Respiratory Emergencies

1. Respiratory Emergencies Chapter 11

2. Respiratory System

3. Anatomy and Functionof the Lung

4. Characteristics of Adequate Breathing • Normal rate and depth • Regular breathing pattern • Good breath sounds on both sides of the chest • Equal rise and fall of chest • Pink, warm, dry skin

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

6. Signs of Inadequate Breathing • Slower than 12 breaths/min or faster than 20 breaths/min • Unequal chest expansion • Decreased breath sounds • Muscle retractions • Pale or cyanotic skin • Cool, damp (clammy) skin • Shallow or irregular respirations • Pursed lips • Nasal flaring

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

8. Upper or Lower Airway Infection (treatment) • 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.

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

10. Acute Pulmonary Edema (treatment) • Administer 100% oxygen. • Suction secretions. • Transport in position of comfort.

11. 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

12. COPD Patients • COPD patients cannot handle pulmonary infections well • Usually age 50 or older • History of recurring lung problems • Long-term smokers • Tightness in chest/constant fatigue

13. Chronic Obstructive Pulmonary Disease (COPD) (treatment) • Assist with prescribed inhaler if patient has one. • Transport promptly in position of comfort.

14. Asthma • Common but serious disease • Asthma is an acute spasm of the bronchioles. • Wheezing may be audible without a stethoscope.

15. Asthma (treatment) • Obtain history. • Assess vital signs. • Assist with inhaler if patient has one. • Administer oxygen. • Transport promptly.

16. 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

17. Spontaneous Pneumothorax (treatment) • Administer oxygen. • Transport in position of comfort. • Monitor closely.

18. Anaphylactic Reactions • An allergen can trigger an asthma attack. • Asthma and anaphylactic (allergic) reactions can be similar. • Hay fever is a seasonal response to allergens.

19. 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

20. Pleural Effusion (treatment) • Definitive treatment is performed in a hospital. • Administer oxygen and support measures. • Transport promptly.

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

22. Obstruction of the Airway (treatment) • Clear airway. • Administer oxygen. • Transport promptly.

23. 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

24. Pulmonary Embolism (treatment) • Administer oxygen. • Place patient in comfortable position, usually sitting. • Assist breathing as necessary. • Keep airway clear. • Transport promptly.

25. 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

26. Hyperventilation (treatment) • 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.

27. You are the provider: • You and your EMT-B partner are dispatched to a 33-year-old woman with difficulty breathing. • You arrive at the office building and an upset man identifies himself as the patient’s coworker. • He tells you that the patient has had breathing problems before, but he’s never seen it this bad. • He leads you to a woman who is standing with her arms outstretched on the desk with a metered-dose inhaler in hand. • She acknowledges your presence with a nod. When you ask her what is wrong, she answers with a two-word response, “can’t breathe.” • You hear audible wheezes.

28. Scene size up • How significant is the person’s response to your question and why? • What should you do next? Should you transport this patient or wait for ALS to arrive on scene?

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

30. Signs and Symptoms • Difficulty breathing • Altered mental status • Anxiety or restlessness • Increased or decreased respirations • Increased heart rate • Irregular breathing • Cyanosis • Pale conjunctivae • Abnormal breath sounds • Difficulty speaking • Use of accessory muscles • Coughing • Tripod position • Barrel chest

31. You are the provider: • You arrange to rendezvous with ALS. • You apply high-flow oxygen and obtain the following vital signs: • Respirations: 42 breaths/min • Pulse oximetry: 90% • The patient indicates that she has used the inhaler twice already. • What can you do before you meet ALS? • Another pulse oximetry reading reveals a reading of 72%. • The patient is using accessory muscles to breathe. • What do these signs indicate?

32. Focused History and Physical Exam • Abnormal breath sounds are symptomatic of COPD • Long history of dyspnea with sudden increase in shortness of breath • Recent chest cold with fever • Vital signs • Normal blood pressure • Rapid, occasionally irregular pulse • Respirations rapid or very slow

33. Interventions • Treat immediate life threats • Possible interventions • Oxygen via nonrebreathing mask at 15 L/min • Positive pressure ventilations • Airway adjuncts • Positioning • Respiratory medications

34. Detailed Physical Exam • Performed only once life threats are addressed. • May not be able to do if busy treating airway or breathing problems.

35. Ongoing assessment • Carefully watch patients for shortness of breath. • Reassess vital signs. • Ask patient if treatment has made a difference. • Check for accessory muscle use.

36. 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.

37. Medications in MDI • Trade names • Proventil • Ventolin • Alupent • Metaprel • Brethine • Generic names • Albuterol • Metaproterenol • Terbutaline

38. 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

39. 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.

40. 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.

41. Administration of MDI • 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. • 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. • 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.

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