What is asthma?
Asthma is a common inflammatory disease of the airways characterised by acute swelling, mucus plugging and bronchoconstriction. The symptoms of asthma are completely reversible, and patients with asthma are symptom free between attacks. It is caused by a combination of genetic and environmental factors.
What is pathophysiology of asthma?
Extrinsic asthma brought on by exposure to an antigen or allergen, and a reaction occurs when the antigen binds to sensitised mast cells on the surface of the bronchial mucosa. The release of mediators causes an inflammatory response; bronchospasm results from direct parasympathetic stimulation and mucosal oedema occurs due to increased vascular permeability and mucus secretion.
Intrinsic asthma occurs from exposure to triggers such as cold air, exercise, infectious agents, pollutants etc. and the pathophysiology differs depending on the trigger. For example, exercise induced asthma is thought to relate to the heat and water loss from the tracheobronchial tree due to the increased volume of air; inhaled irritants trigger bronchospasm by stimulating irritant receptors and vagal reflex
What is Bronchiolitis and patho?
Bronchiolitis is a viral infection of the lower airway, commonly caused by the respiratory syncytial virus (RSV), but can also be caused by the parainfluenza-3 virus, adenoviruses, and some mycoplasms (a type of bacteria). Inflammatory response to the presence of the virus in the airway, which can lead to obstruction of the bronchioles and necrosis of the cells lining the airways.
Most common in under 2’s. May present with viral symptom’s and low grade fever
What is COPD?
Term used which encompasses chronic inflammatory and destructive lung disease including chronic bronchitis, asthma and emphysema. Patients are not completely symptom free between attacks.
What is the pathophysiology of Chronic bronchitis?
Occurs as a result of inflammation of the bronchial passage from exposure to irritants causing the lungs to produce mucous. If constant exposure, the mucous producing cells over produce mucous. This causes thickening of the bronchial walls and narrowing of airway passage.
What is the pathophysiology of emphysema?
Loss of alveolar elasticity and abnormal enlargement of the airspaces distal to the bronchioles. Elastin and alveoli are broken down by elastase and proteases which is released from macrophages
What is pneumonia?
Acute infection of the lung parenchyma (gas exchange tissue). Pathogens evade host defences and this leads to alveoli filling with fluid, mucus and inflammatory cells.
Common pathogens for pneumonia include
Streptococcus pneumoniae - susceptible to penicillin
Haemophilus influenzae - susceptible to penicillin
Legionella
Mycoplasma
What is aspiration pneumonia?
Aspiration pneumonia is a lower RTI caused by microaspiration of non sterile gastric/oropharyngeal contents and can take days - weeks to evolve. Antibiotic coverage is needed for anaerobes as well as streptococci.
What is bronchiectasis?
Bronchiectasis is abnormal bronchial dilation characterized by chronic airway inflammation and impaired mucous clearance which leads to bacterial colonisation leading to repeated infection, inflammation and progressive airway destruction. Can be a result of pneumonia, TB, adenovirus, measles or pertussis.
What are common causes of legionella?
Legionella is responsible for a large proportion of severe cases of CAP. Can be caught from exposure to potting mix or contaminated/aerosolized water source (aircon, humidifiers etc)
Why dose hospital acquired pneumonia need to be treated in hospital?
Hospital acquired pneumonia has higher likelihood of being an antibiotic-resistant organism which will require microbiological identification and IV treatment.
- If have spent 2 days in past 90 days in ED consider HAP
What is croup?
Viral infection of upper airway. Most common in children aged 6 months - 2 years during winter and autumn. Causes inflammation of the upper respiratory tract which narrows the respiratory lumen. Due to children having small airways it can cause stridor. Normal presentation children with nonspecific respiratory symptoms which worsens into harsh barking cough in the evening/night predominantly.
What is the endothelium and subendothelium?
The endothelium is a thin, single-cell layer, lining the inner surface of all blood and lymphatic vessels, serving as the direct interface with blood. The subendothelial layer is a thin supportive layer of loose connective tissue, collagen, and sometimes smooth muscle located directly beneath the endothelium within the tunica intima. When damage to the sub-endothelium occurs haemostasis is activated.
What is the dermis
The dermis is the middle layer of the skin and contains a network of collagen and elastic fibres which are specialised proteins, (Minochi & Choi, 2019). There is also blood vessels, nerves, hair follicles and lymphatic vessels in the dermis (Micochi & Choi, 2019).
What is the epidermis
The epidermis is the outer layer of skin it is 20-30 times thinner than the dermis. Its thickness depends on th location, for example it is thickest on the p[alms and heels. The epidermis acts as a barrier to thermal and chemical exsposures and bacteria and viruses. It is composed of keratinocytes, Langerhans cells and melanocytes. Keratinocytes develop lower in the epidermis and migrate to the outer surface over approximately four weeks. The Langerhans cells are specialised immune cells, and the melanocytes are responsible for the pigment of skin and protection from UV light. There is no blood vessels in the epidermis, however there is nerve fibres.
What is the epidermis
The bottom layer of the skin is the subcutaneous layer, which consist of collagen fibres and adipocytes. The subcutaneous layer provides protection and has many blood vessels and nerves passing through it.
What effect does smoking have on wound healing?
Nicotine causes vasoconstriction, slowing down wound healing
Smoking is a significant factor in delayed healing.
List the nutritional deficiencies that can impair wound healing.
- Vitamin C
- Vitamin A
- Zinc
Both macronutrients and micronutrients are required for effective wound healing.
What is the impact of obesity on wound healing?
Subcutaneous tissue is hypovascular
This can lead to reduced blood flow and impaired healing.
How does Diabetes Mellitus affect wound healing?
-Causes excess production of pro-inflammatory cytokines
-Neuropathy masks pain
-Immune dysfuction, impaired neutrophil and macrophage function
This can lead to chronic inflammation and impaired healing.
What age-related changes contribute to delayed healing?
- Epidermal thinning
- Dermis atrophy
- Reduction in subcutaneous layer
The dermal-epidermal juction (rete ridges) are flattened which makes the skin susceptble to shearing forces resulting in skin tears.
These changes reduce skin strength and flexibility.
How does UV exposure affect skin aging and healing?
Contributes to loss of collagen and elastin
This reduces skin strength and flexibility.
How is the vasculature changed in aging in relation to the skin?
Thinning of blood vessels and and cappilaries, more prone to injury, slower to repair and reduced blood supply to extermities which slows down healing.
This impairs tissue perfusion and resilience.
What is the impact of declining sex hormone levels on wound healing?
Further impair collagen matrix production and re-epithelialisation. Ostrogen in women and testosteron in men.
Hormonal changes can significantly affect healing processes.
-
ECP medicines20
-
Community and remote assessment62
-
Skill sheets 1-641
-
Skill sheets 6-15115
-
Skill sheets 16-2252
-
Skill sheets 22-2846
-
Skill sheets 28-3472
-
Skill sheets 34-3935
-
Skill sheets 40-4863
-
Skill sheets 49-5641
-
Skill sheets 57-6464
-
skill sheets 65-7152
-
Skill sheets 72-77 wound closure58
-
Patient assessment49
-
Respiratory & Cardiac17
-
Abdominal complaints5
-
Pathophysiology Paramedic36
-
ECP Pathophysiology39
