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Respiratory Emergencies

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Emphysema. Chronic Bronchitis ... Emphysema. Loss of elasticity of the alveolar walls. Distention of the sacs causing air trapping ... – PowerPoint PPT presentation

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Title: Respiratory Emergencies


1
Respiratory Emergencies
  • Eileen Humphreys PA-C, EMT-I

2
Respiratory Cycle
  • Inspiration
  • Active process that uses contractions of several
    muscles to increase the size of the chest cavity
  • Diaphragm lowers and ribs move up and out
  • The expanding size of the chest cavity pulls air
    in

3
Respiratory Cycle
  • Expiration
  • Passive process that uses relaxation of muscles
    to decrease chest cavity size and allow air to
    move out
  • Diaphragm moves up and ribs move down and in

4
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

5
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

6
Respiratory Emergencies
  • Dyspnea
  • shortness of breath
  • difficulty breathing

7
Respiratory Emergencies
  • Apnea
  • respiratory arrest

8
Respiratory Emergencies
  • Hypoxia
  • inadequate supply of oxygen

9
Bronchoconstriction
  • Bronchioles of the lower airway are significantly
    narrowed
  • Also called bronchospasm
  • Usually results in wheezing

10
Bronchoconstriction
  • Can be opened up by use of a bronchodilator such
    as Albuterol
  • Relaxes the bronchioles
  • Called a Beta 2 agonist

11
Respiratory Emergencies
  • Scene size-up may give important clues
  • Look for oxygen tanks,tubing, masks

12
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

13
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

14
Initial Assessment
  • Restlessness, agitation, combativeness,
    confusion, and unresponsiveness can be caused by
    inadequate oxygenation to the brain

15
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

16
Initial Assessment
  • Skin
  • Cyanosis to the neck or chest indicates severe
    respiratory distress

17
Respiratory Emergencies
  • All patients in respiratory distress are priority
    transport
  • Decline very rapidly

18
  • SAMPLE history for responsive patients
  • Use OPQRST to gather information of symptoms

19
  • Rapid trauma assessment for unresponsive patients

20
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

21
  • 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

22
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

23
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

24
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

25
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

26
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 seen just before
    resp. arrest. Shallow, gasping
  • Rhythm-may be regular or irregular

27
Assessing Inadequate Breathing
  • Quality
  • Breath sounds may be diminished or absent
  • Depth (tidal volume) will be shallow, inadequate
  • Chest expansion-may be unequal or inadequate
  • Respiratory effort may be increased

28
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

29
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

30
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

31
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 ventilations are
    adequate

32
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

33
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

34
Respiratory arrest
  • If the air goes in, give breaths every 5 seconds
    with each breath lasting 2 seconds and allow to
    passively exhale between breaths
  • If no air goes in, reposition head
  • Check pulse frequently to monitor cardiac status

35
COPD
  • Chronic obstructed pulmonary disease
  • Chronic Bronchitis
  • Emphysema

36
Chronic Bronchitis
  • Usually has a productive cough for 3 months out
    of the year for 2 years
  • Edema, inflammation and excessive mucus
    production of the bronchioles/bronchi
  • Restricted air movement
  • Gas exchange is compromised
  • Retained CO2

37
Chronic Bronchitis
  • Overweight
  • Productive cough
  • Rhonchi

38
Emphysema
  • Loss of elasticity of the alveolar walls
  • Distention of the sacs causing air trapping
  • Air movement is restricted and patient retains
    carbon dioxide

39
Emphysema
  • Thin, barrel chest
  • Non-productive cough
  • Prolonged exhalation
  • Pursed lip breathing
  • Wheezing and rhonchi

40
Treatment of COPD
  • Ensure open airway, adequate breathing,
    supplemental oxygen, position of comfort

41
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 of O2
    over 24 hours

42
Hypoxic Drive
  • Not normally a problem in prehospital
    environments
  • Always give high flow oxygen to those who need it

