Respiratory Emergencies

1. Respiratory Emergencies …or all that wheezes is NOT asthma

2. Apnea Dypsnea Orthopnea Tachypnea Bradypnea Hypercarbia Acidosis Alkalosis Ventilation Diffusion Perfusion Respiration Definitions

3. Anatomy

4. Anatomy

5. Physiology • Takes in oxygen • Disposes of wastes • Carbon dioxide • Excess water O2 + Glucose The Cell CO2 + H2O

6. Physiology

7. Physiology Inspiration Active process Chest cavity expands Intrathoracic pressure falls Air flows in until pressure equalizes Expiration Passive process Chest cavity size decreases Intrathoracic pressure rises Air flows out until pressure equalizes

8. Physiology Autonomic Function Primary drive: increase in arterial CO2 Secondary (hypoxic) drive: decrease in arterial O2

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

10. Inadequate Breathing Breathing rate < 12 or > 20* Shallow or irregular respirations Unequal chest expansion Decreased or absent lung sounds Accessory muscle usage Pale or cyanotic skin color Cool, clammy skin appearance

11. Obstructive Pathophysiology • Tongue • Foreign body obstruction • Anaphylaxis and angiodema • Facial trauma and inhalation injuries (burns) • Epiglottitis and Croup • Aspiration

12. Restrictive Pathophysiology • Asthma • COPD • Emphysema • Chronic Bronchitis

13. Diffusion Pathophysiology • Pulmonary Edema: • Left-sided heart failure • Toxic inhalations • Near drowning • Pneumonia • Pulmonary Embolism: • Blood clots • Amniotic fluid • Fat embolism

14. Ventilation Pathophysiology • Trauma: rib fractures, flail chest, spinal cord injuries • Pneumothorax, hemothorax, SCW • Diaphragmatic hernia • Pleural effusion • Morbid obesity • Neurological/muscular diseases: polio, MD, myasthenia gravis

15. Control System Pathophysiology • Head trauma • CVA • Depressant drug toxicity • Narcotics • Sedative-hypnotics • Ethyl alcohol

16. FBAO • Obstruction may result from head position, tongue, aspiration, or foreign body. • Be prepared to treat quickly and aggressively. • Head-tilt/chin-lift to open airway

17. Upper Airway Infections • Bronchitis • Common cold • Diphtheria • Pneumonia • Croup • Epiglottitis • Severe Acute Respiratory Syndrome

18. Upper Airway Infections

19. Signs & Symptoms • Dyspnea or respiratory distress • Seal-bark cough • Acute angiodema • Excessive salivation • Stridor • Sniff positioning

20. Acute Pulmonary Edema • Fluid buildup in lungs • History of CHF • High recurrence • Signs & symptoms: • Dypsnea • Frothy, pink sputum • Pedal edema, ascities • Rales, wheezes • Hypertension • .

21. Pedal Edema

22. Ascites

23. Bronchitis • Chronic condition similar to emphysema • Reduction in ventilation due to increased mucus production. • Productive cough, copious sputum • “Blue bloaters” • Treatment goals: relief of hypoxia, reversal of bronchoconstriction

24. COPD • Damaged lungs from repeated infections or inhalation of toxic agents. • Signs & symptoms: • Chronic cough • Rhonchi, wheezing • SpO2 88-92% • Clubbing • Pursed lip breathing

25. Clubbing

26. Asthma • Common but serious disease • Acute bronchiole constriction with increased mucus production • Signs & symptoms: • Wheezing • Patient looks tired • Cyanosis

27. Pneumothorax • Spontaneous or trauma induced • Accumulation of air in the pleural space • Signs & symptoms: • Dypsnea • One-sided chest pain • Absent or decreased breath sounds

28. Anaphylaxis • Characterized by respiratory distress and hypotension • Usually results from body response to allergen. • Airway obstruction due to angiodema is major concern

29. Pneumonia • 5th leading cause of death in the U.S. • Infection usually caused by bacteria or virus, rare instances fungal • Patient will present with sick appearance, febrile, shaking, productive cough, increased sputum. • Patient with increase respiratory rate/effort, tachycardic, wheezes/rales/consolidated lung sounds

30. Pleural Effusion • Collection of fluid outside the lung • Caused by irritation, infection, or cancer • Signs & symptoms: • Dypsnea • Decreased breath sounds over effected area • Positional comfort

31. Pulmonary Embolism • Blood clot that breaks off, circulating through venous system. • Signs & symptoms: • Dypsnea/tachypnea • Cyanosis • Acute pleuritic pain • Hemoptysis • Hypoxia

32. Pulmonary Embolism

33. Hyperventilation • Over-breathing resulting in a decrease in the level of CO2 (alkalosis) • Signs and symptoms: • Anxiety • Tingling in hands & feet (carpal-pedal spasms) • A sense of dypsnea despite rapid breathing • Dizziness • Numbness

34. ARDS • Pulmonary edema caused by fluid accumulation in the interstitial spaces, interfering with diffusion causing hypoxia (fluid balance) • Underlying etiology includes sepsis, pneumonia, inhalation injuries, emboli, tumors • Mortality rate >70% • Supportive care at the BLS level

35. Patient Assessment BSI/Scene Safety Initial Assessment (Sick/Not Sick) Focused Exam Detailed Exam Assessment Treatment and Plan

36. Initial Assessment • Initial Impression: • Body position • Skin signs and color • Respiratory rate and effort • Mental status • Pulse (rate & character) • Determine Sick/Not Sick (Oxygen?) • Identify and correct immediate life threats – ABCS!

37. Focused Exam (S) Signs and symptoms Allergies (med allergies) Medications Past medical history Last meal or intake Events leading to call

38. Focused Exam (S) • Onset • Provocation • Quality • Radiation • Severity • Time

39. Listen to the patient… …they will tell exactly what is wrong!

40. Focused Exam (O) • Vital signs: • Skin (signs of adequate perfusion) • Level of consciousness • Respiratory rate and effort • Lung sounds (SpO2?) • Pulse rate and character • Blood pressure (bilateral?) • Pupillary reaction

41. Crackles (Rales) CHF Pneumonia Rhonchi Pneumonia Aspiration COPD Sometimes Asthma Stridor FBAO Croup Anaphylaxis Epiglottitis Airway burn Wheezing Asthma CHF COPD Focused Exam (O)

42. Focused Exam (O) • Based upon your clinical findings. • Observe the patient while they are talking to you, note any distress. • Watch for critical signs: JVD, tracheal deviation, paradoxial chest movement.

43. Detailed Exam • Complete and thorough head, neck-to-toe exam with non critical patients. • Elicit further information and necessary interventions. • Key in on critical signs!

44. Assessment (A) This is your best guess (or rule out) as to what is going on with the patient. It is based upon YOUR Subjective and Objective findings and should help you develop and implement a Plan.

45. Plan Medics? ABC’s/Monitor vitals Patient in position of comfort. Oxygen via ? Assist with medications. Maintain body temperature. Calm and reassure. Minimize patient movement. Rapid transport!

46. PT Management (P) Golden Rules: • If you are thinking about giving O2, then give it! • If you can’t tell whether a patient is breathing adequately, then they aren’t! • If you’re thinking about assisting a patient’s breathing, you probably should be! • When a patient quits fighting it does not mean that they are getting better!

47. Tools of the Trade