Airway and Respiratory Emergencies

Airway and Respiratory Airway and Respiratory EmergenciesEmergencies

EMD CE PresentationSilver Cross EMSS

March 2012

Life ThreatsLife Threats

Two most important lifesaving skills:◦Airway care

◦Rescue breathing

The ABCs consist of:◦Airway

◦Breathing

◦Circulation

Respiratory System Respiratory System

To maintain life, all humans must have food, water, and oxygen.◦Lack of oxygen, even for a few minutes, can

result in irreversible damage and death.

The main purpose of the respiratory system is to work with the circulatory system to provide oxygen and remove carbon dioxide via the red blood cells.

Time is Critical!Time is Critical!

Eventually all cells will die if deprived of oxygen. Brain and heart are the most sensitive.

Anatomy of the Anatomy of the Respiratory System Respiratory System

◦At the back of the throat are two passages: The esophagus The trachea

◦The epiglottis helps prevent food or water from entering the airway.

◦The airway divides into the bronchi.

◦The lungs are located on either side of the heart. The right lung has 3 lobes, the left has 2 and the heart sits slightly more towards the left side.


Other parts of the respiratory system: (cont’d)◦The smaller airways that branch from the

bronchi are called bronchioles.

◦At the end of the bronchioles are tiny air sacs called alveoli.

◦The exchange of oxygen and carbon dioxide occurs in the alveoli.


The lungs consist of soft, spongy tissue with no muscles.◦ Movement of air into the lungs depends on movement

of the rib cage and the diaphragm muscles.

◦ When the diaphragm contracts during inhalation, it flattens and moves downward, increasing the size of the chest cavity.

◦ Air moves in and out of the lungs because of pressure changes, moving from high to low pressure to equalize.

◦ On exhalation, the diaphragm relaxes and once again becomes dome shaped, decreasing the size of the chest cavity.

Check for Responsiveness Check for Responsiveness

Ask callers to:

◦ Evaluate the victim’s responsiveness. If there’s a response, assume that the patient is conscious and has an open airway.

◦ If there is no response, advise callers to gently shake the patient’s shoulder and repeat questions.

““A” Is for AirwayA” Is for Airway

In healthy individuals, the airway automatically stays open.

An injured or seriously ill person is not able to protect the airway and it may become blocked.◦You must take steps to have callers check the

airway and correct any problems.

Correct the Blocked AirwayCorrect the Blocked Airway

In an unconscious patient lying on his or her back, the passage of air through both nose and mouth may be blocked by the tongue.◦The tongue is attached to the lower jaw.

◦A partially blocked airway often produces a snoring sound.

◦The head tilt chin lift will fix the problem.

Correct the Blocked Airway Correct the Blocked Airway

Head tilt–chin lift maneuver◦ Place the patient on his

or her back.

◦ Place one hand on the patient’s forehead and apply firm pressure backward.

◦ Place the tips of your fingers under the bony part of the lower jaw.

◦ Lift the chin forward and tilt the head back.

Correct the Blocked AirwayCorrect the Blocked Airway

Potential blocks include:◦Secretions such as vomit, mucus, or blood

◦Foreign objects such as candy, food, or dirt

◦Dentures or false teeth

If there is anything in the patient’s mouth, remove it.Finger sweeps can be done quickly and require

no special equipment.

Recovery Position Recovery Position

If an unconscious patient is breathing and has not suffered trauma, place the patient in the recovery position.

◦Helps keep the patient’s airway open

◦Allows secretions to drain out of the mouth

◦Uses gravity to help keep the patient’s tongue and lower jaw from blocking the airway

““B” is for BreathingB” is for Breathing

Use the look, listen, and feel technique.◦Look for the rise and fall of the patient’s chest.

◦Listen for the sounds of air passing into and out of the patient’s nose or mouth.

◦Feel the air moving on the side of your face.

Adults have a normal breathing rate of 12 to 20 breaths per minute, children 15 to 30 and infants 25 to 50.

