Section 4: Medical Emergencies

1
Section 4 Medical Emergencies
2
Chapter 10

• Respiratory Emergencies

3
Objectives (1 of 2)

• List the structure and function of the
  respiratory system.
• State the signs and symptoms of a patient with
  difficulty breathing.
• Describe the emergency medical care of the
  patient with breathing difficulty.

4
Objectives (2 of 2)

• Distinguish between the emergency medical care of
  the infant, child, and adult patient with
  breathing difficulty.
• Describe the special considerations due to high
  altitude.
• Defend OEC treatment regimens for various
  respiratory emergencies.
• Demonstrate the emergency medical care for
  breathing difficulty.

5
Respiratory System
6
Anatomy and Function of the Lung
7
Characteristics of Poor Breathing

• Pulmonary vessels become obstructed.
• Alveoli are damaged.
• Air passages are obstructed.
• Blood flow to the lungs is obstructed.
• Pleural space is filled.

8
Characteristics of Normal Breathing

• Normal rate and depth
• Regular breathing pattern
• Good breath sounds on both sides of the chest
• Equal rise and fall of chest
• Movement of the abdomen

9
Signs of Abnormal Breathing

• Slower than 8 breaths/min or faster than 24
  breaths/min
• Muscle retractions
• Pale or cyanotic skin
• Cool, damp (clammy) skin
• Shallow or irregular respirations
• Pursed lips
• Nasal flaring

10
Dyspnea

• Shortness of breath or difficulty breathing
• Patient may not be alert enough to complain of
  shortness of breath.

11
Upper or Lower Airway Infection

• 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.

12
Acute Pulmonary Edema

• Fluid build-up in the lungs
• Signs and symptoms
• Dyspnea
• Frothy pink sputum
• History of chronic congestive heart failure
• Recurrence high

13
Chronic Obstructive Pulmonary Disease (COPD)

• COPD is the result of direct lung and airway
  damage from repeated infections or inhalation of
  toxic agents.
• Bronchitis and emphysema are two common types of
  COPD.
• Abnormal breath sounds may be present.
• Rhonchi and wheezes

14
Spontaneous Pneumothorax

• Accumulation of air in the pleural space
• Caused by trauma or some medical conditions
• Dyspnea and sharp chest pain on one side
• Absent or decreased breath sounds on one side

15
Asthma or Allergic Reactions

• Asthma is an acute spasm of the bronchioles.
• Wheezing may be audible without a stethoscope.
• An allergen can trigger an asthma attack.
• Asthma and anaphylactic reactions can be similar.

16
Pleural Effusion

• Collection of fluid outside lung
• Causes dyspnea
• Caused by irritation, infection, or cancer
• Decreased breath sounds over region of the chest
  where fluid has moved the lung away from the
  chest wall
• Eased if patient is sitting up

17
Mechanical Obstruction of the Airway

• Be prepared to treat quickly.
• Obstruction may result from the position of the
  head, the tongue, aspiration of vomitus, or a
  foreign body.
• Opening the airway with the head tilt-chin lift
  maneuver may solve the problem.

18
Pulmonary Embolism

• A blood clot that breaks off and circulates
  through the venous system
• Signs and symptoms
• Dyspnea
• Acute pleuritic pain
• Hemoptysis
• Cyanosis
• Tachypnea
• Varying degrees of hypoxia

19
Hyperventilation

• Overbreathing resulting in a decrease in the
  level of carbon dioxide
• Signs and symptoms
• Anxiety
• Numbness
• A sense of dyspnea despite rapid breathing
• Dizziness
• Tingling in hands and feet

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Treatment of Dyspnea

• Perform initial assessment.
• Place the patient on oxygen.
• If patient is in respiratory distress, ventilate.
• Check pulse.

21
Signs and Symptoms (1 of 2)

• Difficulty breathing
• Anxiety or restlessness
• Decreased respirations
• Cyanosis
• Abnormal breath sounds
• Difficulty speaking
• Accessory muscles

22
Signs and Symptoms (2 of 2)

• Altered mental status
• Coughing
• Irregular breathing rhythm
• Tripod position
• Barrel chest
• Pale conjunctivae
• Increased pulse and respirations

23
Emergency Medical Care

• Give supplemental oxygen at 10 to 15 L/min via
  nonrebreathing mask.
• Patients with longstanding COPD may be started on
  low-flow oxygen (2 L/min).
• Assist with inhaler if available.
• Consult medical control.

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Inhaler Medications

• Trade names
• Proventil
• Ventolin
• Alupent
• Metaprel
• Brethine

• Generic names
• Albuterol
• Metaproterenol
• Terbutaline

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Prescribed Inhalers

• Actions
• Relax the muscles surrounding the bronchioles
• Enlarge the airways leading to easier passage of
  air
• Side effects
• Increased pulse rate
• Nervousness
• Muscle tremors

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Prior to Administration

• Read label carefully.
• Verify it has been prescribed by a physician for
  this patient.
• Consult medical control.
• Make sure the medication is indicated.
• Check for contraindications.

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Contraindications for MDI

• Patient unable to help coordinate inhalation
• Inhaler not prescribed for patient
• No permission from medical control
• Maximum dose prescribed has been taken

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Administration of MDI (1 of 3)

• Obtain order from medical control or local
  protocol.
• Check for right medication, right patient, right
  route.
• Make sure the patient is alert.
• Check the expiration date.
• Check how many doses have been taken.

29
Administration of MDI (2 of 3)

• Make sure inhaler is at room temperature or
  warmer.
• Shake inhaler.
• Stop administration of oxygen.
• Ask the patient to exhale deeply and put lips
  around opening.
• If the inhaler has a spacer, use it.

30
Administration of MDI (3 of 3)

• Have the patient depress the inhaler and inhale
  deeply.
• Instruct the patient to hold his or her breath.
• Continue administration of oxygen.
• Allow the patient to breathe a few times, then
  repeat dose according to protocol.

31
Reassessment

• Carefully watch for shortness of breath.
• 5 minutes after administration
• Obtain vital signs again.
• Perform focused reassessment.
• Transport and continue to assess breathing.

32
Upper or Lower Airway Infection

• Administer warm, humidified oxygen.
• Do not attempt to suction the airway or insert an
  oropharyngeal airway in a patient with suspected
  epiglottitis.
• Transport patient in position of comfort.

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Acute Pulmonary Edema

• Administer 100 oxygen.
• Suction secretions.
• Transport in position of comfort.

34
Chronic Obstructive Pulmonary Disease (COPD)

• Assist with prescribed inhaler if patient has
  one.
• Transport promptly in position of comfort.

35
Spontaneous Pneumothorax

• Administer oxygen.
• Transport in position of comfort.
• Monitor closely.

36
Asthma or Allergic Reactions

• Obtain history.
• Assess vitals signs.
• Assist with inhaler if patient has one.
• Administer oxygen.
• Transport promptly.

37
Pleural Effusion

• Definitive treatment is performed in a hospital.
• Administer oxygen and support measures.
• Transport promptly.

38
Mechanical Obstruction of the Airway

• Clear airway.
• Administer oxygen.
• Transport promptly.

39
Pulmonary Embolism

• Administer oxygen.
• Place patient in comfortable position, usually
  sitting.
• Assist breathing as necessary.
• Keep airway clear.
• Transport promptly.

40
Hyperventilation

• Complete initial assessment and history of the
  event.
• Assume underlying problems.
• Do not have patient breathe into a paper bag.
• Give oxygen.
• Reassure patient and transport.