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Medicine (Expanded) | Paramedic School Study Aid

Respiratory
37 Picmonics to Learn | 59 mins
Respiratory Anatomy
Characteristics
Nasal Cavity
Hair Filters
Mucus Filters and Moistens
Capillaries Warm
Pharynx (Throat)
Larynx (Voice Box)
Cilia Expel Mucus and Dust
Trachea
Bronchi
Alveoli
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2 mins
Physiologic Dead Space (VD)
Tidal Volume (VT)
Partial pressure of arterial CO2 (PaCO2)
Partial pressure of CO2 in expired air (PECO2)
VD = TV x (PaCO2-PECO2) / PaCO2
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2 mins
Alveolar Gas Exchange
Characteristics
Pulmonary Artery Blood is O2-Poor, CO2-Rich
Two-Cell Thick Air-Blood Barrier
CO2 Diffuses Into Air
O2 Diffuses Into Blood
Gases Equilibrate
Pulmonary Vein is O2-Rich, CO2-Poor
Thermoregulation
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2 mins
Alveolar Gas Equation
Equation
Partial Pressure of Alveolar Oxygen (PAO2)
Partial Pressure of Oxygen in the Inspired Air (PIO2)
PIO2 Normally Approximated = 150 mmHg
Arterial Partial Pressure of CO2 (PaCO2)
Respiratory Quotient (R)
R Normally Approximated = 0.8
PAO2 = PIO2 - (PaCO2/R)
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1 min
Lung Sounds - Wheezes
Location
Throughout Lung
Description
High Pitched
Sounds Like
Musical
Cause
Air Moving through Narrowed Airways
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38 secs
Lung Sounds - Rhonchi
Location
Trachea and Bronchi
Description
Low Pitched Rumbling
Sounds Like
Gurgling
Cause
Narrowed Airway
Secretions or Bronchospasm
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49 secs
Lung Sounds - Crackles
Location
Lower Lobes
Description
Fine/Coarse
Sounds Like
Fine: Twisting Hair through Fingers
Coarse: Velcro
Cause
Collapsed Small Airways and Alveoli "Popping Open"
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1 min
Lung Sounds - Pleural Friction Rub
Location
Anterior Lateral Lung
Description
Dry, Rubbing, or Squeaking
Sounds Like
Rubbing a Balloon with Finger
Cause
Inflamed Pleura
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50 secs
Hypoxia (Early Symptoms)
Diaphoresis
Restlessness
Tachypnea
Dyspnea on Exertion
Tachycardia
Hypertension
Arrhythmias
Decreased Urine Output
Unexplained Fatigue
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1 min
Hypoxia (Late Symptoms)
Cyanosis
Cool, Clammy Skin
Use of Accessory Muscles
Retractions
Hypotension
Arrhythmias
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2 mins
Respiratory Acidosis
Hypoventilation
Increased PaCO2 > 45
Barbiturates Depress Central Respiratory Center of Brain
Opioids Depress Central Respiratory Center of the Brain
Airway Obstruction
Respiratory Muscle Weakness/Paralysis
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3 mins
Respiratory Acidosis Interventions
Improve Respiration
Pharmacologic Interventions
Bronchodilators
Respiratory Stimulants
Drug Antagonists
Nonpharmacologic Interventions
Oxygen
Assisted Ventilation
Prevent Complications
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1 min
Respiratory Alkalosis
Hyperventilation
High Altitude
Aspirin
Restrictive Lung Disease
Pulmonary Embolism
Pregnancy
Progesterone
Rib Fracture
Anxiety
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2 mins
Respiratory Alkalosis Interventions
Treat Underlying Cause
Mechanically Ventilated Patients
Decrease Tidal Volume and/or Respiratory Rate
Give Adequate Pain Control and Sedation
Hyperventilation Syndrome
Rebreathing into Paper Bag
Sedatives
Antidepressants
Considerations
Compensatory Drop in Serum Bicarbonate
Correct CO2 Slowly
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2 mins
Obstructive Lung Disease
Blocked Airflow
Increased residual volume
V/Q Mismatch
Decreased forced vital capacity (FVC)
Decreased FEV1/FVC ratio
Asthma
Bronchiectasis
Chronic bronchitis
Emphysema
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51 secs
Restrictive Lung Diseases
Poor Breathing Mechanics
Interstitial Lung Diseases
Goodpasture's Syndrome
Eosinophilic Granuloma
Granulomatosis with Polyangiitis
Sarcoidosis
Pneumoconiosis
Idiopathic Pulmonary Fibrosis
Drug Toxicity
Acute Respiratory Distress Syndrome (ARDS)
Neonatal Respiratory Distress Syndrome
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2 mins
Restrictive vs. Obstructive Lung Diseases
Restrictive Lung Disease
Decreased Lung Volume
FEV1/FVC Ratio Normal to Increased
Obstructive Lung Disease
Increased Lung Volume
Decreased FEV1/FVC Ratio
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2 mins
Chronic Bronchitis
Pathophysiology
Chronic Inflammation of Bronchi
Signs and Symptoms
Early-Onset Cyanosis
Blue Bloaters
Productive Cough
Wheezing
Chronic Obstructive Pulmonary Disease (COPD)
Late-Onset Dyspnea
Crackles
Diagnosis
Reid Index > 50%
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2 mins
Chronic Bronchitis Assessment
Clinical Findings
Chronic Productive Cough
> 3 Months for 2 Years
Increased Mucus Production
Dyspnea
Cyanosis
Wheezes
Complications
Right Side Heart Failure
Jugular Venous Distention (JVD)
Peripheral Edema
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2 mins
Chronic Bronchitis Interventions
Tripod Position
Humidified Oxygen
Pursed Lip Breathing
