Post on 04-Jun-2018
8/13/2019 RespEmergencies_eileen1
1/71
Respiratory Emergencies
Eileen Humphreys PA-C, EMT-I
8/13/2019 RespEmergencies_eileen1
2/71
Respiratory Cycle
Inspiration
Active process that uses contractions of
several muscles to increase the size of thechest cavity
Diaphragm lowers and ribs move up and
out
The expanding size of the chest cavity pulls
air in
8/13/2019 RespEmergencies_eileen1
3/71
Respiratory Cycle
Expiration
Passive process that uses relaxation of
muscles to decrease chest cavity size andallow air to move out
Diaphragm moves up and ribs move down
and in
8/13/2019 RespEmergencies_eileen1
4/71
Respiratory Cycle
Oxygen and carbon dioxide are exchanged
in the alveoli and capillaries of the lungs as
well as the capillaries of the body Critical to support life
8/13/2019 RespEmergencies_eileen1
5/71
Respiratory Emergencies
May be a result of head/neck/chest
injuries
Emotional distress
Obstruction to the upper or lower
respiratory tract
Fluid or collapse of the alveoli
Cardiac compromise
Allergic reaction
8/13/2019 RespEmergencies_eileen1
6/71
Respiratory Emergencies
Dyspnea
shortness of breath
difficulty breathing
8/13/2019 RespEmergencies_eileen1
7/71
Respiratory Emergencies
Apnea
respiratory arrest
8/13/2019 RespEmergencies_eileen1
8/71
Respiratory Emergencies
Hypoxia
inadequate supply of oxygen
8/13/2019 RespEmergencies_eileen1
9/71
Bronchoconstriction
Bronchioles of the lower airway are
significantly narrowed
Also called bronchospasm
Usually results in wheezing
8/13/2019 RespEmergencies_eileen1
10/71
Bronchoconstriction
Can be opened up by use of a
bronchodilator such as Albuterol
Relaxes the bronchioles
Called a Beta 2 agonist
8/13/2019 RespEmergencies_eileen1
11/71
Respiratory Emergencies
Scene size-up may give important clues
Look for oxygen tanks,tubing, masks
8/13/2019 RespEmergencies_eileen1
12/71
Initial Assessment
General impression
usually in a tripod position
patient lying in a supine or reclining
position may be in mild distress or in such
distress that they have become too
exhausted to stay upright
8/13/2019 RespEmergencies_eileen1
13/71
Initial Assessment
Frightened or confused facial expression
may indicate severe distress
Speech-usually limited or absent
If speech is normal-airway is open and
clear with minimal distress
8/13/2019 RespEmergencies_eileen1
14/71
Initial Assessment
Restlessness, agitation, combativeness,
confusion, and unresponsiveness can be
caused by inadequate oxygenation to thebrain
8/13/2019 RespEmergencies_eileen1
15/71
Initial Assessment
Listen for crowing, snoring, stridor, or
gurgling
Indicates partial airway obstruction
Look for adequate rise and fall of chest,
exchange of oxygen, volume exchanged
8/13/2019 RespEmergencies_eileen1
16/71
Initial Assessment
Skin
Cyanosis to the neck or chest indicates
severe respiratory distress
8/13/2019 RespEmergencies_eileen1
17/71
Respiratory Emergencies
All patients in respiratory distress are
priority transport
Decline very rapidly
8/13/2019 RespEmergencies_eileen1
18/71
SAMPLE history for responsive patients
Use OPQRST to gather information of
symptoms
8/13/2019 RespEmergencies_eileen1
19/71
Rapid trauma assessment for
unresponsive patients
8/13/2019 RespEmergencies_eileen1
20/71
Physical Exam
Assess the skin for discoloration
Assess the neck for tracheal deviation,
retractions, JVD (jugular venous distention)
Assess the chest for retractions of the
intercostal spaces, asymmetrical chest
rise, subcutaneous emphysema
Auscultate the lungs for equal breath
