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Post by fortunateson on Jan 30, 2015 19:28:40 GMT
Respiratory DiseaseThe normal adult takes approximately 10 to 14 breaths a minute. Bradypnea is an abnormal slowing of respiration; tachypnea is an abnormal increase. Apnea is the temporary cessation of breathing. Hyperpnea is an increased depth of breathing, usually associated with metabolic acidosis. It is also known as Kussmaul’s breathing.  [1] Chest Examination Inspect the Patient’s Facial Expression Is the patient in acute distress? Is there nasal flaring or pursed lip breathing? Nasal flaring is the outward motion of the nares during inhalation. This is seen in any condition that causes an increase in the work of breathing. Are there audible signs of breathing, such as stridor and wheezing? These are related to obstruction to airflow. Is cyanosis present? Inspect the Patient’s Posture Patients with airway obstructive disease tend to prefer a position in which they can support their arms and fix the muscles of the shoulder and neck to aid in respiration. A common technique used by patients with bronchial obstruction is to clasp the sides of the bed and use the latissimus dorsi muscle to help overcome the increased resistance to outflow during expiration. Patients with orthopnea remain seated or lie on several pillows.
Inspect the Neck Is the patient’s breathing aided by the action of the accessory muscles? Use of the accessory muscles is one of the earliest signs of airway obstruction. The accessory muscles assist in ventilation; they raise the clavicle and anterior chest to increase the lung volume and produce an increased negative intrathoracic pressure. Is the patient’s breathing aided by the action of the accessory muscles? Palpate for Tenderness
With your fingers, firmly palpate any chest areas where tenderness is experienced by the patient. A complaint of “chest pain” may be related only to local musculoskeletal disease and not to disease of the heart or lungs. Be meticulous in assessing for areas of tenderness. Percussion  Percussion refers to tapping on a surface to determine the underlying structure. It is similar to a radar or echo detection system. Tapping on the chest wall creates vibrations that are transmitted to the underlying tissue, reflected back, and picked up by the examiner’s tactile and auditory senses. Percussion over a solid organ, such as the liver, produces a dull, low-amplitude, short-duration note without resonance. Percussion over a structure containing air within a tissue, such as the lung, produces a resonant, higher amplitude, lower pitched note. Percussion over a hollow air-containing structure, such as the stomach, produces a tympanic, high-pitched, hollow-quality note. Percussion over a large muscle mass, such as the thigh, produces a flat, high-pitched note. Normally, in the chest, dullness over the heart and resonance over the lung fields are heard and felt. As the lungs fill with fluid and become denser, as in pneumonia, resonance is replaced by dullness. [2] Chest Examinationwww.youtube.com/watch?v=4EKL9D1pS2g[1] studentnurses3.blogspot.com/p/medical-surgical-nursing-mnemonics.html[2] Complete Handbook of Nature Cure, Shri H. K. Bakhru
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Post by fortunateson on Jan 30, 2015 20:34:38 GMT
Lung AuscultationLung sounds, also called respiratory sounds or breath sounds, can be auscultated across the anterior and posterior chest walls with a stethoscope. Adventitious lung sounds are referenced as crackles (rales), wheezes (rhonchi), stridor and pleural rubs as well as voiced sounds that include egophony, bronchophony and whispered pectoriloquy.  [1] Types of Breath SoundsBreath sounds are heard over most of the lung fields. They consist of an inspiratory phase followed by an expiratory phase. There are four types of normal breath sounds: • Tracheal • Bronchial • Bronchovesicular • Vesicular Tracheal breath sounds are harsh, loud, high-pitched sounds heard over the extrathoracic portion of the trachea. The inspiratory and expiratory components are approximately equal in length. Although these sounds are always heard when the examiner listens over the trachea, they are rarely evaluated because they do not represent any clinical lung problems. Bronchial breath sounds are loud and high-pitched and sound like air rushing through a tube. The expiratory component is louder and longer than the inspiratory component. These sounds are normally heard when the examiner listens over the manubrium. A definite pause is heard between the two phases. Bronchovesicular breath sounds are a mixture of bronchial and vesicular sounds. The inspiratory and expiratory components are equal in length. They are normally heard only in the first and second interspaces anteriorly and between the scapulae posteriorly. This is the area overlying the carina and mainstem bronchi. Vesicular breath sounds are the soft, low-pitched sounds heard over most of the lung fields. The inspiratory component is much longer than the expiratory component, which is also much softer and frequently inaudible.  [1] In addition to the normal breath sounds discussed, other lung sounds may be produced in abnormal clinical states. These abnormal sounds heard during auscultation are called adventitious sounds. Adventitious sounds include the following: • Crackles • Wheezes • Rhonchi • Pleural rubs Crackles are short, discontinuous, nonmusical sounds heard mostly during inspiration. Also known as rales or crepitation, crackles are caused by the opening of collapsed distal airways and alveoli. A sudden equalization of pressure seems to result in a crackle. Coarser crackles are related to larger airways. Crackles are likened to the sound made by rubbing hair next to the ear or the sound made when hook-and-loop patches are pulled apart. They may be described as early or late, depending on when they are heard during inspiration. The timing of common inspiratory crackles is summarized in Table 10-6. The most common causes of crackles are pulmonary edema, congestive heart failure, and pulmonary fibrosis. Wheezes are continuous, musical, high-pitched sounds heard mostly during expiration. They are produced by airflow through narrowed bronchi. This narrowing may be caused by swelling, secretions, spasm, tumor, or foreign body. Wheezes are commonly associated with the bronchospasm of asthma. Rhonchi are lower pitched, more sonorous lung sounds. They are believed to be more common with transient mucous plugging and poor movement of airway secretions. A pleural rub is a grating sound produced by motion of the pleura, which is impeded by frictional resistance. It is best heard at the end of inspiration and at the beginning of expiration. The sound of a pleural rub is like the sound of creaking leather. Pleural rubs are heard when pleural surfaces are roughened or thickened by inflammatory or neoplastic cells or by fibrin deposits.  [1] [1] Complete Handbook of Nature Cure, Shri H. K. Bakhru
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Post by fortunateson on Jan 30, 2015 21:01:23 GMT
AuscultationNormal Breath Sounds
Vesicular breath sounds are soft and low pitched with a rustling quality during inspiration and are even softer during expiration. These are the most commonly auscultated breath sounds, normally heard over the most of the lung surface. They have an inspiration/expiratory ratio of 3 to 1.  www.easyauscultation.com/cases?coursecaseorder=1&courseid=201Fine crackles are brief, discontinuous, popping lung sounds that are high-pitched. Fine crackles are also similar to the sound of wood burning in a fireplace, or hook and loop fasteners being pulled apart or cellophane being crumpled. Crackles, previously termed rales, can be heard in both phases of respiration. Early inspiratory and expiratory crackles are the hallmark of chronic bronchitis. Late inspiratory crackles may mean pneumonia, CHF, or atelectasis.  www.easyauscultation.com/cases?coursecaseorder=2&courseid=201Wheezes are adventitious lung sounds that are continuous with a musical quality. Wheezes can be high or low pitched. High pitched wheezes may have an auscultation sound similar to squeaking. Lower pitched wheezes have a snoring or moaning quality. The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of airway obstruction. Wheezes are caused by narrowing of the airways.  www.easyauscultation.com/cases?coursecaseorder=4&courseid=201
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Post by fortunateson on Jan 30, 2015 21:14:53 GMT
AuscultationBronchial
