October 2016 EMS CE: Respiratory assessment (Adult), capnography

1. October 2016 EMS CE: Respiratory assessment (Adult), capnography IDPH Site Code: 107200E-1216 Teresa Ehrhardt BSN, RN, TNS

2. Objectives Upon successful completion of this module, the EMS provider will be able to: • Discuss the steps necessary to perform an assessment of the patient’s respiratory system. • Interpret lung sounds when presented with a variety of audible recordings. • Choose the appropriate Region X SOP intervention based on scenario presentation of respiratory complaint. • Review the benefits of capnography and how it is used in the field. • Justify a diagnosis based on the waveform capnography reading and patient signs and symptoms. • Actively participate in group interpretation of a variety of waveforms for capnography. • Actively participate in ventilating a manikin at the appropriate ventilation rate for the situation. • Successfully demonstrate the correct ventilation rate via BVM and via an advanced airway device. • Successfully demonstrate measurement and placement of an oropharyngeal and nasopharyngeal airway in a manikin. • Successfully demonstrate the ability to assemble nebulizer kits for in-line administration • Successfully complete the post quiz with a score of 80% or better.

3. Respiratory A & P

4. Upper Airway

5. Lower Airway

6. Gas Exchange

7. Respiratory Assessment in the Adult • RESPIRATORY ASSESSMENT CONSISTS OF 3 PARAMETERS • Respiratory Rate • Respiratory Effort • Quality of Respiration Assessed by • Inspection (Visualization) • Palpation (Feel) • Percussion (Tap) • Auscultation (LISTEN)

8. Inspection • Form your general impression (LOOK!) • Chest • Is it uniform? • Is the chest wall movement symmetrical? • Is the A-P diameter large? • Is there any sign of trauma?

9. Palpation • Feel for abnormalities • Feel for tenderness • Feel for loose segments • Feel for crepitus • Feel for vibrations (fremitus)

10. Percussion • Determine if underlying tissues are air filled, fluid filled, or solid • Determine the position of the diaphragm • Note if percussion is different on one side

11. Auscultation • Listen to the chest • Evaluate sounds heard • Differentiate between vesicular and adventitious breath sounds

12. Let’s Listen Common Lung Sounds

13. Putting it all together • Video

14. Capnography • Understand M-V-P • Metabolism • Ventilation • Perfusion

17. Capnography Why Capnography???

18. Capnography Waveforms

19. Respiratory Emergencies Airway Obstruction, Pulmonary Edema, COPD, Asthma

20. Upper Airway obstruction • Tongue • Foreign body • Trauma • Burns • Allergic reaction

21. Pulmonary Edema • Cardiogenic pulmonary edema • Non-cardiogenic pulmonary edema • Causes • Presentation • Tests and studies • Treatment Video

22. COPD • Chronic Obstructive Pulmonary Disease • Symptoms • Causes • Risk Factors • Complications • Treatment

23. Asthma • Symptoms • Causes • Risk Factors • Complications • Treatment

24. Ready, set, Scenarios

25. Sample Scenario • It’s 3 am and you are called to a residence for a 64 year old man in respiratory distress. You find him sitting up in bed with feet dangling off the end. He presents in obvious distress and cannot speak due to the shortness of breath. Lung fields are very diminished with crackles. He is pale, diaphoretic, and appears to be getting weaker. Family tells you that he has a bad heart and takes a “heart pill”, and a “water pill”. While in your presence the pt becomes obtunded with labored breathing. He still has a gag reflex.

26. Scenario Cont…

27. Skills Stations • Intubation • BVM Ventilation • Capnography • Airway Adjuncts- Nasopharyngeal and oropharyngeal airways • Nebulizer assembly

28. References • https://acls-algorithms.com/waveform-capnography/ • http://what-when-how.com/wp-content/uploads/2012/04/tmp2A92_thumb221.jpg • https://vanessajunkin.files.wordpress.com/2013/06/waveform.jpg • http://www.mayoclinic.org/diseases-conditions • Bledsoe, Porter, Cherry. Paramedic Care Principles & Practice 4th Ed. Brady. 2013.