Respiratory Therapy! Just breathe!

Review of Respiratory We breathe by negative pressure. The diaphragm pulls down and we pull air in through our nose and mouth. We breathe in O2 ( Oxygen) and exhale CO2 ( carbon dioxide) COPD = Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow as you exhale and make it increasingly difficult for you to breathe. Emphysema and chronic asthmatic bronchitis are the two main conditions that make up COPD. In all cases, damage to your airways eventually interferes with the exchange of oxygen and carbon dioxide in your lungs.

Homeostasis Too much O2 ( hyperventilating) and CO2 levels will fall too much resulting in dizziness, confusion and eventually you will “pass out”. * Emphysema Too little O2 (hypoxia) and CO2 levels will rise (hypercapnea) and if not corrected you will fall asleep, coma and eventually die. * Emphysema The body works to keep O2 and CO2 level.

Acidosis Too much CO2 in the body is called acidosis – Can be caused by Respiratory problems or Metabolic problems : ( Kidney/Diabetes) Respiratory Acidosis comes from inadequate ventilations. Head trauma, drug overdose, anesthesia, neuromuscular diseases, spinal cord injury and obesity ( pickwickian syndrome) The body will start breathing faster to correct this. If it can’t correct the acidosis, the person requires a ventilator.

Alkalosis Too little CO2 in the body is called alkalosis – Can be both Respiratory (Rare) or Metabolic. (Diuretics, Vomiting, or Antacids) Respiratory alkalosis is caused mainly by anxiety resulting in hyperventilation. Calming the person down will correct respiratory alkalosis, Sedation helps…….

Nasal Cannula Nasal Cannula 0.5-5 liters per minute of oxygen Used for Chest pain, COPD, post operative support, mild pneumonias ,etc

Venti Mask Venturi Mask (venti mask) 24%-50% concentration of oxygen 24% uses 2-4, 35% uses 6-8 liters of O2, 45% uses 10 - 12liters and 50% uses 12-15 liters of O2. Used for patients who require more than 5 liters of O2 or breathe through the mouth more. Copd, Pulmonary Emboli, Pneumonia, etc

100% Non-Rebreather 100% Non-Rebreather. 100% O2 Used for Medical Emergencies, Severe Hypoxia Oxygen fills the bag and a one-way valve prevents any CO2 from being reinhaled,

Nebulizers Used for the treatment of Asthma, Bronchitis, Pneumonia, post operatively and post intubation. Most contain steroids to reduce swelling in respiratory tracts Some contain medicine to help remove mucous. Can be used during codes to give meds if not other alternative… not very effective.

Ambu Bag 100% Oxygen Placed securely over nose and mouth Bulb is squeezed and air is forced into lungs. Used before and during intubation, codes and surgery.

CPAP Machine CPAP = Continuous Positive Air Pressure Used for sleep apnea, hypoxic patients and High CO2 levels Will be tried before intubation. Not tolerated by everybody…. Person must be able to initiate breath.

Intubation and Ventilation Used for Surgery, Cardiac and Respiratory arrest, Respiratory failure due to pneumonia, drugs, cancer, end stage COPD, head trauma and airway protection for alcohol withdrawal, uncontrolled seizures and uncontrolled psychotic events. Settings on the ventilator can range from breathing on your own to full respiratory support. Settings are adjusted by Physician ( Emergency Room, Anesthesiologist or Intensivist) according to ABG results and body size

Intubation ET Tube (Endotracheal Tube ) is placed trough the mouth (or nose –rarely) down the trachea, through the vocal cords to above where the bronchus split ( 1inch above the Corina)

ET Tube The ET Tube is checked for placement all 3 ways : 1)CO2 detector - 2) Listening to the lungs for breath sounds 3) Chest X-ray Tube must be secured at all times and pt is almost always sedated.

Tracheostomy ET Tubes are only good for 7-14 days. If the pt requires ventilation longer, a tracheostomy tube is placed. More comfortable, easier to breath and the person does not have to be sedated.

Ventilator Uses Positive pressure to ventilate. Multiple settings are used to adjust the acid base balance. Rate – the number of breaths per minute to machine will give. Tidal Volume – The volume of air with each respiration Oxygen- How much O2 to deliver PEEP – (Positive end expiratory pressure) How much O2 to leave in the lungs during exhalation.

Ventilators

Positives and Negatives Positive : It saves lives Negative : Intubation trauma – teeth, vocal cords, erosion of trachea ( bleeding), infection ( ventilator acquired Pneumonia), restraints, bed sores, blood clots, swelling,painful and lastly -its frightening!!!