OEC Session 15

2. Respiratory Complaints Breathing O2 is fundamental to life, any condition that interferes with this is life threatening

3. Respiratory Complaints Respiratory Distress (Dyspnea) Laboured or difficult breathing Can be faster, slower, deeper, or more shallow Common Causes Difficulty moving air in and out Usually lung stiffness, lung compression Interference with respiratory mechanics Working muscles require more O2 A change in the amount of O2/CO2 Psychological problems

4. Breathing Sounds Coughing helps rid the respiratory tract of irritating material Can result from Irritation from infections, allergies, injuries Excessive dryness / wetness Most medical causes of dyspnea May Produce Sputum: Yellow, Green, Grey Infection Bloody Injury

5. Breathing Sounds Wheezes A high pitched sound characterising conditions of the smaller air passages. Common Causes: Asthma Emphysema Pulmonary Edema Infection of the Bronchiolitis Bronchitis

6. Breathing Sounds Rhonchi Coarse low pitched sound that�s produced by moving air through the larger air passages. Medical Causes Bronchitis Tracheitis Stidor High pitched crowing produced by air moving through narrow parts of the respiratory tract above the Bronchi Medical Causes Irritation, infection, growth that causes swelling of the Laryax

7. Respiratory Complaints Pain Usually felt in the throat/neck beneath the sternum on one side of the chest Throat Pain Usually due to infection of Tonsils or pharynx Neck Pain Typically infection of the Larynx Below Sternum Infection/Irritation of the Trachea / Larger Bronchi Chest Infection/Irritation of the Pleura, Lung, usually sharp, knifelike & increased by deep breathing

8. Respiratory Complaints Common Medical Causes Respiratory infection Fluid in the lungs (Pulmonary Edema) Emphysema Asthma Pulmonary Embolism Foreign body in the airway (Airway Obstruction) Malignant Disease Benign Hyperventilation

9. Respiratory Infections Respiratory infections may involve the upper or lower respiratory tract Upper Respiratory Tract Common Cold Influenza (The Flu) Sore Throat Earache Lower Respiratory Tract Pneumonia Pleurisy Bronchitis

10. Respiratory Infections - Upper Common Cold Characterised by stuffy runny nose, sneezing and a scratchy throat. Fever is usually absent or low grade Influenza Symptoms same as a cold, with high fever, chills, generalised aching, a sore throat, and a severe cough Sore Throat May occur by itself or with a URI. Usually caused by an infection of the tonsils, pharynx or soft palate. Severe soar throat with chills, fever, swollen, red throat or tonsil covered y white spots or pus and tender lymph nodes is usually Streptococcus (Strep Throat) Earache May occur on its own or part of a URI. An infection of the pharynx moves up to the eustachian tube to the middle ear on one or both sides. When the tube is blocked by swelling from a sore throat the ear feels full. Swallowing opens the tube which allows your ears to pop

11. Respiratory Infections � Lower Pneumonia An infection of the lungs, stiffing the involved part of the lung as the alveoli and the spaces between them fill with blood and pus. Sputum contains pus and may contain blood. Typically hurts on one side. Pleurisy Infection of the pleura. Breathing becomes painful as infection eliminates the lubrication provided by the pleura. Breathing is typically rapid and shallow. Bronchitis Main infection is in the Bronchi. Rhonchi and wheezes may be audible. Coughing may be severe. Sputum usually green or yellow.

12. Pulmonary Edema Fluid portion of the blood leaves the capillaries and collects in the alveoli Due to Increased capillary pressure, failing heart, high altitude, alveolar/capillary wall damage from infection of inhalation of toxic material S&S Bubbly sounds, wheezing, rattles, short of breath, frequent/chronic coughing, cyanotic Sputum maybe frothy pink

13. Emphysema A chronic degenerative lung disease caused by cigarette smoking, polluted air and chronic severe asthma Pulmonary irritants and infections cause scarring and obstructions on the alveoli and narrowing / inflammation of the bronchi S&S Barrel Chest, breath sounds are subdued, exhalation is prolonged.