Bronchial breath sounds are hollow, tubular sounds that are lower pitched. They can be auscultated over the trachea where they are considered normal. There is a distinct pause in the sound between inspiration and expiration. I:E ratio is 1:3 .  www.easyauscultation.com/cases?coursecaseorder=6&courseid=201Pleural RubsPleural rubs are discontinuous or continuous, creaking or grating sounds. The sound has been described as similar to walking on fresh snow or a leather-on-leather type of sound. Coughing will not alter the sound. They are produced because two inflamed surfaces are sliding by one another, such as in pleurisy. During auscultation, pleural rubs can usually be localized to a particular place on the chest wall. They also come and go. Because these sounds occur whenever the patient's chest wall moves, they appear on inspiration and expiration. Pleural rubs stop when the patient holds her breath. If the rubbing sound continues while the patient holds a breath, it may be a pericardial friction rub.  www.easyauscultation.com/cases-waveform?coursecaseorder=7&courseid=201Bronchophony – AbnormalAsk the patient to say "99" several times while auscultating the chest walls. Over consolidated areas "99" is understandable. This is because acoustic filtering is reduced in consolidated lung tissue, which allows better sound transmission. Compare this breath sound to the recording in the "Bronchophony - Healthy" lesson.  www.easyauscultation.com/cases-waveform?coursecaseorder=3&courseid=202
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Post by fortunateson on Mar 8, 2015 18:21:21 GMT
Pneumonia
Pneumonia (nu-mo'ne-a) is an inflammatory condition of the lung affecting primarily the microscopic air sacs known as alveoli. It is usually caused by infection with viruses or bacteria and less commonly other microorganisms, certain drugs and other conditions such as autoimmune diseases. [1] [2]  Physical exam Physical examination may sometimes reveal low blood pressure, high heart rate, or low oxygen saturation. The respiratory rate may be faster than normal, and this may occur a day or two before other signs. Examination of the chest may be normal, but it may show decreased chest expansion on the affected side. Harsh breath sounds from the larger airways that are transmitted through the inflamed lung are termed bronchial breathing and are heard on auscultation with a stethoscope. Crackles (rales) may be heard over the affected area during inspiration. Percussion may be dulled over the affected lung, and increased, rather than decreased, vocal resonance distinguishes pneumonia from a pleural effusion. [1]  [1] Treatment [3] 
Must read: How To Survive In A World Without Antibioticswww.tachyon-aanbieding.eu/Documentation/NewAntibiotics.pdf[1] en.wikipedia.org/wiki/Pneumonia[2] The Netter Collection of Medical Illustrations: Respiratory System , Second Edition, David A. Kaminsky, MD [3] www.top10homeremedies.com/home-remedies/home-remedies-pneumonia.html
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Post by fortunateson on Mar 8, 2015 18:56:53 GMT
Pneumonia Treatment - ContinuedSteam InhalationSteam helps fight infection and improves breathing by relieving coughing and congestion. Boil water in a pot and add a few drops of essential oils such as eucalyptus, lavender, tea tree, lemon, or camphor oil. Inhale the steam from this solution. While inhaling, cover your head with a towel so that the steam does not escape. Taking a hot shower is also beneficial. [1]  Postural DrainagePostural drainage, also called gravitational drainage,is the preferred and best-tolerated means for clearing the bronchial tree. Other techniques, such as suctioning or bronchial washing, cause considerable discomfort, often requiring local anesthetic and specialized para-medical personnel. Postural drainage can be practiced effectively in the patient’s home with the assistance of a family member. Indeed, the fact that the patient is able to participate actively in his or her own therapy, rather than being merely a passive recipient, is also of value. Adequate hydration is also important in facilitating drainage. Drainage is then accomplished by means of the following manual or electrically operated maneuvers to dislodge and help propel the trapped secretions toward the trachea: (1) percussion with rapid vibration tap, (2) tapping