Summary
Samenvatting CRK 2 - Respiratoir (Samera)
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Samenvatting van de lessen respiratoire kinesitherapie (Samera)
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Hyperventilatie= condition veroorzaakt door langdurige mentale of fysieke stress -> diepe en / of te snelle ademhaling + zuchten
Psychosomatische symptomen (gevarieerd)
Initieel medicamenteus (betablokkers), intense AH oefeningen, relaxatie, veranderen van stressoren,
voldoende motivatie nodig om “gewoonte” van AH te veranderen
Fysiologie
Normaal ademhalingspatroon in rust -> rustige diafragmatische AH, ribben bewegen niet, respiratoire pauze tussen
in- en expiratie (abdominale beweging)
Tijdens inspanning: zowel buik als thorax gaan bewegen tijdens diepere adem, hulpademhalingsspieren werken mee,
RR stijgt, het accent in het ritme verschuift naar inspiratie met een kortere pauze
Paradoxaal ademen vermijden!
Costodiafragmatische ademhaling
Het limbisch systeem = interactie tussen lichaam en mind/ emoties (Thalamus, subcorticale nucleii, archicortex (oa
hippocampus))
Processen:
- Ademhaling en psyche
- Tonus van striated muscles
- Conscience
- Functies endocrien en vegetatief systeem
- Sympatisch systeem: hogere HR en cardiac output, pupildilatatie, arterioconstrictie
- Parasymptaisch systeem (<-> sympatisch)
- Verandering hormoonconcentratie
- Connectie adrenal medulla
Balans tussen:
ergotrope ftie = prepare body voor actie (sympatisch, neuro) -> meer actief bij hyperventilatie ptn
trophotrope functie = regeneratie en construction van het lichaam (parasympatisch, neurohormonaal,
somatisch, psychologisch)
Pathofysiologie
↑ RMV = ↑↑ O2 (absorptie) en ↓↓ CO2 (release)
dysbalans waardoor niet alle O2 kan worden opgenomen in de cellen wat leidt tot hypocapnie op LT
↑ acid zorgt voor ↑ ventilatie MAAR hier dus alkalose
Beïnvloedt: zenuwstelsel, bloedsupply aar hersenen
en beschikbaarheid van minderalen in het bloed
Ademhalingspatroon effect
- Thoracale ademhaling, geen diafragma gebruikt
- Regelmatig zuchten (maakt thorax weider in anterieure richting)
- Irregular frequentie en AH diepte -> dyspneu: Thorax raised en abdomen retracted = paradoxaal
Consequenties: ↓ air en O2, ↓ ventilatie lagere longen, secundaire AHspieren meer aangesproken,
kortademigheid, verschillende symptomen
, CO2 stimuleer O2 uptake en release van bloed naar cellen, relaxeert smooth muscles, pH homeostase
Airways -> astma Arteries -> high BP
Capillairen -> koude handen en voeten Organen -> constipatie/ diarree
Types van hyperventilatie
3 types:
Artificiele / Conscious / Unconcious hyperventilatie
Mogelijke oorzaken
Hypoxemia, Low pH & high pCO2 in the arterial blood (e.g. dysregulated DM; chronic kidney failure; lack O2;
salicylic acid intoxication), Cranial disorders (e.g. encephalitis, circulatory disorders,…), Medication, Hormones
(e.g. progesterone & estrogen), Sedentary lifestyle (e.g. driving in poorly ventilated vehicles), Bacteraemia (e.g.
