Basic respiratory therapy lexicon

Here are some basic terms used by respiratory therapists.

• Ventilation: Moving air in and out of the lungs. Measured by respiratory rate, tidal volume, chest movement, breath sounds, Measurement of Carbon Dioxide (PaCO2), etc. This is your first priority in an emergency (establish and open the airway)
• Oxygenation: Getting oxygen from the air, to the lungs, and then to the bloodstream. Measured by Heart rate, color, sensorium, Oxygen (PaO2 and SpO2), color (cyanosis, gray or normal), sensorium, etc. This is your second priority in an emergency (increase FiO2). This is also the most common problem.
• Circulation: Moving the blood through the body. Measured by pulse and heart rate and strength, cardiac output (blood pressure). This is your third priority in an emergency (chest compressions, defibrillate, heart drugs, etc.)
• Perfusion: Getting blood and oxygen to the tissues. Measured by blood pressure (cardiac output), sensorium, temperature, urine output, hemodynamics. This is your fourth priority in an emergency, raise the blood pressure.
• Signs: Objective information, those things that you can see or measure. Examples include color, pulse, edema, blood pressure, pulse ox, etc.
• Symptoms: Subjective information, those things that the patient must tell you. Examples include dy spnea, pain, nausea, muscle weakness, etc.
• Objective:  Judgement not based on personal feeling; opinions based on fact; what you find upon assessment; examples include blood pressure, pulse oximetry, lung sounds, temperature, level of consciousness, etc. 
• Subjective:  Judgement or opinion based on personal feelings.  Examples include pain level, level of dyspnea, anxiety, etc. 
• Smoking history: How many years and how many packs per day. Measured by # of packs per day times years smoked.
• Advanced directives: Set of instructions documenting what treatment a patient would want if he was unable to make medical decisions on his own. Does the patient want to be a full code, or does he want all measures to be taken to restart his heart if it stops beating. Does he want to be placed on a ventilator. These are questions that should be answered.
• Do not Resuscitate (DNR): This is an order from a patient requesting that no efforts be made to restart the heart if it should so happen to stop, and no efforts should be made to intubate the patient (No Mechanical Ventilation) should he stop breathing. Otherwise, the patient should be treated, but no invasive procedures should take place.
• Arterial Blood Gas: A sampling of arterial blood drawn from the radial, brachial or femerol arteries to determine PAO2, PCO2, HCO3 and accurate SaO2, and pH. Used to monitor respiratory status and metabolic status.
• Venous Blood Gas: In a patient who is not showing signs of respiratory distress, recent research shows this should be just as useful as an ABG (unless your goal is to monitor oxygenation status). Venous pH and HCO3 are basically similar, and PO2 is expected to be a normal of 75, so if it is low, you can be assured PO2 is low. Actually, VBG is just as useful as ABG so long as you can momitor oxygen status with a pulse oximeter (SpO2).
• Capilary Blood Gas: Used to determine pH, HCO3 and pH values in a newborn, especially when no cord blood access is available, or if it's difficult to get an ABG. With the exception of oxygen status, the values are similar as an ABG and just as useful. CBGs are now coming back into play, as for a while they were not being ordered much.
• Pulmonary Function Test: A test that measures lung function. It measure how much air you exhale, and how fast this air flows.  It's a very useful tool to help physicians diagnose various lung diseases.
• Urine output: This is the measure of the normal output of a person per day. Normal is 40 ml/hour or 1 liter per day. When input is greater than output, this results in weight gain, electrolyte imbalance, increased hemodynamic pressures, decreased lung compliance, etc. (see central venous pressure below)
• Sensible water loss: Water lost by urine, vomiting.
• Insensible water loss: Water lost by lungs and skin
• Hypervolemia: Too much fluid in the body.
• Hypovolemia: Too little fluid in the body, dehydration, also indicated by a high hematocrit.
• Level of Consciousness: Normal is awake, alert and orientated (AAOx). Abnormal is lethargic, somnolent, stuporiouis, confused, obtunded, coma.
• Lethargic: Very sleepy, somnolent. May be too many sedatives or possible CO2 toxicity (although rare).