with cupped hands, and (3) high-frequency ultrasonography. These techniques are applied where drainage is most necessary, over either the anterior or the posterior chest wall, and are repeated during the time each position or posture is held by the patient. Proper positioning of the patient, which is paramount, is done according to the distribution and configuration of the bronchopulmonary segments. To achieve maximal drainage of the apical segments of the upper lobe, for example, a slightly reclining upright position is the most effective. For drainage of the trachea and major bronchi, the right-angled head-down position should be assumed. The head-down (Trendelenburg) position should be used in draining the middle and lower pulmonary lobes. Most patients tolerate these positions well, the exception being that the debilitated patient may initially experience diffi culty in a achieving the right-angled head-down position. In such cases, this position should be attained very gradually and only to the degree of the individual’s tolerance. Postural drainage should be practiced at least twice a day. Each position should be held for 3 to 5 minutes. If at all possible, a family member should accompany the patient during the initial training for optimal prepa-ration for assisting in home treatment. The more recently developed high-frequency chest oscillation vest applies high-frequency vibrations throughout the chest wall. Patients typically wear the vest for 20 minutes twice a day. Vibrations can also be applied to the airways by breathing out through a small, handheld device that causes airway fl utter. This may also facilitate removal of secretions. Autogenic drainage is another technique whereby patients breathe and “huff” cough at progressively larger lung volumes to facilitate movement of secretions from the smaller to the larger airways, where they can be more easily expectorated. [2]  [1] www.top10homeremedies.com/home-remedies/home-remedies-pneumonia.html[2] The Netter Collection of Medical Illustrations: Respiratory System , Second Edition, David A. Kaminsky, MD
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Post by fortunateson on Mar 13, 2015 15:00:20 GMT
Airway Management
Heimlich ManeuverThe Heimlich maneuver is a technique whereby sub-diaphragmatic compression creates an expulsive force from the lungs that is able to eject an obstructing object from the airway. Notably, chest thrusts and back slaps should not be used, as was once advocated. Chest thrusts produce less expelling force than the Heimlich maneuver, and back slaps may actually force an obstructing object deeper into the lungs. The Heimlich maneuver can also be performed in an adult victim who collapses to the floor supine. The rescuer simply kneels astride or straddles the victim and provides the maneuver via sharp inward and upward thrusts of the heel of the hand, maintaining a midline position. Adults may also apply the maneuver to themselves, either with their own fist, or by thrusting themselves over the edge of a chair, table, or other object to duplicate a rescuer’s effort. In children, the rescuer applies the same technique using the index and middle fingers of one or both hands, depending on the child’s size, either with the child supine, or held upright in the rescuer’s lap. [1]   Conscious Adult Chokingwww.youtube.com/watch?v=DE45ks9miIwConscious Infant Chokingwww.youtube.com/watch?v=axqIju9CLKAUnconscious Child Chokingwww.youtube.com/watch?v=aoLzcnvQpQA[1] The Netter Collection of Medical Illustrations: Respiratory System , Second Edition, David A. Kaminsky, MD
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Post by fortunateson on Mar 13, 2015 15:08:51 GMT
Airway Management - Continued