14. Asthma Condition in which periodic bronchial narrowing results in coughing, wheezing and shortness of breath. Can be initiated by: Inhaling a substances that causes an allergic reaction Emotional stress Irritation from infection Air pollution, Cold air, Exercise Care: You may help them take their medication according to directions given on the label. If no improvement after 20 minutes, rapid transport

15. Pulmonary Embolism Blood clot carried to the lung where it gets trapped an shuts off blood flow to that section of the lung. May kill that part of the lung. S&S coughing up blood, chest pain, cardiogenic shock Care Medical Emergency, Load and Go High Flow O2

16. Airway Obstruction Major cause of upper airway obstruction is related to trauma or unresponsiveness. Lower obstructions is usually chronic caused by malignant disease S&S coughing, cyanosis, hoarseness, inability to talk or swallow, wheezing

17. Malignant Disease Malignant disease of the upper and lower respirator tract is a common cause of of death and disability. Lung Cancer is the most common type of malignant respiratory disease. S&S Progressive Respiratory distress, blood in sputum, weakness, weight loss and chronic hoarseness.

18. Benign Hyperventilation Over breathing causes a reduction in CO2 levels in the blood making the blood more Alkaline. Most commonly a result of anxiety. Usually found in healthy children, teenager and young adults. S&S rapid shallow breathing, coldness, numbness, and tingling in the hands, lightheadness, flexor spasm of the feet and hands. Care breath into a paper bag for a few minutes

19. Respiratory Distress Assessment BSI LOR Urgent Survey Assess Breathing Is patient sitting up (to ease breathing) Look for breathing sounds (cough, wheezing, rhonchi, stidor) Assess skin colour, temperature, moisture Is there sputum? What Colour Have patient describe problem SAMPLE

20. Respiratory Distress General Emergency Care Place in position of comfort (assumes no spinal injury) High Flow O2 Remove any obstructions (Heimlich Maneuver) See a Physician if: Yellow, Green, bloody sputum Severe soar throat with white spots or pus on tonsils Fever above 101F Rapid Transport Respiratory distress with stridor, cyanosis, inability to speak, extreme or worsening fatigue, fever, shaking, shils, signs of shock, pulse over 130 Suspected pheumonia, severe bronchitis, or pulmonary embolus Evidence of heart disease Asthma attack does not abate within 20 min Any Respiratory distress that doesn not improve with rest, reassurance and high flow O2

21. Chest Pain Chest pain can be very frightening due to its connection with heart disease. General causes of Chest Pain: Minor Chest Injury Heart disease Respiratory system disease Gastrointestinal system disease Stress and anxiety

22. Minor Chest Injury Usually occurs at weak points in the chest cage such as the joints between ribs and sternum or the costochondral junctions. S&S pain on breathing, twisting, using upper extremities area painful to palpations

23. Chest Pain - Heart Disease 2 Main Types � Angina Pectoris � Myocardial Infarction Angina Most often occurs during physical exertion or emotional stress. Unusually does not last beyond 15min Will respond to Nitroglycerin within 3-5min => NEVER give more then 2 dose of Nitro! Why? Myocardial Infarction Blockage that causes a part of the heart to die Not related to stress, won�t respond to nitro Covered in More Detail in Session 16 Medical Emergencies

24. Chest Pain � Respiratory Disease Covered in Respiratory Complaints

25. Chest Pain � Gastrointestinal Disease Commonly mistaken for heart disease Usually originates in the esophagus, stomach, gallbladder, intestines or pancreas and is often associated with indigestion. Usually relieved by antacids or acid suppressants => Note: sometimes heart disease can also be calmed with antacids <=

26. Chest Pain � Stress and Anxiety Caused by sustained contraction of the chest wall muscles enthusiasm S&S pain is usually a chronic ache pain is usually constant & may last days worsens if with patient�s level of anxiety may be accompanied by symptoms of I indigestions: heartburn, bloating, frequent belching, increase flatulence, change in bowel movements