No Breathing….. Start CPR No Breathing….. Start CPR

Causes of respiratory arrest◦ Heart attacks◦ Mechanical blockage or obstruction caused by the

tongue◦ Vomitus, particularly in a patient weakened by a

condition such as a stroke◦ Foreign objects◦ Illness or disease◦ Drug overdose◦ Poisoning◦ Severe loss of blood◦ Electrocution by electrical current or lightning

C – A - BC – A - B

30 compressions in the center of the chest, 2 inches deep. Pushing hard and fast, 100 times per minute.

As you perform breathing, keep the patient’s airway open. (head-tilt)◦Pinch the nose, take a deep breath, and blow

slowly into the mouth for 1 second.◦Remove your mouth and let the lungs deflate.◦Breathe for the patient a second time.◦Alternate 30:2 compressions and breaths, until the

patient responds or experienced help takes over.

Causes of Airway Obstruction Causes of Airway Obstruction

The most common airway obstruction is the tongue.◦If the tongue is blocking the airway, the head

tilt–chin lift maneuver will clear the patch for air movement.

Food is the most common foreign object that causes an airway obstruction.◦If a foreign body is lodged in the air passage,

you must use other techniques to remove it.

Are You Choking?Are You Choking?

• If conscious:Ask the patient, “Are you choking?”◦If the patient can reply, the airway is not

completely blocked.

◦ If the patient cannot speak or cough, the airway is completely blocked.

Mild airway obstruction◦The patient coughs and gags.

◦The patient may be able to speak, but with difficulty. Encourage the patient to cough.


Severe airway obstruction◦The patient is unable to breathe in or out and

speech is impossible.

◦Other symptoms may include: Poor air exchange Increased breathing difficulty A silent cough Loss of consciousness in 3 to 4 minutes

◦Treatment involves abdominal thrusts.


Airway obstruction in an adult or child◦If the patient is conscious, stand behind him or

her and perform abdominal thrusts.

◦Perform CPR on a patient who has become unresponsive.


Airway obstruction in an infant◦If the infant has an audible cry, the airway is

not completely obstructed.

◦Use a combination of 5 back slaps and 5 chest thrusts, if the infant is awake but not breathing from airway obstruction.

◦ If the infant becomes unresponsive: Begin CPR. Continue CPR until EMS personnel arrive.

Breathing for Patients With Breathing for Patients With Stomas Stomas

Check every patient for the presence of a stoma.If you locate a stoma, keep the patient’s neck

straight.Examine the stoma and clean away any mucus

in it.Place your mouth directly over the stoma and

use the same procedures as in mouth-to-mouth breathing.

If the patient’s chest does not rise, seal the mouth and nose with one hand and then breathe through the stoma.

Gastric Distention Gastric Distention

Occurs when air is forced into the stomach instead of the lungs

Increases the chance that the patient will vomit

Breathe slowly into the patient’s mouth, just enough to make the chest rise.

Make sure airway is properly tilted open.

Respiratory EmergenciesRespiratory Emergencies

There are a variety of problems that can cause Difficulty in Breathing (DIB) or Shortness of Breath (SOB). The rest of the presentation will cover some of those conditions.

Signs of Inadequate Breathing Signs of Inadequate Breathing

Noisy respirations, wheezing, or gurgling (rales or crackles)◦ http://www.easyauscultation.com/lung-sounds-reference-guide.as

px click on this link to listen to abnormal lung sounds

Rapid or gasping respirations Pale or blue skin Increased work of breathing Talking in 1 or 2 word sentences The most critical sign is respiratory arrest, which is

characterized by:◦ Lack of chest movements◦ Lack of breath sounds◦ Lack of air against the side of your face

DIBDIB

Causes:◦Upper or lower airway infection◦Acute pulmonary edema (Fluid in lungs)◦Chronic obstructive pulmonary disease (COPD)◦Asthma◦Hay fever◦Hyperventilation syndrome◦Environmental/industrial exposure◦Carbon monoxide poisoning◦Infectious diseases

DIBDIB

Causes (cont’d)◦Anaphylaxis (Severe Allergic Reaction)

◦Spontaneous pneumothorax (Collapsed Lung)

◦Pleural effusion (Fluid around the Lung)

◦Prolonged seizures

◦Obstruction of the airway (Choking)

◦Pulmonary embolism (clot in Lung area)

We will explore some of these problems a little further, read on………..

