There is a high demand for the need of diagnostic imaging
such as Positron Emission Tomography in order to image the respiratory system.
This is in order to look for neuronal activations that are likely to occur with
afferent vagal inputs from the lungs themselves. This is to help focus on
sensations induced from the lung as a result in a biochemical imbalance.
Hypercapnia is defined as an elevated Carbon
Dioxide level. It is
commonly viewed to be a condition with negative connotations due to the acute
symptoms its patients present with in an emergency environment. This includes Tachypnoea,
flushed skin and Dyspnoea. However, Hypercapnia is involved in the protection
against Central Nervous System (CNS) Ischaemia. It does this by mediating the
levels of Anti-Apoptotic B-Cell CLL (Claire, 2015).
Bronchospasms are the main culprit of the associated
chest tightness that dyspnoeic patients suffer with due to Hypercapnia. The
mechanism of this bronchospasm is mediated by the stimulation of vagal-irritant
receptors. Signals of an afferent nature originating from the upper respiratory
airways and intercostal spaces in the chest wall pass via conductive pathways
and travel dorsally up to the Brain Stem. As a result, these signals are
conducted to the Sensory Cortex. The Sensory Cortex is then responsible for
sending these signals onto the Somatosensory Cortex for processing. What we end
up with is the clinical presentations of this condition as discussed above. This
now leaves us with the task of managing the condition at hand.
The initial treatment would be the introduction of
supplementary Oxygen therapy. The actual administration is typically down to
the control of a Nurse/Doctor but often in high pressure environment such as
Cardiac Catheterisation Laboratories, Cardiac Physiologists are often known to
help assist in the first hand care treatment of the patient as the
Interventional Cardiologists carry out their investigations. The main target is
to use this method of non-invasive positive pressure ventilation to achieve an
oxygen saturation level from anywhere between 85-95%. In this situation, it is
the role of the Clinical Physiologists to be able to monitor the blood Oxygen saturations.
This is achieved by using a finger probe that implements the physics of using infrared
light and the concept of light absorption.
The supplementary Oxygen is used to predominantly improve gas
exchange in the lungs between the Alveoli and Capillaries to increase Alveolar
ventilation. Whilst this is occurring, Clinical Cardiac Physiologists have a greater
input into the management of these types of patients. This is because
Electrocardiogram monitoring is advised if the patient has a Pulse Rate that is
greater than 120 beats per minute (Davidson, 2016). Monitoring is also advised
in patients with dysrhythmia’s or Cardiomyopathies which is common in these
patients. Cardiomyopathies can then be investigated by highly trained Physiologists
by using Echocardiography to view structural abnormalities in the heart. The
most vital point in Hypercapnic patients presenting with Dyspnoea is to
stabilise them and to locate the cause of the imbalance. The role of Clinical
Physiologists (Both Cardiac and Respiratory) is of paramount importance here in
achieving such a goal.