sounds
8/13/2019 RespEmergencies_eileen1
21/71
Wheezing- musical sound caused by
bronchospasm or fluid in the lungs
Rhonchi-snoring or rattling sounds
Crackles-bubbling or crackling noises
heard on inhalation. Associated with fluid
and heard first at bases
8/13/2019 RespEmergencies_eileen1
22/71
Assessing Adequate Breathing
Patient does not appear to be in distress
Can speak in full sentences without
stopping to catch their breath
Color will be normal
Mental status and orientation (person,
place, time) will be normal
8/13/2019 RespEmergencies_eileen1
23/71
Assessing Adequate Breathing
Rate:
Adult- 12 to 20 per minute-12
Child- 15 to 30 per minute-20
Infant-25 to 50 per minute-20
Rhythm:
Regular and even
Inspiration and expiration usually last
about the same length of time
8/13/2019 RespEmergencies_eileen1
24/71
Assessing Adequate Breathing
Quality:
Breath sounds will be present and equal
bilaterally
Both sides of chest should rise and fall
equally and adequately
Unlabored-should not require effort
8/13/2019 RespEmergencies_eileen1
25/71
Treatment of Adequate Breathing
If patient is breathing at a slightly
abnormal rate but it is adequate:
15 lpm via NRB
Monitor closely
Be on the lookout for beginnings of
inadequate breathing or respiratory arrest
Intervene quickly if condition worsens
8/13/2019 RespEmergencies_eileen1
26/71
Assessing Inadequate Breathing
Not adequate to support life and will
progress to death unless there is
intervention Rate-can be too fast or slow
Agonal respirations-dying respirations
which are sporadic, irregular breaths seenjust before resp. arrest. Shallow, gasping
Rhythm-may be regular or irregular
8/13/2019 RespEmergencies_eileen1
27/71
Assessing Inadequate Breathing
Quality:
Breath sounds may be diminished or
absent
Depth (tidal volume) will be shallow,
inadequate
Chest expansion-may be unequal orinadequate
Respiratory effort may be increased
8/13/2019 RespEmergencies_eileen1
28/71
Assessing Inadequate Breathing
Quality:
Accessory muscle use seen
Skin may be pale or cyanotic
Skin may be cool and clammy
Snoring or gurgling in unresponsive
patients or patients with diminished
responsiveness
8/13/2019 RespEmergencies_eileen1
29/71
Treatment of Inadequate
Breathing Inadequate breathing with abnormal rate
Begin artificial ventilations with either the
pocket mask or BVM
Ventilate 12 times per minute for adults
Ventilate 20 times per minute for
children/infants
8/13/2019 RespEmergencies_eileen1
30/71
Treatment of Inadequate
Breathing You may have to treat a patient with
inadequate breathing who is awake
enough to fight artificial ventilations In this case contact medical direction and
transport immediately
8/13/2019 RespEmergencies_eileen1
31/71
Patient Care for Inadequate
Breathing If properly performed, pulse rate will return
to normal (in adults pulse usually
increases in resp. distress) If pulse stays high re-evaluate the
technique
Color will return to normal if ventilationsare adequate
8/13/2019 RespEmergencies_eileen1
32/71
Patient Care
If pulse does not return to normal re-
evaluate airway, ventilations, O2 canister
(empty), tubing (kinked) If chest does not rise or pulse does not
return to normal, increase ventilation force
after assuring proper technique
8/13/2019 RespEmergencies_eileen1
33/71
Respiratory arrest
Confirm unresponsiveness
Open airway by jaw thrust or chin-lift
Look, listen, feel for 3-5 seconds
If not breathing
Give 1 full breath lasting 2 seconds and
allow patient to exhale
