BLS Management of Respiratory Emergencies

1. BLS Management of Respiratory Emergencies

2. Objectives • Discuss the terms: respiration and ventilation. • Discuss the pathophysiology of structures utilized in the respiratory system. • Discuss respiratory diseases and how they alter structure and function of the system. • Discuss assessment techniques of respiratory patients. • Discuss appropriate treatment of respiratory emergencies.

3. Respiration The process of gas exchange; specifically at the alveolar and cellular level.

4. Ventilation The process of inspiration and expiration. Inspiration is an active process and expiration is a passive process.

5. Structures Involved in Ventilation • Diaphragm • Intercostal and chest muscles • Visceral and parietal pleura • Oral and nasal cavity • Epiglottis • Trachea • Bronchus/Bronchials • Alveoli

6. Structures Involved in Respiration • Alveolar - Capillary Membrane • Hemoglobin • Capillaries • Cellular Membrane

7. Respiratory Rate • Decreased by: • Depressant Drugs • Sleep • Increased by: • Fever • Fear • Exertion

8. Adult Lung Volumes • 5,500 to 6,000mL at end inspiration. • Normal tidal volume: 500mL • Dead space air: 150mL • Alveolar Air: 350mL

9. Minute Volume Tidal Volume X Respiratory Rate = Minute Volume

10. Ventilation Control Center • Located in the pons region of the brainstem • Detects increases in CO2 or decreases in pH and informs the brain to increase the respiratory rate. • Increased respiratory rate reduces CO2 and will increase pH.

11. “Hypoxic Drive” • Develops in some patients with Chronic Lung Disease • Pons region of brain becomes sensitized to constant increased CO2 state • Regulation is now based on O2 level in blood • Increased oxygen level states may tell the brain to stop breathing

12. Chronic Lung Diseases • Asthma • Chronic Obstructive Pulmonary Disease • Chronic Bronchitis • Emphysema

13. Asthma • Form of “reactive airway disease” • Effects a reported 6 Million Americans • As many as 5,000 deaths annually attributed to Asthma • One half of asthma diagnosis are made before age 10.

14. Asthma • Airway tubules “react” to stimulants • chemicals • pet dander • dust • perfumes • infections • emotional responses may trigger attack

15. Asthma • Initial response is bronchospasm • Bronchospasm is followed by swelling of mucosal membranes in the bronchioles • Thick, tenacious sputum begins to plug smaller airway passages • These mucous plugs allow air to enter but not to escape. This causes air trapping

16. Asthma • Patients develop wheezes as they attempt to force air out of distended alveoli through mucous plugged bronchioles • They develop a prolonged expiratory phase as they attempt to empty overfilled alveoli • Chest becomes hyper-inflated • Cessation of wheezes is not always an improvement

17. Asthma Assessment • Onset? • Physical Assessment • Trigger? • Severity? • Treatment PTA of EMS?

18. Asthma Treatment • Calm reassurance • Oxygen administration • Assess Vital Capacity • Bronchodilator Therapy

19. Bronchodilators • Beta II agonist • Stimulate receptor sites causing bronchiole relaxation • May improve air passage around mucous plugs • Many side effects

20. Asthma Secondary event: Several hours after onset of initial symptom patients may suffer a second, more severe, attack.

21. Chronic Bronchitis • Highest incidence in heavy cigarette smokers • Often they are obese • Many have associated right sided heart failure or Cor-Pulmonale

22. Chronic Bronchitis • Chronic coughing • Chronic, excessive mucous production throughout the bronchioles • Patients are often described as “Blue-Bloaters” due to their obese and slightly cyanotic state

23. Chronic Bronchitis • Condition worsens in presence of an acute respiratory infection (increased risk due to steroid use) • Worsening condition is caused by changes in mucous thickness and concentration • Breath sounds worsen. Rales, rhonchi or expiratory wheezes may be audible

24. Chronic Bronchitis Treatment • Oxygen administration - May have hypoxic drive. Do not withhold oxygen; but be prepared to assist ventilations • Hydrate accordingly. Remember may already have heart failure • Assist with Bronchodilator therapy • Encourage patient to mobilize sputum

25. Emphysema • Associated primarily with heavy cigarette smokers; however, may also be caused by air pollution or second hand cigarette smoke exposure • Patients are often very thin. They expend more calories breathing than they intake with meals. • Seldom does cyanosis develop in chronic state • They utilize pursed lip breathing to keep airways open • Often referred to as “Pink Puffers”

26. Emphysema • Alveolar walls lose their elasticity. They do not recoil with expiration • Eventually individual sacs may rupture creating larger air pockets with decreased gas exchange capabilities • Patients may develop a barrel chest appearance due to hyper-inflated lungs • Hypoxia may cause agitation

27. Emphysema Treatment • Oxygen administration. These patients may too have “hypoxic drive.” However, do not withhold oxygen therapy. Be prepared to assist ventilations. • Assist with Bronchodilator administration. • Frequent reassessment.

28. Management of Respiratory Emergencies Respiratory emergencies must be approached in a calm and professional manner. Patients who suffer respiratory diseases are often very anxious and stressed regarding an acute flare-up. Your professionalism will provide reassurance and help to alleviate the stress involved in their disease process.