43
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

44
Asthma
  • Exhalation becomes difficult and patients must
    force air out past constricted airways
  • This causes wheezing on exhalation
  • Exhalation becomes an active process

45
Asthma
  • Lack of wheezing or lung sounds in a patient
    suffering from an asthma attack is ominous
  • Status asthmaticus-prolonged attack which does
    not respond to oxygen or medication

46
Pneumonia
  • Viral or bacterial disease infecting the lower
    respiratory tract
  • Causes lung inflammation
  • Poor gas exchange

47
Pneumonia
  • Signs/symptoms
  • fever/chills
  • cough
  • dyspnea
  • chest pain-localized, sharp, worse with breathing
  • rhonchi/crackles

48
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

49
Pulmonary Embolus
  • Risk factors
  • recent surgery
  • prolonged immobilization
  • multiple fractures
  • thrombophlebitis
  • chronic atrial fibrillation
  • medications (OCPs)

50
Pulmonary Embolus
  • Suspect if sudden onset of unexplained dyspnea,
    hypoxia, tachypnea, and stabbing chest pain
  • Will have normal breath sounds and adequate
    volume

51
Acute Pulmonary Edema
  • Excessive amount of fluid between alveoli and
    capillary space
  • Disturbs gas exchange
  • Causes hypoxia
  • Cardiogenic and non-cardiogenic

52
Acute Pulmonary Edema
  • Signs/symptoms
  • dyspnea worse with exertion
  • orthopnea
  • blood tinged sputum
  • tachycardia
  • pale, moist skin
  • swollen lower extremities

53
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

54
Inadequate Pediatric Breathing
  • Early signs
  • accessory muscle use
  • retractions
  • tachypnea
  • tachycardia

55
Inadequate Pediatric Breathing
  • nasal flaring
  • coughing
  • cyanosis to the extremities
  • grunting (Bad Bad Sign)-seen in infants during
    exhalation signaling imminent failure

56
Pediatric Respiratory Failure
  • Altered mental status
  • Pulse rises early then drops fast
  • Bradycardia
  • Hypotension
  • Irregular breathing pattern

57
Pediatric Respiratory Failure
  • Seesaw pattern-abdomen and chest move in
    different directions
  • Limp appearance
  • Head bobbing with each breath

58
Pediatric Problems
  • Distinguish whether the airway problem is upper
    or lower

59
Pediatric Problems
  • Stridor and crowing indicate upper airway
    obstruction
  • Usually due to edema or foreign body obstruction
  • Wheezing is sign of lower airway problem

60
Epiglottis
  • Inflammation of the epiglottis
  • History of sore throat, fever, stridor
  • Child sits upright leaning forward, sits the neck
    out, drooling
  • Life-threatening emergency
  • Do not inspect the airway as bronchospasm may
    completely obstruct the airway

61
Croup
  • Swelling of the larynx, trachea, and bronchi
  • Sore throat and fever worse at night
  • Seal-like cough
  • Cool night air usually helps

62
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

63
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 force after
    ensuring proper technique

64
Treatment
  • Oxygen is a drug
  • It must be administered correctly and monitored

65
MDIs
  • Metered dose inhalers
  • Delivers a precise dose of medication each time
    canister is depressed

66
MDIs
  • Bronchodilators
  • Albuterol- Proventil, Ventolin
  • Atrovent
  • Serevent
  • Steroids
  • Vanceril
  • Aerobid
  • Azmacort

67
MDIs
  • Before using
  • patient must have signs symptoms of breathing
    difficulty
  • has a physician prescribed MDI
  • approval from medical control

68
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

69
Administration
  • Check name of medicine, date, and name prescribed
    to
  • Obtain medical control order
  • Shake canister for 30 seconds

70
Administration
  • Have patient
  • exhale fully
  • wrap lips around opening
  • inhale slowly as you depress canister (5 seconds)
  • hold breathe for 10 seconds
  • exhale slowly

71
MDIs
  • Side effects include
  • tachycardia
  • arrhythmia
  • anxiety
  • nervousness
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