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Spinal Cord Injury Notebook THE RESPIRATORY SYSTEM
The respiratory system includes the lungs and all the passages which bring air into and out of the body. The lungs are made up of thousands of tiny air sacs called alveoli and are lined with a moist membrane similar to the inside of your mouth. A network of blood vessels in the lungs collects oxygen from the air and distributes it throughout the body. Your body needs a constant supply of oxygen to stay alive.
HOW YOUR RESPIRATORY SYSTEM WORKS
The respiratory system includes your mouth, nose, windpipe (trachea), and lungs. Air is breathed into your mouth and nose, goes down your windpipe, and into your lungs. The major muscle that you use to breathe is your diaphragm. This sheet of muscle is located below your lungs but above your stomach, and it is attached to your breast bone, ribs, and lumbar vertebrae. The lungs are soft and spongy. Around the lungs are airtight bags called pleura. The lungs have no muscles of their own. When you breathe in, your diaphragm moves downwards and your stomach bulges. When you are exercising and need to take in more air with deeper breaths, other muscles such as those in your neck, between your ribs, and in your stomach may work also. The air you breathe in is filtered and moistened by mucous membranes in your mouth, nose, and windpipe. There are tiny particles in the air you breathe, like dust for example. Hairs in your nose trap the particles so that they do not get into your lungs. The mucus traps particles also, and little hairs sweep the mucus into your nose and mouth to be swallowed, coughed up, sneezed or blown out. Moisture is added to the air from the mucus in your nose. This mucus can build up. With a spinal cord injury, muscles that assist in breathing and the removal of mucus may be weakened.
HOW SPINAL CORD INJURY (SCI) AFFECTS BREATHING
If your injury is above T-12, your breathing or coughing muscles may be weakened. A common problem involves the secretions (fluids) which coat the inside of the lungs and all the air passages. Normally, your daily activity and coughing keep these secretions moving up and out of the lungs. After SCI, your immobility and weakened cough may allow the secretions to build up. They tend to block the air passages and become a breeding ground for infection.
If you have a problem with secretions, you will need to learn how to do assisted coughing ("quad cough") and/or some other ways to clear your lungs. How much of this will be necessary depends on the level of your injury and on the amount of secretions you have. Even if you do not usually need respiratory assistance, you may need it when you have a cold, flu or bronchitis.
In order to keep your respiratory system as healthy as possible you need to strengthen the muscles that help you to breathe, stretch your lungs, and learn to produce an effective cough.
BREATHING EXERCISES
Deep breathing stretches the lungs and helps to get air behind the mucus so that you can cough more effectively. It is best done while lying on your back, but it can also be done sitting. First, breathe in as deeply as you can, hold it for one or two seconds, then breathe out. Repeat 6 - 10 times, doing normal relaxed breathing in between each one. There are other breathing exercises that your therapist may teach you to do.
WEIGHTED BREATHING
Your therapist may also have you do weighted breathing. While you lie on your back he/she may place a weight on your stomach just below your breast bone. When you breathe in you will push your stomach against this weight and try to raise it up.
Abdominal binders or corsets may be used to provide support to your weak or absent stomach muscles, especially when you are sitting. It is easier to breathe when your trunk muscles are held close to your body.
BREATHING TREATMENT
You may have special breathing treatments using an Intermittent Positive Pressure Breathing machine (IPPB) which will expand your lungs and help loosen secretions. You may also be given a small "breathing exercise machine" called an INCENTIVE SPIROMETER which will help you strengthen your breathing muscles. Your breathing exercises will become part of your daily routine and will help prevent lung infections.
Another type of spirometer regulates the resistance to breathing in by changing the size of the opening that you are breathing in through. This device is called a P-flex.
QUAD COUGH
Assisted coughing, or "quad cough," simply means having another person help you breathe out forcefully in order to clear your air passages better. It is performed very much like the "Heimlich Maneuver," used to save people who are choking. The person helping you stands in front of or behind you if you are sitting, or over you if you are lying down, and pushes up on your diaphragm while you cough or breathe out as hard as you can. This is done until you can bring up any extra mucus or secretions into your throat where you can spit them out or swallow them.
When doing "quad cough" be sure to tell your helper:
There are also other methods of assisted coughing such as lying on your side and having someone pull back on your hip and push on your shoulder to breathe in and push on your hip and pull on your shoulder to breathe out. The nurses and therapists will teach people who will be around you at home to do this.
If possible, you can help yourself when coughing by pushing on your stomach with your hands.
PERCUSSION AND POSTURAL DRAINAGE
If the quad cough does not work to loosen and bring up secretions, PERCUSSION AND DRAINAGE is very helpful and effective. You are placed in a series of positions which allow gravity to help drain the secretions. Your caregiver taps firmly on your chest with cupped hands. This loosens the secretions from the lining of the air passages. The secretions work their way up to your throat, where they can be spit out or suctioned out if you cannot cough them up yourself.
If you need this type of treatment, a respiratory therapist or nurse will teach you and your helpers how to do it. This can then be done at home whenever it is needed to keep your breathing clear.
HOW TO KEEP YOUR LUNGS HEALTHY
Like most diseases, respiratory infections are easier to prevent than to cure. By getting into good habits, you can avoid serious illnesses such as pneumonia and improve your overall health and well-being.
1. DO NOT SMOKE, AND DO NOT ALLOW OTHERS TO SMOKE AROUND YOU.
2. DRINK PLENTY OF FLUIDS (WITHIN YOUR FLUID LIMITS).
3. AVOID PEOPLE WITH COLDS OR COUGHS.
4. USE YOUR SPIROMETER OR TAKE SEVERAL DEEP BREATHS SEVERAL TIMES A DAY TO FULLY EXPAND YOUR LUNGS AND STRENGTHEN YOUR BREATHING MUSCLES.]
5. IF YOU DO GET A COLD:
6. SEE A DOCTOR IF YOU HAVE A FEVER, SHORTNESS OF BREATH, THICK YELLOW OR GREEN SECRETIONS, OR CHEST PAIN. THESE ARE SIGNS OF A LUNG INFECTION. BACK|FORWARD|CIR HOME PAGE
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