Chapter 19 Respiratory Emergencies

2. Chapter 19Respiratory Emergencies

3. Objectives • There are no 1985 objectives for this chapter.

4. Respiratory Emergencies • Dyspnea • Difficulty breathing • Common chief complaint • COPD • Impedes normal functioning • Learn the signs and symptoms. • Feeling air-starved is frightening, no matter what the cause.

5. Anatomy and Function of the Lungs • Structures that contribute to breathing • Upper and lower airways • Lungs • Diaphragm • Path of air travel • Principle function of the lungs • Respiration • Diffusion

6. Lung Disorders • Pulmonary vessels are prevented from absorbing oxygen, and releasing carbon dioxide. • Alveoli are damaged. • Air passages are obstructed. • Blood flow to the lungs is obstructed. • Pleural space is filled with air or fluid.

7. Normal Respiratory Drive • Brainstem senses carbon dioxide levels in arterial blood. • Carbon dioxide level surrounding the brain stem is what stimulates breathing. • When the carbon dioxide levels are too low, rate and depth of breathing decrease, and vice versa.

8. Adequate Breathing • Normal rate and depth • Regular pattern of inhalation and exhalation • Good audible, bilateral breath sounds • Equal, bilateral chest rise and fall • Pink, warm, and dry skin

9. Inadequate Breathing • Rate that falls out of the range of 12-20 breaths/min • Reduced flow of expired air • Muscle retractions or pursed lips • Diminished, noisy, or absent breath sounds • Unequal chest wall movement • Pale, cool, cyanotic skin • Shallow, irregular respirations

10. Rising Levels of Carbon Dioxide • Lung disorders • Excessive carbon dioxide production • Chronic carbon dioxide retention • Hypoxic drive

11. Causes of Dyspnea (1 of 2) • Acute pulmonary edema • Airway obstruction • COPD • Asthma or allergic reaction • Rib fractures • Spontaneous pneumothorax • Upper or lower airway infections

12. Causes of Dyspnea (2 of 2) • Pleural effusion • Pulmonary thromboembolism • Hyperventilation syndrome • Prolonged seizures • Use of CNS depressant drugs • Neuromuscular disease

13. Upper or Lower Airway Infection • Some can cause mild discomfort, whereas others can be life threatening • Some form of obstruction • Flow of air • Exchange of gases • Diseases associated with dyspnea

14. Acute Pulmonary Edema • Two categories • High pressure • High permeability • Accumulation of fluids • Myocardial damage • Patients can present with: • Dyspnea/orthopnea • Fatigue/pulmonary rales

15. Management of Cardiogenic Pulmonary Edema • Place in position of comfort. • Assess the airway, provide oxygen. • Establish IV access. • Monitor flow rates to avoid fluid excess. • Consider NTG. • Transport to nearest appropriate facility.

16. Management of Noncardiogenic Pulmonary Edema • Place in position of comfort. • Manage ABCs. • Transport to the nearest appropriate facility. • Remove patient from toxins/underlying problems. • Provide reassurance.

17. Obstructive Airway Disease • Encompasses diseases that affect people worldwide • COPD • Asthma • Exacerbation of underlying conditions • Internal • External

18. Obstruction • Occurs in the bronchioles • May result from smooth muscle spasm or mucous production • May be reversible or irreversible • Caused by air trapping • Affects 10-20% of the U.S. population • Many causes; cigarette smoking most common

19. COPD • Chronic bronchitis • Constant, excess mucous production • Productive cough for at least 3 months/yr • “Blue bloaters” • Emphysema • Surfactant • Irreversible condition • “Pink puffers”

20. Commonalities of COPD Patients • Sputum production • Chronic cough • Difficulty expelling air • Long expiration times • Wheezing • Usually older than 50 years of age • Hx of recurring lung problems • Long-term cigarette smokers

21. Abnormal Breath Sounds • Rales • Fine, crackling sounds • Chronic scarring of small airways • Rhonchi • Coarse rattling sounds • Mucous in large airways • Wheezing • Whistling sounds • Heard on expiration

22. Common Complaints/Hx/Signs • Chest tightness • Fatigue • Recent “chest cold” • Normal BP • Rapid, sometimes irregular pulse • Respirations either rapid or slow

23. Asthma • Affects 6 million Americans • Kills 4,000-5,000 people yearly • “Audible wheezing” or no sounds • Reversible condition • Common causes • Allergic reaction • Exercise or stress • Upper respiratory infection

24. Assessment Findings • Signs of respiratory impairment • Inability to speak freely • Common chief complaints • Dyspnea, cough, nocturnal dyspnea • Obtain thorough history • Determine possibility of acute exposure • Other common signs • Retractions

25. Management of Asthma • Place in position of comfort. • Monitor the airway. • Provide high-flow oxygen. • Initiate IV access. • Assist with MDI.