Increase Fluid Intake
ABGs
Early Detection of Exacerbation
Considerations
Lowest O2 Therapy
Assisted Ventilation
Increased Infection Risk
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2 mins
COPD Overview (Chronic Obstructive Pulmonary Disease Overview)
Causes
Inhaled Toxins
Smoking
AAT Deficiency
Assessment
Emphysema
Chronic Bronchitis
Asthma
Considerations
Spirometry
Slow Progression
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2 mins
Emphysema
Mechanism
Hyperinflation and Loss of Elasticity
Assessment
Pursed Lip Breathing
Barrel Chest
Dyspnea on Exertion
Clubbing
Depression and Anxiety
Thin Appearance
Nursing Considerations
CO2 Retention
Low Concentration of O2
High Fowler's Position
High Calorie, High Protein Diet
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2 mins
Emphysema
Clinical Features
Pink Puffer
Exhale through Pursed Lips
Barrel Chest
Pathophysiology
Obstructive Lung Disease
Increased Lung Compliance
Types
Centriacinar
Panacinar
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2 mins
Asthma
Obstructive lung disease
Bronchial Hyperresponsiveness
History of Atopic Disease
Beta2 agonists
Corticosteroids
Curschmann's spirals
Hypertrophy of smooth muscle
Reversible
Charcot Leyden crystals
Methacholine challenge
Wheezing
Cough
Initially decreased PaCO2
Pulsus paradoxus
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2 mins
Persistent Mild Asthma
Diagnosis
Symptoms (Brochoconstriction) and Rescue Inhaler Use > 2 Days / Week
Nighttime Awakening 3-4 / Month
Greater or equal to 80 % of Predicted FEV1
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1 min
Persistent Moderate Asthma
Diagnosis
Symptoms (Bronchoconstriction) and Rescue Inhaler Use Daily
Nighttime Awakening > 1 / Week
60-80% Predicted FEV1
FEV1/FVC Decreased 5%
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2 mins
Persistent Severe Asthma
Diagnosis
Symptoms (Bronchoconstriction) and Rescue Inhaler Use: Multiple/ Day
With Minimal Activity
Nighttime Awakening: Nightly
< 60% Predicted FEV1
> 5% Decrease FEV1/FVC
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2 mins
Asthma Assessment
Assessment
Triggers (Cold air, Dander, Dust, Infection, Mold, Pollen, Smoke)
Shortness of Breath (SOB)
Tachypnea and Tachycardia
Wheezing
Diaphoresis
Accessory Muscles
Decreased Pulmonary Function Tests
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2 mins
Stages of Asthma Treatments
Mild Intermittent
Short-acting Inhaled Beta-Agonist
Mild Persistent
Low-Dose Inhaled Corticosteroid
Montelukast (Leukotriene Receptor Antagonist)
Moderate Persistent
Low to Medium-dose Inhaled Corticosteroid
Zileuton
Severe Persistent
High-Dose Inhaled Corticosteroid
Systemic Corticosteroids
Omalizumab (Allergies)
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2 mins
Asthma Implementation and Education
Medication
Oxygen
Corticosteroids
Ipratropium (Anticholinergic)
Albuterol
Implementation
Inhaler/nebulizer
Pulse Oximetry
Pursed Lip Breathing
Education
Carry Inhaler
Rinse Mouth after Inhaler
Identify Trigger (Cold Air, Dander, Dust, Infection, Mold, Pollen, Smoke)
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2 mins
Acute Respiratory Distress Syndrome (ARDS) Assessment
Cause
Damaged Alveolar-Capillary Membrane
Assessment
Restlessness
Dyspnea
Refractory Hypoxemia
Decreased PaO2
Diffuse Pulmonary Infiltrates
Atelectasis
Pulmonary Hypertension
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2 mins
Acute Respiratory Distress Syndrome (ARDS) Interventions
Interventions
Closely Monitor Patient
ABG's (Arterial Blood Gases)
Oxygen
Assess for O2 Toxicity
Mechanical Ventilation
PEEP
Assess for Pneumothorax
Permissive Hypercapnia
Considerations
High Mortality Rate
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2 mins
Spontaneous Pneumothorax
Mechanism
Accumulation of Air in Pleural Space
Tall and Thin Young Males
Bleb or Bulla Rupture
Underlying Disease
Signs and Symptoms
Hypoxemia
Chest Pain
Decreased Breath Sounds
Hyperresonance
Shortness of Breath (SOB)
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1 min
Adenocarcinoma of the Lung
Characteristics
Most Common Lung Cancer
Most Common in Nonsmokers
Peripheral Location
KRAS, EGFR, and ALK Mutations
Diagnosis
Glandular Pattern
Often Stains with Mucin
Clinical Features
Presents with Hemoptysis
Clubbing
Treatment
Surgical Resection
Chemotherapy and Radiation
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2 mins
A-a Gradient
Partial pressure of alveolar oxygen (PAO2)
Partial Pressure of Arterial O2 (PaO2)
Normal 10 to 15 mmHg
Hypoxemia with an Abnormal A-a Gradient
Diffusion problem
Shunting (Low V/Q)
Dead space (high V/Q)
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1 min
Venous Thromboembolism (DVT) Assessment
Mechanism
Venous Wall Inflammation caused by Thrombus
Assessment
Tenderness
Edema
Warmth
Asymmetry
Considerations
Could be Asymptomatic
Monitor for Pulmonary Embolism
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58 secs
Venous Thromboembolism (DVT) Interventions
Anticoagulants
Prevention Education
Frequent Ambulation
Leg Exercises
Compression Stockings or SCD's
Avoid Nicotine and Oral Contraceptives
Surgery
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1 min

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