8/13/2019 RespEmergencies_eileen1
34/71
Respiratory arrest
If the air goes in, give breaths every 5
seconds with each breath lasting 2
seconds and allow to passively exhalebetween breaths
If no air goes in, reposition head
Check pulse frequently to monitor cardiacstatus
8/13/2019 RespEmergencies_eileen1
35/71
COPD
Chronic obstructed pulmonary disease
Chronic Bronchitis
Emphysema
8/13/2019 RespEmergencies_eileen1
36/71
8/13/2019 RespEmergencies_eileen1
37/71
Chronic Bronchitis
Overweight
Productive cough
Rhonchi
8/13/2019 RespEmergencies_eileen1
38/71
Emphysema
Loss of elasticity of the alveolar walls
Distention of the sacs causing air trapping
Air movement is restricted and patient
retains carbon dioxide
8/13/2019 RespEmergencies_eileen1
39/71
Emphysema
Thin, barrel chest
Non-productive cough
Prolonged exhalation
Pursed lip breathing
Wheezing and rhonchi
8/13/2019 RespEmergencies_eileen1
40/71
Treatment of COPD
Ensure open airway, adequate breathing,
supplemental oxygen, position of comfort
8/13/2019 RespEmergencies_eileen1
41/71
Hypoxic Drive
COPD patients
Low levels of oxygen in the body stimulate
breathing
In theory too much oxygen can cause the
body to reduce or stop breathing
Usually occurs with high concentrations ofO2 over 24 hours
8/13/2019 RespEmergencies_eileen1
42/71
Hypoxic Drive
Not normally a problem in prehospital
environments
lw ysgive high flow oxygen to those whoneed it
8/13/2019 RespEmergencies_eileen1
43/71
Asthma
Reversible narrowing of the lower airways
Edema, bronchospasm, and increased
mucus production
Mucus production block smaller airways
and causes air to be trapped in the alveoli
8/13/2019 RespEmergencies_eileen1
44/71
Asthma
Exhalation becomes difficult and patients
must force air out past constricted airways
This causes wheezing on exhalation Exhalation becomes an active process
8/13/2019 RespEmergencies_eileen1
45/71
Asthma
Lack of wheezing or lung sounds in a
patient suffering from an asthma attack is
ominous
Status asthmaticus-prolonged attackwhich does not respond to oxygen or
medication
8/13/2019 RespEmergencies_eileen1
46/71
Pneumonia
Viral or bacterial disease infecting the
lower respiratory tract
Causes lung inflammation Poor gas exchange
8/13/2019 RespEmergencies_eileen1
47/71
Pneumonia
Signs/symptoms
fever/chills
cough
dyspnea
chest pain-localized, sharp, worse with
breathing
rhonchi/crackles
8/13/2019 RespEmergencies_eileen1
48/71
Pulmonary Embolus
Sudden blockage of blood flow through a
pulmonary artery or branches
Due to blood clot, air bubble, foreign body,fat particle
Decrease in gas exchange
Hypoxia
8/13/2019 RespEmergencies_eileen1
49/71
Pulmonary Embolus
Risk factors
recent surgery
prolonged immobilization
multiple fractures
thrombophlebitis
chronic atrial fibrillation
medications (OCPs)
8/13/2019 RespEmergencies_eileen1
50/71
Pulmonary Embolus
Suspect if sudden onset of unexplained
dyspnea, hypoxia, tachypnea, and stabbing
chest pain Will have normal breath sounds and
adequate volume
8/13/2019 RespEmergencies_eileen1
51/71
Acute Pulmonary Edema
Excessive amount of fluid between alveoli
and capillary space
Disturbs gas exchange Causes hypoxia
Cardiogenic and non-cardiogenic
8/13/2019 RespEmergencies_eileen1
52/71
Acute Pulmonary Edema
Signs/symptoms
dyspnea worse with exertion
orthopnea
blood tinged sputum
tachycardia
pale, moist skin
swollen lower extremities
8/13/2019 RespEmergencies_eileen1
53/71
Respiratory-Pediatric Patients
Remember the most common cause of
cardiac problems in pediatrics is---???
