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Respiratory Emergencies

Respiratory Emergencies. Eileen Humphreys PA-C, EMT-I. 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.

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Respiratory Emergencies

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  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 (OCP’s)

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

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