26. Anaphylaxis • Characterized by: • Airway swelling • Dilation of blood vessels • Can significantly lower BP • Can be associated with itching and asthma-like condition • Most occur within 30 minutes of exposure • Oxygen, epinephrine, antihistamines

27. Hay Fever • Caused by allergic reaction to substances such as pollen, molds, and grasses • Generally does not produce major emergency problems • Signs are a stuffy/runny nose and sneezing

28. Spontaneous Pneumothorax • Vacuum pressure in the pleural space • Accumulation of air in the pleural space • Caused by medical conditions • Pleuritic chest pain • Subcutaneous emphysema • Some severe findings: • Altered mental status • Cyanosis

29. Management of Spontaneous Pneumothorax • Monitor ABCs. • Provide high-flow oxygen. • Watch for signs of tension pneumothorax. • Initiate IV access. • Place patient in a position of comfort. • Call ALS if needed.

30. Pneumonia • Infection of lung parenchyma • Most commonly bacterial • Fifth leading cause of death in the U.S. • Risk factors • Cigarette smoking • Alcoholism • Exposure to the cold • Very young or old

31. Management of Pneumonia • ABCs • Ventilatory support PRN • High-flow oxygen • IV fluids • Cool if high fever present

32. Pleural Effusion (1 of 2) • Cause dyspnea. • Response to irritation, infection, or cancer. • Should be considered a possibility in lung patients with SOB. • Decreased lung sounds where fluid has moved the lung away from the chest wall. • Most patients feel better sitting upright. • Fluid must be removed by a physician.

33. Pleural Effusion (2 of 2)

34. Mechanical Airway Obstruction • Semi- and unconscious patients can have an obstruction as the result of a foreign body or the tongue. • Always consider upper airway obstruction from a foreign object first in patients who were just eating. • Can be the result of trauma, edema, mucous accumulation, or muscle spasm.

35. Pulmonary Thromboembolism • Embolus – anything that obstructs distal blood flow • May occur from damage to the lining of the vessels, tendency of blood to clot fast, or blood flow in a lower extremity • Some risk factors • Bedridden patients, prolonged inactivity, recent surgery, and oral contraceptives

36. Signs and Symptoms • Acute dyspnea/pleuritic chest pain • Hemoptysis • Cyanosis • Tachypnea • Varying degrees of hypoxia • Tachycardia • Normal breath sounds or wheezing

37. Management of Pulmonary Thromboembolism • Provide high-flow oxygen. • Assist with ventilations PRN. • Initiate CPR PRN. • Initiate IV access. • Give fluid for hydration based on clinical symptoms. • Transport to nearest appropriate facility.

38. Hyperventilation Syndrome • Defined as overbreathing to the point at which the level of arterial carbon dioxide falls below normal. • Most common physical findings: • Rapid breathing with high minute volume • Carpopedal spasms • Diagnosis should occur in hospital.

39. Management of Hyperventilation Syndrome • Provide psychological support. • Have the patient mime your breathing. • Never withhold oxygen. • Rate of oxygen is based on symptoms and pulse oximetry readings. • Never use a paper bag. • Transport to closest facility.

40. Emergency Care of Respiratory Emergencies • Pay attention to respirations while gathering vital signs. • Administer oxygen. • Provide reassurance. • Reassess the patient every 5 minutes. • Never withhold oxygen. • Assist breathing via BVM if necessary.

41. Scene Size-Up and Initial Assessment • Assure safe environment. • Recognize and treat life threats. • Some signs of life-threatening respiratory distress • Altered mental status • Absent breath sounds • 1- to 2-word dyspnea • Tachycardia

42. Approach to the Patient in Respiratory Distress • Obtain a general impression • Signs and symptoms • Determine whether breathing is adequate • Focused history and physical exam • C/C • OPQRST • Vital signs • Determine respiratory pattern

43. Management • Provide high-flow oxygen. • Ensure a patent airway. • Provide positive pressure ventilation PRN. • Consider a dual-lumen airway. • Obtain vital signs and a SAMPLE history. • Assist with MDI. • Use IV and cardiac monitor.

44. Prescribed Inhalers • Inhaled beta agonists • Selective beta-2 receptors in the lungs • Albuterol, metaproterenol, terbutaline • Common side effects • Tachycardia • Nervousness • Muscle tremors • Ensure no contraindications prior to administration

45. Administration of MDIs • Obtain an order. • Check the “6 rights.” • Shake MDI vigorously. • Provide instructions if needed. • Apply spacer if one’s available. • Replace oxygen after administration. • Repeat per protocol. • Reassess during transport.