequent causes
>lood vessels ruptures
>lood in 4999cc/&999cc
1lat Nec? #eins
+Kinematics ;igher
2ach can hold up to &999cc of !lood
ife/threatening often requiring
chest tu!e and or< surgery
5f associated with 0reat< #essel or
cardiac inDury:
9Q die immediately
'Q die to 49 minutes
'Q may live &9 minutes or longer
8/9/2019 Respiratory System-Review Patho
64/100
>OO- OSS R2STS 5N:
;ypovolemia
-ecreased ventilation a@ected lung
Accumulation of !lood in Pleural
Space
Penetrating or !lunt trauma
%hest wall vessels
5ntercostal vessel
$yocardium $ASS5#2 hemothorax indicates
great vessel or cardiac inDury
5ntercostal Artery can !leed
50cc/min
Results in %ollapse lung Accumulation of !lood eventually
producing a tension hemothorax
shifting the mediastinum producing:
#entilation impairment
%ardiovascular collapse
ASS)SS=)NT ."ND"N(S:
8/9/2019 Respiratory System-Review Patho
65/100
Tachypnea or Respiratory
Distress
Shoc? Rapid. wea? pulse
;ypotensive. Narrow PP
Restlessness. Anxiety
%ool. Pale. %lammy S?in
Thirst
Pleuritic %hest Pain -ecreased ung sounds
%ollapsed nec? veins
-ullness on Percussion
=ANA(A)=)NT:
)sta,lish Air#ay
;igh %onc" O' Assist ventilations with >#$
$AST in Profound ;ypotension
Needle Thoracostmy if tension =
una!le to di@erate from Tension
Pneumothorax 5#s B' with R
8/9/2019 Respiratory System-Review Patho
66/100
2$2R02NT TRANSPORT to TRA$A
%2NT2R
PUL=ONAR CONTUS"ON: PAT+OP+S"OLO(:
Blunt Trauma to the Chest
Rapid deceleration forces cause
lung to stri?e chest wall
;igh energy shoc? wave from
explosion
ow velocity as with 5ce pac?
$OST Trauma from !lunt thoracic
trauma:
&9/7Q of !lunt trauma
$ortality 46/'9Q Ri! fx in many !ut not all cases
Alveolar rupture with hemorrhage 7
2dema
5ncreased capillary mem!rane
permea!ility arge vascular shunt develop
0as exchange distur!ances
;ypoxemia
8/9/2019 Respiratory System-Review Patho
67/100
;ypercar!ia
ASS)SS=)NT ."ND"N(S:
Tachypnea or Respiratory distress
Tachycardia
2vidence of !lunt chest trauma
%ough and
8/9/2019 Respiratory System-Review Patho
68/100
(reat 'essel inEury until proven
other#ise
=OCARD"AL CONTUS"ON:$ost common !lunt trauma to heart
sually due to Steering wheel
SigniFcant cause of mor!idity and
$ortality in the !lunt trauma patient
PAT+OP+S"OLO(:
Behaves li-e an Acute ="
;emorrhage with 2dema
%ellular inDury
#ascular damage
;emopericardium may occur from
acerated epicardium or endocardium
)!lood Pericardium Sac*
$ay produce Arrhythmias )2ctopic
1oceye. extra !eats*
$ay cause unresponsive ;ypotension
to ,uid and drug therapyASS)SS=)NT ."ND"N(S:
8/9/2019 Respiratory System-Review Patho
69/100
%ardiac Arrhythmias following !lunt
chest trauma
Angina/li?e pain unresponsive toNitroglycerin
Precordial discomfort indepence of
respiratory movement
Pericardial friction ru! )late*
2%0 %hanges:
Persistent Tachycardia
ST elevation. T wave 5nversion
R>>>
Atrial 1lutter. Atrial 1i!rillation
P#%Cs
PA%Cs =ANA()=)NT:
)sta,lish Air#ay
;igh %onc" O'
5# R
8/9/2019 Respiratory System-Review Patho
70/100
Consi%er vasopressors !or
hypotension
)mergent Transport0 Trauma
Pericar%ial Tampona%e:
Usually associate% #ith
Penetrating trauma
Rare #ith Blunt trauma
Occurs in 'Q of chest trauma
