What are the 3 things that keep the lungs dry and not in pulmonary oedema?
- Lymphatic drainage
- balance between pressures
- Capillary permeability
What is cardiogenic PO?
oedema due to the movement of excess fluid into the alveoli as a result of an alteration in one o more of starling’s forces. Its high pulmonary capillary pressures that responsible for abnormal fluid movement.
What is non-cardiogenic PO?
caused by various disorders not related to the heart.
what are two main causes for non-cardiogenic PO?
Injury to capillary endothelium
Blockage of lymphatic vessels
What is the pathophysiology for non-cardiogenic PO?
- injury to capillary endothelium
- increased capillary permeability and disruption of surfactant production by alveoili
- movement of fluid and plasma proteins from capilary to interstitial space and alveoli
- Pulmonary oedema
What are the causes of non cardiogenic APO?
- Smoke inhialation
- drowning
- negative pressure PO
- Acute respiratory distress syndrome
- Sepsis
- Disseminated intravascular coagulopathy
- High altitude
- neurogenic PO
- Opiod overdose
- PE
- Eclampsia
what are the 2 ways that smoke or toxic chemical interferes with alveolar?
- presence of gas other than air means a reduction in o2 available to capillary blood
- causes a shunt
- toxic gases likely to irritate lung causing inflammatory response
- results in fluid moving into alveoli
- more shunting
what does inhalation injury cause?
damage to endothelial cells
produces mucosal oedema of small airways
decreases alveolar surfactant activity
results in bronchospasm/airflow obstruction and atelectasis
what are some clues for smoke inhalation?
- burns to face singed eyebrows blistering inside mouth sooty sputum hoarseness, stridor, brassy cough SOB
what are signs and symptoms of inhalation injury?
cough sore throat SOB increased RR hoarseness or noisy breathing drooling headache red and irritated eyes acute mental status changes confusion, fainting, seizures, coma skin colour
what are some major consequences of smoke inhalation?
carbon monoxide poisoning
what is carbon monoxides affinity for haemoglobin?
200x more than oxygen
what should all patients with carbon monoxide poisoning recieve?
100% oxygen non-rebreather
evaluate for hyperbaric o2 therapy
What are signs and symtoms of cyanide poisoning?
- general weakness
- confusion
- bizarre behaviour
- excessive sleepiness
- coma
- sob
- headache
- diziness
- seizures
- may complain of palpitations
What are signs and symtoms of cyanide poisoning?
- general weakness
- confusion
- bizarre behaviour
- excessive sleepiness
- coma
- sob
- headache
- diziness
- seizures
- may complain of palpitations
- no signs of cyanosis
What should you do to manage a patient with cyanide poisoning?
- remove pt from source
- 100% o2 with BVM
- may need intubation
- if pt has resp distress of mental status changes need intubation
may need to suction mucus
IV fluids as required
pain mgmt as required
transport
Define drowning?
the process of experiencing respiratory impairment from submersion/immersion in liquid.
What are the three reflexes involved in drowning?
- Airway irritant reflexes - aspiration of water into mouth initially stimulates swallowing, followed by coughing, glottic closure and laryngospasm (if water goes beyond vocal fold it causes bronchospasm
- Cold shock - combination of cardio and resp reflexes due to sudden total-body immersion in cold water
- Diving reflex - cold water stimulation of face and eyes - produces bradycardia, peripheral vasoconstriction and apnoea
what percentage of drownings involve aspirating large amount of water?
90%
what drowning reflex is more common? cold shock or diving?
cold shock.
what is ARDS (acute respiratory distress syndrome)
severe inflammatory lung injury to the vascular endothelium and the alveolar epithelium.
What can cause ARDS?
direct or indirect injury to the lung.
What is an example of a direct injury to the lung causing ARDS?
pneumonia
aspiration of gastric contents
What is an example of indirect injury to the lung causing ARDS?
sepsis
shock
bacterial pneumonia
multiple trauma