Emergency Airway ManagementMaintenance of a patent airway is a primary supportive and resuscitative maneuver, and every physician should be able to insert an oropharyngeal or nasopharyngeal airway, pass an endotracheal tube, and perform an emergency tracheotomy or cricothyrotomy. Loss of consciousness is associated with relaxation of the pharyngeal musculature, causing the tongue to fall back and occlude the oropharynx. Simple repositioning with the neck extended and the mandible brought forward helps open the airway. If this fails, an oropharyngeal or nasopharyngeal airway can be used to reestablish the airway and allow for appropriate resuscitation measures to continue. [1]  How to insert a nasal and oral airway adjunctwww.youtube.com/watch?v=37tgYjiBqdI Skills - Bag Valve Mask Ventilation www.youtube.com/watch?v=O3vR8DQW1U0 Cricothyrotomy carries the risk of permanent damage to the larynx and should be performed only in extreme emergencies when all other methods of providing an artifi cial airway have been exhausted. Serious bleeding may occur, and life-threatening subcutaneous emphysema has been reported. There is also the potential for adverse long-term sequelae, such as subglottic stenosis. Several temporizing measures have been described in an attempt to provide additional time to secure the airway without having to resort to emergent tracheotomy or cricothyrotomy. One example is “needle cricothyrotomy,” in which a large-bore angiocatheter Skin and criocothyroid membrane incised with care not to injure the larynx or perforate the esophagus. Patency is then maintained by inserting the tube or, if not available, a distending object needle is used to cannulate the airway and deliver supplemental oxygen to the lungs. This technique carries the risk of inadvertently introducing air into the subcutaneous tissues of the neck, further complicating an already difficult situation. Ultimately, the potential morbidity and complications associated with emergent tracheotomy or cricothyrotomy are preferable to the anoxic brain injury or death that will occur if the airway is not secured. [1] www.youtube.com/watch?v=p-Yl2_epWO0www.youtube.com/watch?v=C0GE3Dn_5A8[1] The Netter Collection of Medical Illustrations: Respiratory System , Second Edition, David A. Kaminsky, MD
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Post by fortunateson on Mar 16, 2015 22:22:00 GMT
AsthmaAsthma is a clinical syndrome characterized by variable airflow obstruction, increased responsiveness of the airway to constriction induced by nonspecific inhaled stimuli (airway hyperresponsiveness), and cellular inflammation. Asthmatic symptoms are characteristically episodic and consist of dyspnea, wheezing, cough, and chest tightness caused by airflow obstruction because of airway smooth muscle constriction, airway wall edema, airway inflammation, and hypersecretion by mucous glands. A major feature of the airflow obstruction of asthma is that it is partially or fully reversible either spontaneously or as a result of treatment.In severe asthma exacerbations, the patient prefers to sit upright; visible nasal alar flaring and use of the accessory respiratory muscles reflect the increased work of breathing. Anxiety and apprehension generally relate to the intensity of the exacerbation. Tachypnea may be the result of fear, airway obstruction, or changes in blood and tissue gas tensions or pH. Chest examination reveals a hyperresonant percussion note, a low-lying diaphragm, and other evidence of hyperinflation. When airflow is severely reduced, the chest may become paradoxically silent. This ominous finding may be inadvertently induced or worsened by administration of hypnotics, tranquilizers, or sedatives, which depress respiration. At the point where airflow is so decreased that the chest becomes silent, cough becomes ineffective, and ventilatory failure supervenes. This requires immediate and intensive therapy. Asthma treatment guidelines have been remarkably consistent in identifying the goals and objectives of asthma treatment. These are to (1) minimize or eliminate asthma symptoms, (2) achieve the best possible lung function, (3) prevent asthma exacerbations, (4) do the above with the fewest possible medications, (5) minimize short- and long-term adverse effects, and (6) educate the patient about the disease and the goals of management.  I. The primary therapies for severe asthma exacerbations include repetitive administration of rapid-acting inhaled β 2 -agonists (bronchodilator), 2 to 4 puffs every 20 minutes for the first hour.  