Respiratory Emergencies

Dr. Maha Al-Sedik

Respiratory pathophysiology

Why do we study respiratory emergency?

Respiratory Calls are some of the most Common

calls you will see.

Respiratory care is as essential as the ABC’s

Mishandling a respiratory call can be fatal.

•Infectious diseases may affect all parts of the airway.

•The problem is some form of obstruction to the air

flow or the exchange of gases.

Upper or Lower Airway Infection

Examples:

Bronchitis

Common cold

Diphtheria

TB

Pneumonia

Epiglottitis

Influenza

Some form of obstruction causes dyspnea:

Obstruction to flow of air in major passages:

Colds, diphtheria, epiglottitis.

Obstruction to exchange of gases:

Pneumonia.

Assessment:

Administer warm, humidified oxygen.

Do not attempt to suction the airway or insert an

oropharyngeal airway in a patient with suspected

epiglottitis because this may cause a spasm and a

complete airway obstruction.

Transport patient in position of comfort.

Acute Pulmonary Edema

• Heart muscle can’t circulate blood properly.

• Fluid builds up between alveoli and capillaries.

•Signs and symptoms

–Dyspnea

–Frothy pink sputum

•History of chronic congestive heart failure

Fluid betweenalveolus andcapillary

CO2

O2

Gas exchange inhibitedby fluid between alveolusand capillary

Pathophysiology:

Acute pulmonary edema occurs when an excessive

amount of fluid collects in the spaces between the

alveoli and the capillaries.

This fluid disturbs normal gas exchange by reducing

the ability of oxygen and carbon dioxide to diffuse

across the alveolar-capillary surface.

This leads to hypoxia.

Assessment:

Place the patient in a position of comfort, usually

sitting up.

Administer high-flow oxygen.

Provide ventilatory support.

Obstructive Pulmonary Disease

A call for a patient complaining of shortness of breath who has an obstructive pulmonary (lung) disease is common in the pre-hospital environment.

An obstructive lung disease

Obstruction of airflow through the respiratory tract

Reduction in gas exchange

hypoxia

Chronic Obstructive Pulmonary Disease (COPD)A call for a patient complaining of shortness of breath

who has an obstructive pulmonary (lung) disease is common in the pre-hospital environment.

An obstructive lung disease

obstruction of airflow through the respiratory

tract

reduction in gas exchange

hypoxia

The two most commonly obstructive pulmonary

diseases:

emphysema

chronic bronchitis

Many patients have a combination of chronic bronchitis and emphysema and present with a mixture of signs and symptoms associated with both conditions.

Hypoxic drive: Normally, the amount of carbon dioxide in the blood

is the primary stimulus for breathing.

A secondary stimulus for breathing is hypoxia, a

decrease in oxygen.

COPD patients whose expirations are so inefficient

that their bodies have become accustomed to higher

than normal levels of co2.

So hypoxic drive is a condition in which the body's

stimulus for taking a breath is low oxygen.

Occurs in people with COPD.

Emphysema

More common with smokers.

Emphysema is a permanent disease that is

characterized by destruction of the alveolar walls

and distention of the alveolar sacs.

Severe reduction in the alveolar/capillary area for

gas exchange to occur.

Pathophysiology:

In emphysema, the lung tissue loses its elasticity,

the alveoli become distended with trapped air, and

the walls of the alveoli are destroyed.

Loss of the alveolar wall reduces the surface area in

contact with pulmonary capillaries.

Decrease in gas exchange occurs.

The patient becomes progressively hypoxic and

begins to retain carbon dioxide.

Exhaling becomes an active rather than

a passive process, requiring muscular

contraction; therefore, the patient uses

most of his energy to breathe.

Assessment:

Dyspneic

Thin, barrel-chest appearance from chronic air

trapping in the alveoli causing the anterior–

posterior diameter of the chest to increase

Prolonged exhalation

Pursed-lip breathing (physiologic PEEP)

Diminished breath sounds

Wheezing and rhonchi on auscultation

Extreme difficulty of breathing on minimal exertion

Pink puffer (extra hemoglobin to make up for poor

oxygen pick up).

Tachypnea: breathing rate usually greater than 20 per

minute at rest.

Tachycardia (increased heart rate).

Pursed-lip breathing

Management:

Ensuring an open airway

position of comfort

Administration of supplemental oxygen

Chronic Bronchitis

• Increased mucus production.

• Decreased alveolar ventilation.

• Underlying problem: Ventilation and inflammation.

Pathophysiology:

Chronic bronchitis involves inflammation, swelling,

and thickening of the lining of the bronchi and

bronchioles and excessive mucus production.

The alveoli remain unaffected by the disease.

The airways become very narrow, causing a high

resistance to air movement and chronic difficulty in

breathing.

Obstructive Pulmonary Disease

An obstructive lung disease

Obstruction of airflow through the respiratory tract

Reduction in gas exchange

hypoxia

Assessment:

Cough (hallmark sign) is prominent; with sputum

Cyanosis ( so it was called “blue bloaters” )

Minimal difficulty in breathing and anxiety.

Wheezes and, possibly, crackles at the bases of the

lungs

Secure airway

Correct hypoxia

Albuterol bronchodilation if wheezing

Management