Airway InfectionsAirway Infections

Bronchitis – inflammation of bronchioles. Patients will have a productive cough and wheezing.

Common Cold – viral infection with swollen mucous membranes and excess fluid production from sinuses and nose.

TB – a respiratory disease that can lay dormant in the lungs for years. Is spread by respiratory droplets.

Pneumonia – viral or bacterial infection that can damage lung tissue. Characterized by productive cough, fever and congestion.

Diphtheria – A highly contagious disease that causes a layer of debris to form in the upper airway and can causes obstruction. This is a rare problem.

Airway InfectionsAirway Infections

Epiglottitis – Bacterial infection that affects mostly school aged children. Causes swelling of the flap above the larynx. Patients will have Stridor (a harsh, high pitched sound) as the air moves past the swelling. They will also have a fever, sore throat and drooling.

Croup – Viral Infection, usually seen in children under 3years old. Causes inflammation of the airway and a “seal bark” type of cough.

RSV – Highly contagious infection that is spread through airborne droplets. Affect young children and can lead to more serious lund or heart problems.

Pertussis (Whooping Cough) – Highly contagious bacterial infection that mostly effects children under 6. Patient will have a fever and coughing episodes where they can’t catch their breath.

SARS – Potentially life-threatening viral infection that starts with flu-like symptoms and can progress to death. Spread from person-to-person contact.

Chronic Obstructive Pulmonary Chronic Obstructive Pulmonary Disease (COPD)Disease (COPD)

Slow process of dilation and disruption of airways and alveoli

Caused by chronic bronchial obstructionFourth leading cause of deathTobacco smoke can create chronic bronchitis.Emphysema is another type of COPD.

◦ Loss of elastic material around air spaces

◦ Causes include inflamed airways, smoking.

Most patients with COPD have elements of both chronic bronchitis and emphysema.

Asthma, Hay Fever, and Asthma, Hay Fever, and Anaphylaxis Anaphylaxis

Result of allergic reaction to inhaled, ingested, or injected substance◦ In some cases, allergen cannot be identified.

Asthma is acute spasm of smaller air passages (bronchioles)◦ Excessive mucus production◦ Swelling of mucous lining of respiratory passages.

Hay fever causes cold-like symptoms.◦ Allergens include pollen, dust mites, pet dander.

Anaphylactic reaction can produce severe airway swelling. ◦ Total obstruction is possible.◦ Reaction occurs within 30 minutes of exposure

Hyperventilation Hyperventilation

Rapid, deep breathing to the point that arterial carbon dioxide falls below normal

May be indicator of major illness ◦ High blood sugar, overdose of aspirin, respiratory

infection, etc Acidosis: buildup of excess acid in blood or body

tissues Alkalosis: buildup of excess base in body fluids Alkalosis can cause symptoms of panic attack,

including:◦ Anxiety◦ Dizziness◦ Numbness

Cystic FibrosisCystic Fibrosis

◦Genetic disorder that affects lungs and digestive system

◦Disrupts balance of salt and water resulting in very thick mucus

◦Disposed to repeated lung infections and malabsorption of nutrients in intestines

Congestive Heart Failure Congestive Heart Failure (CHF)(CHF)

Cardiac problem that causes fluid to back up in the lungs◦Risk factors include hypertension and a history

of coronary artery disease and/or atrial fibrillation.

◦In most cases, patients have a history of congestive heart failure.

TreatmentTreatment

Have patient assume a comfortable position, usually sitting up and leaning forward.

Loosen any tight clothing.Follow their doctor’s orders for any

medication administration.If there is oxygen on scene, it is helpful in

cases of DIB.

ResourcesResources

AAOS Emergency Medical Responder 5th edition

• AAOS Emergency Care and Transport of the Sick and Injured

10th Edition

• 2010 AHA BLS Guidelines

• Will County 9-1-1 EMDPRS

Airway and Respiratory Emergencies

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