• Confused: Stuporious; change in mental status; responds inappropriately from patients normal; also consider drug overdose, too many sedatives (valium, morphine, psychotropic drugs, etc.)
• Obtunded: This is a drowsy state where the patient is so tired he can barely plop his eyes open. At this point you should consider high CO2, decreased gag reflux and decreased cough. May consider drug toxicity, respiratory failure, sepsis, etc. You'll have to problem shoot.
• Coma: Patient does not respond even to painful stimuli. This may be an end stage disease condition, or it may be drug induced, or it may be a sign of drug toxicity, etc. You'll have to problem shoot. May also be normal in a ventilated patient to allow their lungs and system to relax while the body heals.
• Orthopnea: Shortness of breath when lying down, have to be sitting up to breath. Common with congested heart failure
• Malaise: Geneeral feeling of nausea or pain; flu-like symptoms, headache, tired, weakness, fatigue.
• Dyspnea: A feeling that you can't catch your breath. It's a subjective measure.   It's the medical description of shortness of breath (see #73). Shortness of breath, or breathing discomfort, or uneasy breathing feelings. You may feel dyspnea after a long sprint, and this is normal and it resolves itself. More severe is dyspnea at rest. Dyspnea while slowly walking is less severe than dyspnea while walking fast. Chronic end stage lung patients may feel dyspnea doing normal tasks like shaving, preparing food, etc.
• Clubbing of fingers: This is caused by any disease that caused chronic hypoxia, such as lung cancer of cystic fibrosis. The anlge of the nails is increased, almost smooth looking.
• Venous distention: A popping out of the veins, especially in the neck. Common in patients with end stage lung disease due to high pressure needed to pump blood through lungs and body
• Edema: This is excess fluid somewhere in the body, causing swelling, such as in the ankles. It's common with heart failure, or kidney failure.
• Ascites: Accumulation of fluid in the abdomen; liver failure
• Diaphoresis: Sweating. May be sign of heart failure (CHF), fever, infection, anxiety, nervousness, etc.
• Jaundice: Yellow skin; liver failure; increased biliruben (new born infants). If newborn, patient may be placed under radiant light and the problem will resolve itself.
• Barrel Chest: Increased a/p diameter of chest, and a result of air trapping. This may be a short term condition (asthma) or chronic (end stage emphysema, COPD)
• Nasal flaring: A flaring out of the nostrils during inspiration. This is usually a signs of respiratory distress in newborn babies and infants
• Retractions: This is a sucking in of the chest during inspiration, and is a sign of respiratory distress in neonates. The higher up in the chest the retractions are the more severe the respiratory distress.
• Grunting: A grunting on expiration, and is usually a common sign of respiratory distress in neonates. It's the patients natural attempt to keep the alveoli open and get more oxygen.
• Tracheal deviation: This is when the trachea is moved either to the left or right. The trachea is usually pushed away from pathologies such as pleural effusions, tension pneumothorax, neck or thyroid tumors, large mediastinal masses. ( or things that take up space in the lungs). It moves toward pulmonary atelectasis, pulmonary fibrosis, pneumonectomy and diagphragmatic paralysis (or things that make more room in the lungs).
• Crepitis: A crunchy feeling felt by the hand over the chest wall, neck, and around a chest tube. It's usually air that creeps and bubbles under the skin. Subcutaneous emphysema.
• Vesicular: Normal lung sounds
• Bronchial: Normal lung sounds heard over the upper airway (trachea and bronchi).
• Adventitious: Abnormal lung sounds (wheezing, rhonchi, rhales, crackles, etc.)
• Coarse lung sounds: Rhonchi (see rhonchi below)
• Wheezes: High pitched sound heard on inspiration and or expiration, and is usually indicitive of bronchospasm. Don't get upper airway wheezes confused for bronchospasm, because all that wheezes is not necessarily bronchospasm. Usually, if it's audible, it's not a wheeze technically speaking.
• Crackles:  The sound of fluid in the lungs or the alveoli popping open with inspiration.  There are two types:  1) Coarse crackles (a.k.a. rhales) are heard on inspiration and expiration and represent fluid in the lungs, 2) Fine crackles are heard on inspiration only and represent alveoli popping open with inspiration; often a sign of atelectasis; may be sign of early pneumonia.
