Respiratory Lecture Series: Acute Lower Respiratory Health Deviations

Anatomy and Physiology Review

• Discussion focuses on chest wall anatomy below the larynx.
• Key components:
  • Parietal pleura, visceral pleura, and pleural fluid.
• Pulmonary circulation: arteries and capillaries.
• Lung compliance: ability to stretch and expand.

Acute Disorders Affecting Lung Compliance

• Pneumonia, Pneumothorax, Pulmonary Edema, ARDS: Disorders causing decreased compliance.
• Chest Pain: Can be from various sources, often confused with cardiac issues.
  • Pleurisy: Inflammation of pleura, treat by laying on affected side.

Assessing Respiratory Status

• Pulse Oximetry: Normal 94-100%, below 90% indicates poor oxygenation.
  • Affected by cold hands, low perfusion, anemia, hypercapnia.
  • Best measure: Arterial Blood Gas (ABG).
• Chest X-ray and CT: Used to detect fluid, air, and bone issues.
  • CT used for vasculature issues.

Blood Gases

• Arterial vs. Venous Blood Gas:
  • Arterial is more accurate.
  • Use Allen test to check blood flow before arterial blood gas.

Diagnostic Imaging

• CT and MRI: Mainstay for vasculature issues.
• VQ Scan: For pulmonary embolism.
  • Gallium and PET Scans: For cancer staging and metastasis detection.

Procedures and Interventions

• Flexible Bronchoscopy: Outpatient procedure, requires informed consent.
  • Monitor for airway and bleeding post-procedure.
• Thoracoscopy and Thoracentesis:
  • Thoracoscopy can cause pneumothorax; indication for chest tubes.
  • Thoracentesis removes fluid from pleural space; requires careful positioning.

Oxygen Therapy

• Oxygen Toxicity: Avoid excessive oxygen, especially in COPD patients.
  • Use of CPAP/BiPAP to reduce oxygen needs.

Pneumonia

• Types: Community-acquired, hospital-acquired, ventilator-associated.
  • Prevention: Hand hygiene, turning, coughing, deep breathing, elevating head of bed.

Pleural Conditions

• Pleurisy: Inflammation and pain in the pleura.
• Pleural Effusion: Fluid in pleural space, can be transudate or exudate.
  • Diagnosed via X-ray; treated with thoracentesis.
• Empyema: Infection in pleural space, requires long-term antibiotics.

Lung Cancer

• Types: Non-small cell and small cell (most aggressive).
  • Risks: Smoking, mediastinal involvement.
• Surgical Options: Lobectomy, wedge resection, pneumonectomy.
  • Post-op care: Pain management, infection monitoring, and lung expansion exercises.

Chest Trauma

• Types: Blunt and penetrating.
  • Monitor airways, breathing, circulation.
• Rib Fractures: Risk of pneumonia due to shallow breathing.
  • Avoid splinting, provide adequate pain control.

Pneumothorax

• Open vs. Closed: Air in pleural cavity, can lead to tension pneumothorax.
  • Symptoms: Decreased breath sounds.
  • Treatment: Three-sided dressing, chest tube insertion.

Chest Tubes

• Purpose: Drain air/fluid from pleural space.
  • Monitor for output, titling, and air leaks.
  • Careful handling to prevent complications.

Pulmonary Embolism

• Causes: Often from DVTs, can cause ventilation-perfusion mismatch.
  • Risk Factors: Immobility, surgeries, obesity, contraceptives.
  • Diagnosis: D-dimer, spiral CT, VQ scan.
  • Treatment: Anticoagulation, thrombolytic therapy.

Anticoagulation Therapy

• Heparin and Warfarin: Traditional anticoagulants, require monitoring.
  • Newer DOACs: Less monitoring, but no antidote available.

Conclusion

• Importance of comprehensive assessment and appropriate intervention in managing respiratory health deviations.