Respiratory Therapy!
Just breathe!
Review of Respiratory
 We breathe by negative pressure. The diaphragm pulls down
and we pull air in through our nose and mouth.
 We breathe in O2 ( Oxygen) and exhale CO2 ( carbon
dioxide)
 COPD = Chronic obstructive pulmonary disease (COPD)
refers to a group of lung diseases that block airflow as you
exhale and make it increasingly difficult for you to breathe.
 Emphysema and chronic asthmatic bronchitis are the two
main conditions that make up COPD. In all cases, damage to
your airways eventually interferes with the exchange of
oxygen and carbon dioxide in your lungs.
Homeostasis
 Too much O2 ( hyperventilating) and CO2 levels will fall too
much resulting in dizziness, confusion and eventually you will
“pass out”.
* Emphysema
 Too little O2 (hypoxia) and CO2 levels will rise
(hypercapnea) and if not corrected you will fall asleep, coma
and eventually die. * Emphysema
 The body works to keep O2 and CO2 level.

Acidosis
 Too much CO2 in the body is called acidosis – Can be caused
by Respiratory problems or Metabolic problems :
( Kidney/Diabetes)
 Respiratory Acidosis comes from inadequate ventilations.
Head trauma, drug overdose, anesthesia,
neuromuscular diseases, spinal cord injury and
obesity ( pickwickian syndrome)
 The body will start breathing faster to correct this. If it can’t
correct the acidosis, the person requires a ventilator.
Alkalosis
 Too little CO2 in the body is called alkalosis – Can be both
Respiratory (Rare) or Metabolic.

(Diuretics, Vomiting, or Antacids)
 Respiratory alkalosis is caused mainly by anxiety resulting in
hyperventilation.
 Calming the person down will correct respiratory alkalosis,
 Sedation helps…….
Nasal Cannula
 Nasal Cannula
 0.5-5 liters per minute of oxygen
 Used for Chest pain, COPD, post operative support, mild
pneumonias ,etc
Venti Mask
 Venturi Mask (venti mask)
 24%-50% concentration of oxygen
 24% uses 2-4, 35% uses 6-8 liters of O2, 45% uses 10 -
12liters and 50% uses 12-15 liters of O2.
 Used for patients who require more than 5 liters of O2 or
breathe through the mouth more.
 Copd, Pulmonary Emboli, Pneumonia, etc

100% Non-Rebreather
 100% Non-Rebreather.
100% O2
 Used for Medical Emergencies, Severe Hypoxia
 Oxygen fills the bag and a one-way valve prevents any CO2
from being reinhaled,

Nebulizers
 Used for the treatment of Asthma, Bronchitis, Pneumonia,
post operatively and post intubation.
 Most contain steroids to reduce swelling in respiratory tracts
 Some contain medicine to help remove mucous.
 Can be used during codes to give meds if not other
alternative… not very effective.
Ambu Bag
 100% Oxygen
 Placed securely over nose and mouth
 Bulb is squeezed and air is forced into lungs.
 Used before and during intubation, codes and surgery.
CPAP Machine
 CPAP = Continuous Positive Air Pressure
 Used for sleep apnea, hypoxic patients and High CO2 levels
 Will be tried before intubation.
 Not tolerated by everybody….
 Person must be able to initiate
breath.
Intubation and Ventilation
 Used for Surgery, Cardiac and Respiratory arrest,
Respiratory failure due to pneumonia, drugs, cancer, end
stage COPD, head trauma and airway protection for alcohol
withdrawal, uncontrolled seizures and uncontrolled
psychotic events.
 Settings on the ventilator can range from breathing on your
own to full respiratory support.
 Settings are adjusted by Physician ( Emergency Room,
Anesthesiologist or Intensivist) according to ABG results and
body size
Intubation
 ET Tube (Endotracheal Tube ) is placed trough the mouth (or
nose –rarely) down the trachea, through the vocal cords to
above where the bronchus split ( 1inch above the Corina)
ET Tube
 The ET Tube is checked for placement all 3 ways :
1)CO2 detector 2) Listening to the lungs for breath sounds
3) Chest X-ray
 Tube must be secured at all times and pt is almost always
sedated.
Tracheostomy
 ET Tubes are only good for 7-14 days. If the pt requires
ventilation longer, a tracheostomy tube is placed.
 More comfortable, easier to breath and the person does not have
to be sedated.
Ventilator
 Uses Positive pressure to ventilate. Multiple settings are used



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to adjust the acid base balance.
Rate – the number of breaths per minute to machine will
give.
Tidal Volume – The volume of air with each respiration
Oxygen- How much O2 to deliver
PEEP – (Positive end expiratory pressure) How much O2 to
leave in the lungs during exhalation.
Ventilators
Positives and Negatives
 Positive : It saves lives
 Negative : Intubation trauma – teeth, vocal cords, erosion of
trachea ( bleeding), infection ( ventilator acquired
Pneumonia), restraints, bed sores, blood clots,
swelling,painful and lastly -its frightening!!!