• Fluid challenge: If you have a patient who has a low blood pressure, shock, hypovolemia, etc. you'll challenge him with a rapid bolus of fluid to try to get blood pressure up.
• Blood pressure: Normal is 120/80. Greater than 140/90 should be treated as hypertension, and less than 90/60 should be treated as hypotension. Consider normal values for patinet however.
• Pulmonary Hypertension: High blood pressure in the lungs, which is usually indicative of end stage pulmonary disease, such as COPD, lung cancer, pulmonary fibrosis, cystic fibrosis, etc. It means the heart is working extra hard to push blood through the lungs, and often results in a large right heart (Cor pulmonale) that eventually results in a large left heart and heart failure.
• Cor pulmonale: An enlarged right heart secondary to long term high pulmonary blood pressure (pulmonary vascular resistance) secondary to end stage chronic lung disease.
• Auscultation: Listening to lung sounds
• Bronchial Hygene therapy: positioning a patinet to drain secretions (done in cystic fibrosis patients)
• Chest percussion: Clapping with cupped hands over chest wall to create vibrations in an attempt to move thick and stubborn secretions so they may be expectorated.
• Expectoration: Spitting up phlegm
• Chest physiotherapy (CPT): Using bronchial hygene and chest percussion to stimulate expectoration of secretions; pulmonary toilet.
• Pulmonary toilet: Doing whatever is necessary to help a patient expectorate thick and stubborn secretions; COPD; breathing treatment with bronchodilator and sometimes with Mucomyst; chest physiotherapy; PEP therapy, Flutter valves, etc.
• Suctioning: Removing secretions from the patients airway by artificial means. It is invasive and should never be done on any patient who is awake and alert. It can traumatize the patient and the airway. It is a necessary procedure in an intubated patient.
• Intubation: The process of inserting an endotracheal tube into a patients airway to the lungs to facilitate breathing for that patient. It is necessary for patients who cannot breath on their own. A patient is usually hooked up to mechanical ventilation.
• Mechanical Ventilation: The process of breathing for a patient with a machine called a ventilator.
• Prone position: Lying on belly
• Supine position: Lying on back
• Fowlers position: Sitting up straight
• Semi fowlers position: Sitting up withe the head of bed at a 30-40 degree angle.
• Death Rattle: Increased saliva and secretions in throat due to loss of ability to swallow and clear oral secretions. It's harmless to the patient, but can often be stressful for the family member not familiar with it, or not ecucated about it.
• Cardiac Wheezes: These are usually coarse wheezes, sometimes audible, and often of the upper airway that are caused because of increased pressure around the bronchial tree of the lungs due to heart failure and increased pulmonary edema. The increased pressure and fluid actually squeeze the bronchial tubes, thus causing them to wheeze. This presents similar to asthma, and is often confused as asthma, thus the name.
• Cardiac Asthma: See Cardiac Wheeze. This is asthma-like symptoms caused by heart failure. It presents as dyspnea at rest or on exertion and wheezes. It is often confused for asthma
• Ventilator Delirium: (synonym is psychosis) According to RT Magazine: "Delirium, as defined by the DSM-IV, requires an acute disturbance of consciousness with reduced clarity or awareness of the environment (eg, an inability to focus or to sustain or shift attention) and either (1) a new cognitive change (eg, deficits in memory or orientation, or a language disturbance) or (2) a new perceptual disturbance (eg, hallucinations or misinterpretations).2 Delirium frequently develops over hours or days, and fluctuates over time.
• Ventilator Acquired Pneumonia: This is pneumonia acquired once a patient is on a Vent. For the most part, a vent cannot cause pneumonia, however the term sticks.
• Circadian Rhythm Sleep Disorder: This is what happens to people who work nights. It's the totally whacking out of your circadian rhythm, thus making it difficult to sleep. The only cure is to stop working nights.
• Concurrent therapy:  See treatment stacking
• Treatment stacking:  When you do more than one breathing treatment at a time. 
• Nauseated: You feel sick
• Nauseous:  You make others feel sick
• Shortness of breath (SOB): It's a subjective measure. It's how your breathing feels to you. Do you feel winded? Do you feel you can't get air in? Do you feel dypneic. (see above)

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