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Respiratory Cycle. InspirationActive process that uses contractions of several muscles to increase the size of the chest cavityDiaphragm lowers and ribs move up and outThe expanding size of the chest cavity pulls air in. Respiratory Cycle. ExpirationPassive process that uses relaxation of muscles to decrease chest cavity size and allow air to move outDiaphragm moves up and ribs move down and in.
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1. Respiratory Emergencies Eileen Humphreys PA-C, EMT-I
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
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. MDI’s Metered dose inhalers
Delivers a precise dose of medication each time canister is depressed
66. MDI’s Bronchodilators
Albuterol- Proventil, Ventolin
Atrovent
Serevent
Steroids
Vanceril
Aerobid
Azmacort
67. MDI’s 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. MDI’s Side effects include:
tachycardia
arrhythmia
anxiety
nervousness