0S( have greater mor!ity than
sta! wounds
ower $ortality rate if isolated
TamponadePAT+OP+S"OLO(:
Space normally lle% #ith 5606
ml stra#0colore% ui%
u!rication
ymphatic -ischarge
5mmunologic protection of the heart
RAP5- A%%$AT5ON O1 >OO- 5N
the 5N2AST5% P2R5%AR-5$
8/9/2019 Respiratory System-Review Patho
71/100
;eart is compressed decreased !lood
entering heart:
-ecreased diastolic expansion andFlling
;inders venous return / preload
$yocardial Perfusion decreased due to:
Pressure e@ects on walls of heart
-ecreased diastolic pressures
5schemic dysfunction may result in
inDury
Removal of as little as '9ml may
increase %O drastically
Stro?e #olume/ eft ventricle/ eDection
fractionX 89/Q of stro?e volume
.lui% aroun% cant pump as #ell
S"(NS S=PTO=S:
B)C TR"AD:
Resistant +ypotension Q Boles no
change
"ncrease% Central 'enous
Pressure: Bloo% thats %raining
8/9/2019 Respiratory System-Review Patho
72/100
get collecte% an% causes I'D
1Disten%e% nec-Harm veins in
presence o! %ecrease% arterial BP4 Small uiet +eart 1Decrease%
+eart Soun%s4 Narro# PP
.lui% goes into lungs
+y%rostatic Osmatic pressure ui%
#ill go into Alveoli %ue to pressuresemi0permea,le
Pulsus Paradoxus:
Radial pulse !ecomes wea? or
disappears when patient inhales/
49mm systolic5ncreased intrathoracic pressure on
inhalation causes !lood to !e trapped
in lungs temporarily
P2A/ 2T;A -ISR;I$T$A
O%=ANA()=)NT:
Secure Airway
;igh %ON%" O' $as?
8/9/2019 Respiratory System-Review Patho
73/100
Pericardiocentesis
Out of hospital primarily reserved for
%ardiac ArrestRapid Transport
5#Cs of Rlunt %hest Trauma
8/9/2019 Respiratory System-Review Patho
74/100
4Q of all !lunt chest trauma deaths
4 in 8 people who die in $#% has
Aortic RuptureQ die instantaneously
49/4Q survive to hospital
4lood enters media through a mall
intima tear/Thinned layer may rupture-escending Aorta at the 5sthmus distal
to left su!calvian artery most common
site of rupture/ igamentum ArterisomASS)SS=)NT ."ND"N(S:
Retrosternal or interscapular Pain
Pain in lower !ac? or one leg: not
getting perfused well
Respiratory -istress
8/9/2019 Respiratory System-Review Patho
75/100
Asymmetrical arm >PCs
pper 2xtremity hypertension with
-ecreased 1emoral Pulses or A!sent
1emoral Pulses
-ysphagia )Swollen*
=ANA()=)NT:
2sta!lish Airway;igh %onc" $as?
%/SP5N2
$aintain $inimal >P in dissection
5# R
8/9/2019 Respiratory System-Review Patho
76/100
>ac?ward ,ow of !lood out of right
heart into vessels of upper chest and
!ac?#-
%apillaries rupture
ASS)SS=)NT ."ND"N(S:
Purplish0re%%ish %iscoloration o!:
;ead
Nec? Shoulders
>lood shot. protruding eyes
#-
Sternal 1acture or central ,ail
Shoc? when pressure released
=ANA()=)NT:
Airway with %/spine control
Assist in #entilation
Spinal Sta!iliEations
"' o! LR
$onitor 2K0
$AST in severely ;ypotensive pts"
Rapid Transport
8/9/2019 Respiratory System-Review Patho
77/100
%onsider 2arly Sodium >icar!onate in
Arrest );%O&*
Diaphragmatic Rupture:Usually %ue to ,lunt trauma ,ut
may occur #ith penetrating
trauma
Usually li!e threatening
Li-ely to ,e associate% #ith other
severe inEuries
I'D
A,%ominal Contents in Pleural
SpacePAT+OP+S"OLO(:
Compression to a,%omen results