II. Oxygen should be administered by nasal cannula or by mask and should be titrated against pulse oximetry to maintain a satisfactory oxygen saturation of 90% or above (≥95% in children). III. Systemic glucocorticosteroids ( anti-inflammatory) speed resolution of exacerbations and should be used in all but the mildest exacerbations, especially if the initial rapid-acting inhaled β 2 -agonist therapy fails to achieve lasting improvement. [1]  [1] The Netter Collection of Medical Illustrations: Respiratory System , Second Edition, David A. Kaminsky, MD I. BronchodilatorsBronchodilators are the first line therapy during acute asthmatic exacerbations to reverse airway obstruction primarily by relaxing airway smooth muscle. In the past most clinicians managed asthma mainly according to the patient’s symptom. Asthma was regarded primarily as a problem of bronchospasm and measures to prevent or reverse bronchospasm comprised the mainstay of therapy. However, during early 1980s when asthma emerged as an inflammatory rather than primarily a bronchospastic disorder, the basic approach switched from control of symptoms to control of underlying airway inflammation (Barns 1989). [2] [2] www.hindawi.com/journals/ja/2012/321949/#B2A bronchodilator is an herb that causes the bronchial tubes in the lung to dilate thus easing the passage of air through the lungs. Two ways this can be accomplished are with adrenergic agents and antispasmodics. Adrenergic agents stimulate nerve receptors on the bronchioles causing them to relax. Antispasmodics can prevent or ease spasms or cramps in the muscles controlling the bronchioles, thus increasing the size of the opening. Because many of the antispasmodics are also nervines, they may also ease tension throughout the body. Adrenergic agents Green tea (Camellia sinensis) Coffee (Coffea sp.) Horehound Ephedra/Ma huang (Ephedra sinica) Ginkgo biloba Antispasmodics Angelica root (Angelica archangelica) Anise (Pimpinella anisum) Black cohosh (Cimicifuga racemosa) Elecampane Garlic (Allium sativum) Grindelia Red clover (Trifolium pratense) Skunk cabbage [3] [3] www.greenearthherbs.com/xcart/pages.php?pageid=18
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Post by fortunateson on Mar 16, 2015 22:34:50 GMT
Asthma - ContinuedII. Oxygen TherapyPulse oximetry is a convenient and noninvasive method for monitoring oxyhemoglobin saturation; however, its limitations must be appreciated. Care must be given to supplying enough oxygen to achieve adequate oxygenation (SaO 2 >90%) without causing too much CO 2 retention, which may occur during acute exacerbations in patients with severe COPD. The nasal cannula (nasal prongs) is perhaps the most common mode of oxygen delivery and can provide 30% to 50% oxygen with flow rates of 6 to 8 L/min; higher flow rates may cause nasal irritation. [1]  [1] The Netter Collection of Medical Illustrations: Respiratory System , Second Edition, David A. Kaminsky, MD   III. Anti-inflammatory drugsAs the name implies, these herbs help to reduce inflammation of mucosal tissues that line the sinuses, nasal passages, throat and lungs. Eyebright (Euphrasia officinalis): an excellent remedy for the mucous membranes. The combination of anti-inflammatory and astringent properties make it useful in many conditions of the respiratory tract. The usual dosage is 1 tsp herb per cup of boiling water 3 times daily. Tincture: 1-4 ml 3 times daily. Licorice Eucalyptus (Eucalyptus globulis) Hyssop Lemon balm Sage (Salvia officinalis) Goldenseal Anti-catarrhal
Catarrh is an excessive mucous secretion from the respiratory mucosa such as in hayfever and sinusitis. An anti-catarrhal helps the body to remove excess catarrhal build-ups. They are used mainly for ear, nose and throat infections, but have a role to play in asthma and bronchitis as well. Elderflowers (Sambucus nigra) Goldenrod (Solidago virgauria) Goldenseal (Hydrastis canadensis) Hyssop Ephedra [3] [3] www.greenearthherbs.com/xcart/pages.php?pageid=18Lobelia (Lobelia inflata), also called Indian tobacco, has a long history of use as an herbal remedy for respiratory conditions such as asthma, bronchitis, pneumonia, and cough. Historically, Native Americans smoked lobelia as a treatment for asthma. In the 19th century, American physicians prescribed lobelia to induce vomiting in order remove toxins from the body. Because of this, it earned the name "puke weed." Today, lobelia is sometimes suggested to help clear mucus from the respiratory tract, including the throat, lungs, and bronchial tubes. Although few studies have evaluated the safety and effectiveness of lobelia, some herbalists today use lobelia as part of a comprehensive treatment plan for asthma. [4] [4] umm.edu/health/medical/altmed