gram-negative bacteria), Coma hepaticum, Heavy exercise (untrained vs. trained individuals => lactic acid),
Organ disorders , ↑ outdoor T°
Symptomen + uitleg van mechanisme:
1. General complaints: fatigue, general weakness, exhaustion, irritable, disturbed sleep with anxious dreams -> effort
and energy of HV
2. Psychological complaints: fear, tense, worried, crying and depression. -> anxiety & tension = HV ↔ HV = anxiety
(vicious circle); hallucinations; local vasoconstriction in certain areas of the brain
3. Neurovascular complaints: disturbances in consciousness, dizziness, blurred vision, tendency to vomiting,
occasional collapse with loss of consciousness, memory disturbances and concentration problems, headaches,
pressure in the head, feelings of unreality, paresthesias in the hands (mainly in the fingers), the feet and around the
mouth, cold, clammy hands and feet, profuse sweating. -> anxiety & tension = HV ↔ HV = anxiety (vicious circle);
hallucinations; local vasoconstriction in certain areas of the brain
4. Muscular complaints: general or local myalgia and arthralgia, tremors, gross twitching, stiffness of the hands. ->
auxiliary respiratory muscles; sensitive near sternum (2nd & 3rd ribs); respiratory alkalosis; stimulation of motor
afferents = paraesthesia; stimulation motor efferents = ↑ muscle tone = tetanic contraction (pCO2 ≤ 20 mmHg)
5. Respiratory complaints: tickle in the throat, tendency to cough, feeling inability to sigh, tightness in the thorax,
tendency to sigh and yawn, hoarseness. -> tight feeling; emphasis on inspiration (= ERV ↑ & IRV ↓); dried mucous
membranes + tingling sensation in throat = coughing
6. Cardiovascular complaints: palpitations, irregular pulse, rapid pulse, chest pains, precordial pain, dull nagging pain
precordial or lower on the chest, vasolability -> ↑ HR & palpitations; lumen of peripheral vessels ↓; SV & CO ↓;
pressure on DP by overstretched stomach = pain; exhaustion of thoracic muscles
7. Gastrointestinal complaints: dry mouth, feeling as if there is something in the throat that prevents the food from
sinking, bloating in the upper abdomen, burping and flatulence, diarrhea or constipation. -> constant inhalation;
swallowing ↑ = fatigue of swallowing muscles; air to stomach = bloating + burping + pain + flatulence
-> voornamelijk: borstademhaling, mondademhaling, veel geeuwen met grote ademhaling, rustademhaling hoorbaar,
hoog tidaal volume uptake voor starten met praten, turn-up of nose with noise, veel zuchten
Predispositie: hevige mentale stress en slechte coping, ernstige uitputting, neurosomatsche labiliteit (perfectionisme),
middle-aged, V > M om verschillende redenen (3 (trouwen, nieuwe relatie, menopauze) :1 (carrière))
Etiologie
Somatisch vaak ter compensatie voor acidose, psychologisch is slechte coping met stressoren -> verstoorde
psychosomatische balans
, Diagnose
Inspectie: hyperventilatie – respiratie in rust
Palpatie: M Trapezius Descendens, M Levator scapulae, M pectoralis ajor, nekspieren -> triggerpoints
HVS: provocatietest -> controleren of symptomen optreden
Bloedonderzoek: HV –> pH : 7,45, pO2 : 112, pCO2 : 32 bij HV chronisch met compensated alkalose
EMG : latentie van tetany
Navragen wanneer symptomen optreden, ook het verdwijnen van symptomen nagaan. Controle van pt over attack
en stoppen ervan nagaan.
Ook: WK mobiliteit, functionele examinatie, longfunctie onderzoek (meestal niets bijzonders)
Anamnese eventueel adhv checklist (zie supra)
Differentiaal diagnose
Pleuritis Pulmonary embolism Beginning heart complaints
Pneumothorax Myalgia Circulatory tract disorders
Digestive tract disorders Glucose metabolism disorders Loss of consciousness
Tetany Vascular diseases
Therapie
Acuut: medicatie geven maar oppassen voor dependency (verslaving)
Plastic zak : ↑ pCO2 en telkens opnieuw inademen ook na provocatietest -> cave dependency -> zak ipv zelf controle
te hebben over klachten. Leidt tot hypoxemie <-> anxiety (vicieuze cirkel)
Respiratoire kine
- Info en advies: AH patroon , spieren, adherence
- Relaxatietechnieken (= ook preventief)
- Mobiliseren (preventie van contracturen)
- Functionele verbetering
o Betere positionering
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