in increase% intra0a,%ominal
Pressure:
A!dominal contents rupture through
diaphragm into chest
>owel O!struction and strangulation
Restriction of lung expansion
$ediastinal shift
8/9/2019 Respiratory System-Review Patho
78/100
9Q occur on the left side due to
protection of right side !y liver
ASS)SS=)NT ."ND"N(S:Decrease% Breath Soun%s
sually unilateral
-ullness on percussion
-yspnea or Respiratory -istress
Scaphoid A!domen )hollow
appearance*sually impossi!le to hear !owl sounds
=ANA()=)NT:
)sta,lish Air#ay
Assist #entilations with ;igh %onc" O'
5# of R
$onitor 2K0
N0 tu!e if possi!le
Avoid
$AST
Trendelen!rug Position
Diaphragmatic Penetration:Suspect intra0a,%ominal trauma
#ith any inEury ,elo# 9th "CS
8/9/2019 Respiratory System-Review Patho
79/100
Suspect "ntrathoraic trauma #ith
any a,%ominal inEury a,ove
Um,ilicus)sophageal "nEury:
Rare >lunt Trauma
%an perforate Spontaneously
#iolent emesis
%arcinoma )Tears*
ASS)SS=)NT ."ND"N(:Pain. local tenderness
;oarseness. -ysphagia
Resp" -istress
Resistance of nec? on passive motion
$ediastinal esophageal perfection
$ediastinal emphysema
8/9/2019 Respiratory System-Review Patho
80/100
2$2R02NT TRANSPORT
TRAC+)OBRON"CAL RUPTUR):
Uncommon inEury
ess than &Q of chest trauma
Occurs with Penetrating trauma or
!lunt
;igh $or!ity rate
$ay involve fracture or upper ri!s
osing air into pleural space
Carina splint common
PAT+OP+S"OLO(:
$aDority )9Q* occur near %arina
YRapid movement of air into the Pleural
Space%ontinuous ,ow of air ,ow from needle
of decompressed chestASS)SS)=)NT ."ND"N(S:
Respiratory Distress:
-yspnea
Tachypnea
O!vious S 2mphysema
;emoptysis
>right Red colour
8/9/2019 Respiratory System-Review Patho
81/100
Signs of Tension Pneumothorax
unresponsive to needle decompression
=ANA()=)NT:)sta,lish Air#ay an% 'entilations
%onsider 2arly intu!ation
$ay!e life saving
2$2R02NT TRANSPORT
"NTRODUCT"ON TO CARD"OLO(:
CARD"O'ASCULAR D"S)AS):
Single greatest cause of death and
disa!ility in the S
5ncludes heart disease and #ascular
-isease
' $illion People diagnosed with as
A%S
8/9/2019 Respiratory System-Review Patho
82/100
Almost half of these )'9.99* will
sudden and within the Frst hour of
onset of symptoms99.99 people will su@er a stro?e each
year in the S
Nearly Z of these will die
8/9/2019 Respiratory System-Review Patho
83/100
AT+)ROSCL)ROS"S:
Pla&ue accumulation #ithin the
lumen o! the artery resulting in:
-ecreased umen inner diameter
5ncrease #ascular resistance
Potential for Throm!us or 2m!olus
formation
ASSO%5AT2- (5T;:
;TN
STROK2
AN05NA. ;2ART ATTA%K
R2NA 1A5R2
R"S .ACTOR:
Age
1amily ;istory
;ypertension
;ypercholesterolemia
$ale
Smo?ing
-ia!etes
8/9/2019 Respiratory System-Review Patho
84/100
CONTRUBT"N( .ACTORS:
-iet
O!esity
Oral %ontraceptives
Sedentary ifestyle
Personality Type)=S ROL):
Original #as the nee% !or rapi% response
to i%enti!y emergency care o! victims o!
Su%%en car%iac %eath 1parame%ics have
,een prove to ma-e %i@erence in survival
an% Acute =yocar%ial "n!ractionM
Contri,utions to ,eing reconi/e% in acute
coronary syn%romes
Loo-ing !or ST )levation in 5 or more
lea%s Car%iac Artery is then Splinte% or
Stente%
Bypass )R Department
$ea- 's Strong Chain o!