27. Chest Pain - Assessment BSI Urgent Survey Pay attention to pulse, LOR, breathing, cyanosis, skin Have patient describe exact nature/location of pain, how long it has been present, & whether it has changed Ask about chills, fever, cough, sputum If there is a history of hear disease SAMPLE

28. Chest Pain - Care Emergency Care High Flow O2 Position of comfort Keep Warm If Suspected pneumonia, severe bronchitis, gallbladder attach, pancreatitis or heart attack, Rapid Transport Following Chest Pain is to be considered Serious Chest pain with fever, especially if worsened by coughing or deep breathing Chest pain with shortness of breath, weakness, cyanosis, cold clammy skin Substernal chest pain described as crushing, squeezing, or heavy Chest pain that radiates to the neck, jaw, left shoulder, arm, or both shoulders

29. Gastrointestinal Complaints Gastrointestinal complaints are some of the most common Common Gastrointestinal Complaints Indigestion Diarrhea Blood in Stool Colic Constipation Difficulty Swallowing Jaundice Acute Abdomen

30. Ingestion / Diarrhea / Blood in Stool Ingestion Caused by stress, viral infection, excessive alcohol, overeating, spicy/rich food S&S: Pain, nausea, vomiting Care: Antacids, avoid overeating and spicy foods Diarrhea Usually results from contaminated food or water. Care: mild diarrhea can be controlled by diet recommend non-prescription preparations Blood in Stool Color depends on how long its been in the bowel Bright Red Bleeding from rectum or lower colon Usually from hemorrhoids or fissure of the anus Maroon Upper gastrointestinal tract Usually bleeding of stomach or duodenum Dark Red Partial digestion of blood Usually signifies a serious condition, see a physician

31. Vomiting Vomiting Stomach muscles contract and eject its contents Can be caused by infection, food poisoning, irritating drugs, alcohol, abdominal trauma, ulcers, stomach tumors, high altitude, severe headache, stress, serious injury or illness Serious Effects of Vomiting Loss of fluids and electrolytes - Dehydration Inability to eat - Starvation Aspiration of vomit - Lung Infection Care: Give liquids (with electrolytes is best), small sips, bland food If patient can not keep food down for more then a few hrs, transport to hospital

32. Colic and Jaundice Colic Intermittent, severe abdominal pain caused by obstruction of a hollow tubular organ such as the gallbladder, bowels, or Uretea. Care Apply heat to the abdomen Jaundice Yellow discolouration of the skin, mucous membrane and whites of the eyes. Caused by abnormal accumulation of Bilirubin in the blood. Usually a sign of liver disease or an obstruction of the bile ducts.

33. Acute Abdomen A collective term for several painful abdominal conditions. S&S Pain usually limited to the diseased organ but may spread Fever, Abdominal Pain, Abdominal Tenderness / Rigidity Loss of appetite, nausea and vomiting Some Common Causes Acute Appendicitis Perforation of a peptic ulcer Pancreatitis Intestinal Obstruction Bowel Infarction Sever Kidney Infection Care Keep patient lying down in position of comfort High Flow O2 Monitor vitals Give nothing orally Watch for vomiting

34. Gastrointestinal Assessments Will appear ill not injured BSI Urgent Survey Look for external bleeding SAMPLE Assess Abdomen Note any distention, tenderness, rigidity, scars, enlarged organs, audible bowel movements Note abdominal skin colour, temperature and moisture Tap costrovertebral angles lightly to assess kidney tenderness Check throat & tonsils Check lymph nodes for swelling tenderness

35. Gastrointestinal Emergency Care There is no effective field treatment for patients with vomiting blood, has an abdominal injury, severe rectal bleeding or a severe illness of any type with gastrointestinal symptoms. Patients should be transported rapidly to a hospital ASAP.

36. Genitourinary Complaints Although, potentially serious, most people are hesitant to report genitourinary complaints. Responders must use tact and respect for a patient�s privacy. Common Genitourinary Complaints Painful Urination Blood in Urine Incontinence Inability to Urinate Testicular Torsion Abnormal menstrual Flow Uretharal and Vaginal Discharge