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Post by fortunateson on Mar 16, 2015 22:42:24 GMT
Asthma - Continued
Common Herbal ProductsClearLungs Liquid is an improvement on an all natural Chinese herbal remedy that really works. It is a perfectly balanced formula containing a rich array of Chinese herbal ingredients plus homeopathic extracts that provides temporary relief of bronchial congestion, and is highly effective for any kind of breathing problem. Supplement Facts Serving Size: 2 Capsules Servings Per Container: 60 ClearLungs Herbal Blend: 1000 mg* Dong Quai Root Poria Sclerotium Ophiopogon Root Stemona Root Chinese Asparagus Root Tangerine Mature Peel Zhejiang Fritillary Bulb Gardenia Fruit White Mulberry Root Bark Platycodon Root Chinese Skullcap Root Schisandra Fruit Chinese Licorice Root  Dr. Christopher's common sense approach to natural health is based on three vital processes, cleanse, nourish and heal.  SINUS RELIEF through the ESSENTIAL OILS Contained in Inhale Respiratory Blend - Can Be Used as a Home Remedy to help relieve symptoms of Cold, Flu, Asthma, Allergies, Pneumonia and More. Ingredients include Eucalyptus, Peppermint, Lavender, Rosemary, Cedarwood and Clary Sage. BREATHE DEEPLY AND EASILY - The essential oils used in Ovvio Oils Inhale Respiratory Blend have been specially formulated to help cool, dilate, and sooth the respiratory system and make it much easier to breathe! Oils include peppermint, Eucalyptus Radiata, Rosemary, Cedarwood, and Lavender oil.  Amazon.com
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Post by fortunateson on Mar 23, 2015 18:36:12 GMT
Open Chest WoundPneumothorax is a collection of air within the pleural space; after trauma, pneumothorax is most commonly caused by a rib fracture tearing the visceral pleura of the lung, allowing air to escape during inspiration. Penetrating injuries (e.g., stab wounds, gunshot wounds) also frequently produce a pneumothorax via this mechanism. In these cases of penetrating trauma, 80% of patients will also have blood in the pleural space. If air continues to flow into the pleural space, the lung collapses entirely and can no longer serve to exchange oxygen (O 2 ) and carbon dioxide (CO 2 ). A one-way valve typically occurs on the lung surface, and air is forced into the pleural space with each breath, which progressively increases the intrapleural pressure and may result in escape of air into the subcutaneous tissues, manifesting as diffuse upper torsoswelling and palpable crepitus. Patients with a tension pneumothorax become dyspneic or hypoxic if ventilated mechanically, with cyanosis and distended neck veins. Hyperresonance and lack of breath sounds on the involved side of the thorax cement the diagnosis without the need for radiographic confirmation. Tension pneumothorax is a life-threatening emergency, and the air must be urgently released from the pleural cavity. If it is clinically suspected in a patient who is unstable, immediate treatment is indicated without any further diagnostic tests. In an intubated patient in the prehospital setting, air can be vented with a large-bore needle via the anterior second intercostal space in the midclavicular line. Subsequent defi nitive treatment with tube thoracostomy should follow. In the hospital, a tube thoracostomy is usually done via the fifth intercostal space at the anterior axillary line. Under these dire circumstances, the tube should be placed expeditiously using primarily a scalpel and scissors. After a limited chest wall preparation and local anesthesia, a 2-cm incision should be made into the intercostal space and the chest entered directly using heavy scissors. The tube should then be directed into the posterior sulcus to optimize subsequent drainage of blood or other pleural fluid. Prehospital management of an open pneumothorax is a partially occlusive dressing in which one corner of the bandage is free to permit escape of pleural air under pressure. [1]  [1] The Netter Collection of Medical Illustrations: Respiratory System , Second Edition, David A. Kaminsky, MD
Chest Wound Video (Training)www.youtube.com/watch?v=SWqZeqrWslQ
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