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Current time:0:00Total duration:7:19

Video transcript

prosperity stress is one of those things where if you had it nobody has to tell you that you're short of breath but I think it's important to recognize when somebody else is in respiratory distress so first let's just draw our generic patient let's call him Bob and let's give them some hair I feel like giving hair to my stick figures masks the fact that I can't draw okay so Bob here has respiratory distress let's draw the rest of his body and here we're going to talk about acute respiratory distress in other words it's it happened pretty recently in terms of days not like bob has had lung disease for years and years that would look like a different picture okay so if somebody has respiratory distress we're going to talk about the things that you can see to tell you and things you can hear those are I think the only two senses that are really important I don't think you can touch or taste respiratory distress so in terms of things you can see first of all you never really see a person lying down saying I'm short of breath the first thing that somebody would do if they're short of breath is to stand over to sit up that's why in the hospital somebody has the lung disease you rarely see them lying down all the way in bed now of course there are many different kinds of lung disease but the fact that they like to set up has a few common reasons first there's our muscle called the diaphragm in normal breathing this curved muscle moves down which expands the chest cavity and that's how air goes in through your mouth and your nose just by simple rule of gravity we have to move something down so it makes more sense to it it's easier to do that when sitting up just so you don't have to fight the push of gravity down on your chest where you're trying to move your diaphragm toward your feet now another reason if the reason that you are short of breath is because a fluid if we think of how fluid behaves then when is flat again gravity makes it distribute all over the place and the whole thing your whole lungs are bathed in the fluid but you set up the fluid kind of pulls to the bottom this frees up the top of the lungs here to breathe a little better so usually people like to sit up when they can't breathe now next you might notice that the rate of breathing might go up now in an adult our normal rate of breathing is 8 to 16 per minute and this is going to go up just because when you can't move breath as well people tend to compensate by breathing more along with that the panic of breathing faster and everything happens to trigger the sympathetic nervous system which is our fight-or-flight response this is what happens to your body when it's in an emergency and is trying to either run away or fight one thing that happens here which is kind of not related to our topic is that sympathetic nervous system allows your pupils to get bigger this allows more light in and then additionally your blood flows to your arms your legs and away from your intestines so you have to digest for the few minutes you're going to be fighting in our lungs though sympathetic nervous system can cause bronchial dilation which literally just means these Airways and our lungs as they branch off they get bigger and just a bigger diameter allows air to flow better I didn't mean to draw his trachea his windpipe so deviated here imagine that this is straight down and in the middle of the neck but in fact it actually if you have respiratory distress because of something like a pneumothorax when one long has collapsed then this trachea would deviate to one side or the other but we can't see that just by looking at the person without an x-ray or some other form of imaging today we're just talking about naked eye seeing someone okay so rate goes up and then the next thing there's a group of signs we call it increased work of breathing which is at the same time really specific work of breathing and also really vague what is that so work of breathing usually is pretty quiet the diaphragm moves down the chest expands as you're doing right now it doesn't take too much conscious effort but someone's short of breath other muscles get recruited like muscles in the neck muscles in the shoulders you might see them kind of tensing up their neck and shoulders trying to force that chest cavity bigger additionally we have these what's called retractions which just means these marks between there's muscles between our ribs our ribs going all the way up and the muscles between them can work so hard to compensate for respiratory distress you can see the markings if we take off our patient's shirt you might be able to see the traces of their ribs both because the muscles are working hard and the decreased pressure in the lungs because you can't breathe well sucks that tissue in so these tracks are called retractions and that's part of work of breathing now in an infant you might see something called nasal flaring where their nostrils get bigger if you try it right now you can sort of consciously increase the size of your nostrils and that just again lets more air in that's more seen in little babies another thing you might see is called cyanosis which just means this blue purplish discoloration now we think of blue blood as being lacking oxygen and it's are really blue but it's just a little darker and this in our body can show up kind of bluish and this actually tends to happen in municipal brains because there's less skin to cover that color so in the mouth I mean in the lips and in the eyes and sometimes in the extremities just because they're the furthest away from our heart so the hands and the feet sometimes might get blue now we're talking about acute distress here but if Bob goes on to have this for years and years a son you can see in chronic respiratory distress it's called clubbing so usually we have our hand is that one two three that's four fingers so usually you have your hand and the fingers kind of taper off at the fingertips that's the normal shape but in clubbing the tips of the fingers can get big and kind of sausage like instead of tapering it's called clubbing and this is chronic and the theory is that because these tips lack oxygen here and you're out they kind of go through this hypertrophy which means the more tissues grow to try to gather more oxygen that's why clubbing happens and this again is chronic so we're not going to see a today in Bob since he just developed this all right now moving on to things you can hear there are a lot of lung sounds that are associated with having lung disease but in terms of respiratory distress one thing that comes to mind is Strider now Strider is not it's usually above the chest cavity so the destruction is not so much down there but up here in the shoulder and neck level I don't know if I can make a convincing noise for Strider but it just sounds like when this person is taking the breath in there's that extra noise so it's like if you put a straw in your mouth and you try to inhale this is an inhalation noise next you might hear some grunting this is just because there are so many muscles between the abs or shoulders and neck trying to force air in and out and some of it goes across our vocal cords it just makes it grunt this is like in the movies in the martial arts when they're punching someone and just using so much muscle force that this grunt escapes now in general I think of grunting is kind of an exhaling noise and for example emphysema when air doesn't get out some patients use your abs to try to force it out and the grunting happens when they exhale now usually an adult should be able to say I can't breathe the - a respiratory distress but they'll definitely say I can't catch my breath but in the event that they can't tell you that or if it's a baby or a child it's important to keep these signs in mind the things you can see you can hear when somebody's in respiratory distress