Survival:
8/9/2019 Respiratory System-Review Patho
85/100
Outcome is lo# #ith %elaye% CPR
(oo% &uality CPR is (OOD
"! #e %ont have goo% CPR
then #e can per!use heart
#ith +emoglo,in
TO su,stance 'entricular
.i,ulation 1Rhythm4
$ith ventricular .i,ulation
there is no rhythmic reaction
on pulse
Li!e:
'0.i,
Pulseless '0Tach
8/9/2019 Respiratory System-Review Patho
86/100
P)A0 Pulseless
Pulseless '0Tach
Asystoli 1.lat line4
Anatomy Physiology:
$hen heart must con%ucts
rst
.unctionally sypthom
Autocontratility: #e cancontract our o#n
Pulmonary )%ema: LC+.:
Con%uctive SST)=:
SA0NOD): 1PAC)=A)R4
760366 ,pm 1RA0 Anterior
in!erior #all o! Atrium4
A' NOD): 96076 BP=
P)R-inEie .i,ers: 86096,pm
Per-inEe system
A' IUNCT"ON0 IunctinalRhythm
8/9/2019 Respiratory System-Review Patho
87/100
Loo- !or (AP IUCT"ONS
8/9/2019 Respiratory System-Review Patho
88/100
Parietal - pericardial sac
Pericardial fluid
8/9/2019 Respiratory System-Review Patho
89/100
Bloo% .lo#:
8/9/2019 Respiratory System-Review Patho
90/100
CONDUCT"ON O. PAT+$A O. T+)
+)ART:
(Mitral
valve)
8/9/2019 Respiratory System-Review Patho
91/100
CARD"AC CCL):
8/9/2019 Respiratory System-Review Patho
92/100
D"ASTOL"C SSTOL"C
P)R"P+)RAL 'ASCULAR SST)=
')NOUS R)TURN:
SK22TA $S%2 P$P:
$uscular contraction squeeEes
adDacent veins causing a mil?ing action
#alves prevent opposite ,ow
R)SP"RTOR =O')=)NTS:
-iaphragm contraction exerts pressurein a!domen and decreases pressure in
thoracic cavity
8/9/2019 Respiratory System-Review Patho
93/100
>lood moves to area of lower pressure
in thorax
')NOUS R)TURN:%onstriction of #eins
Sympathetic stimulation causes
contraction of the smooth muscles
walls of veins
0ravity
8/9/2019 Respiratory System-Review Patho
94/100
8/9/2019 Respiratory System-Review Patho
95/100
Negative )@ects on 'enous
Return:
5ncreased intrathoracic Pressure
P22P
8/9/2019 Respiratory System-Review Patho
96/100
ART)R"AL R)S"STANC) 1A!terloa%4BP:
%ardiac Output B Systemic #ascular
Resistance
)Sto?e #olume x ;eart Rate* B
Systemic #ascular Resistance
StarlingCs aw: The 0reater the
Stretch the greater the recoil
SST)="C 'ASCULAR R)S"STANC):
'asoconstriction:
Sympathetic NS e@ects
$edications )prescription. non/
prescription. recreational* Renin/Angiotensin/Aldosterone
$echanism
Atherosclerosis
Anatomical Dea% Space: Airways thatdo not involve gas exchange
8/9/2019 Respiratory System-Review Patho
97/100
Physiological Dea% Space: Anatomical
dead space = the Alveoli that are no
longer wor?ing
Coronary Circulation:
sually thought of as & arteries
eft )$ain* %oronary Artery
eft %ircum,ex Artery
eft Anterior -escending Artery
8/9/2019 Respiratory System-Review Patho
98/100
8/9/2019 Respiratory System-Review Patho
99/100
S&: 2xtra ;eart Sound hear after an
S'. compati!le with ;eart failure.
extra sound of heart opening and
closing
S6: 2xtra Sound hear late in diastolia
instead of following S&. comes !efore
S4" Sometime failure !ut not always"
Thrill: paplapa!le murmur over a
localiEed o!struction felt on pads of
Fngers. can !e found on Radial.
Athroscrosis*
>ruit: ;ear high pitch of ,uid going
through localiEed o!structions
)Auscultate*
Right =" 8?
Le!t ;6?
=" S"(NS S=PTO=S:
Ia# pain
8/9/2019 Respiratory System-Review Patho
100/100
Chest Pain
Diaphertic
Pale
Dyspnea
76 an% a,ove age
Normtensive0+ypertensive