Respiratory intervention must begin
quickly and be monitored at all times
Know the difference in structures from
adults
8/13/2019 RespEmergencies_eileen1
54/71
Inadequate Pediatric Breathing
Early signs
accessory muscle use
retractions
tachypnea
tachycardia
8/13/2019 RespEmergencies_eileen1
55/71
Inadequate Pediatric Breathing
nasal flaring
coughing
cyanosis to the extremities
grunting (Bad Bad Sign)-seen in infants
during exhalation signaling imminent
failure
8/13/2019 RespEmergencies_eileen1
56/71
Pediatric Respiratory Failure
Altered mental status
Pulse rises early then drops fast
Bradycardia
Hypotension
Irregular breathing pattern
8/13/2019 RespEmergencies_eileen1
57/71
Pediatric Respiratory Failure
Seesaw pattern-abdomen and chest move
in different directions
Limp appearance Head bobbing with each breath
8/13/2019 RespEmergencies_eileen1
58/71
Pediatric Problems
Distinguish whether the airway problem is
upper or lower
8/13/2019 RespEmergencies_eileen1
59/71
Pediatric Problems
Stridor and crowing indicate upper airway
obstruction
Usually due to edema or foreign bodyobstruction
Wheezing is sign of lower airway problem
8/13/2019 RespEmergencies_eileen1
60/71
Epiglottis
Inflammation of the epiglottis
History of sore throat, fever, stridor
Child sits upright leaning forward, sits theneck out, drooling
Life-threatening emergency
Do not inspect the airway as bronchospasm
may completely obstruct the airway
8/13/2019 RespEmergencies_eileen1
61/71
Croup
Swelling of the larynx, trachea, and bronchi
Sore throat and fever worse at night
Seal-like cough
Cool night air usually helps
8/13/2019 RespEmergencies_eileen1
62/71
Patient Care-Pediatrics
Monitor airway and breathing constantly
Nothing is more important than adequate
airway care Ensure adequate breathing
Intervene quickly and appropriately when
necessary
If in doubt-Treat as inadequate breathing
8/13/2019 RespEmergencies_eileen1
63/71
Patient Care-Pediatrics
If pulse remains low or breathing
inadequate re-evaluate airway,
ventilations, O2 canister (empty), tubing(kinked)
If chest does not rise or pulse does not
return to normal, increase ventilation forceafter ensuring proper technique
8/13/2019 RespEmergencies_eileen1
64/71
Treatment
Oxygen is a drug
It must be administered correctly and
monitored
8/13/2019 RespEmergencies_eileen1
65/71
MDIs
Metered dose inhalers
Delivers a precise dose of medication each
time canister is depressed
8/13/2019 RespEmergencies_eileen1
66/71
MDIs
Bronchodilators
Albuterol- Proventil, Ventolin
Atrovent
Serevent
Steroids
Vanceril
Aerobid
Azmacort
8/13/2019 RespEmergencies_eileen1
67/71
MDIs
Before using
patient must have signs & symptoms of
breathing difficulty has a physician prescribed MDI
approval from medical control
8/13/2019 RespEmergencies_eileen1
68/71
Contraindications
Not responsive enough to follow directions
Medication out of date
Not prescribed for the patient
Permission not granted by medical control
Patient has already taken the maximum
allowed dose prior to arrival
8/13/2019 RespEmergencies_eileen1
69/71
Administration
Check name of medicine, date, and name
prescribed to
Obtain medical control order Shake canister for 30 seconds
8/13/2019 RespEmergencies_eileen1
70/71
Administration
Have patient
exhale fully
wrap lips around opening
inhale slowly as you depress canister (5
seconds)
hold breathe for 10 seconds
exhale slowly
8/13/2019 RespEmergencies_eileen1
71/71
MDIs
Side effects include:
tachycardia
arrhythmia
anxiety
nervousness