Download Unit 3 Respiratory Emergencies

L O’Sullivan 1
Occupational First Aid. Fetac Level 5
Unit 3 Respiratory Emergencies
Learners should be able to:
3.1 Define respiration
Respiration: The act of inhaling and exhaling air in order to exchange oxygen for carbon
dioxide. Synonymous with breathing and ventilation.
3.2 List the component parts of the respiratory system
The purpose of the respiratory system is to move oxygen into the bloodstream through
inhalation and pick up carbon dioxide to be excreted through exhalation.
There are a number of structures that make up the respiratory system. Air enters the body
through the mouth and nose. It moves through the pharynx. Air then proceeds on a path
toward the lungs. A leaf-shaped structure called the epiglottis closes to prevent foods and
foreign objects from entering the trachea during swallowing. The larynx, also known as the
voice box, contains the vocal cords. The trachea or windpipe is the tube that carries inhaled
air from the larynx down toward the lungs. At the level of the lungs, the trachea splits into
two branches called the bronchi. One mainstem bronchus goes to each lung. Inside each lung,
the bronchi continue to branch and split (the branches are called bronchioles) and the air
passages get smaller and smaller. Eventually, each branch ends at a group of alveoli. The
alveoli are the small sacs within the lungs where gas exchange takes place with the
bloodstream.
The diaphragm is the muscular structure that divides the chest cavity from the abdominal
cavity. During a normal respiratory cycle, the diaphragm and other parts of the body work
together to allow the body to inhale and exhale.
3.3 List the functions of the respiratory system
The primary function of the respiratory system is to supply the blood with oxygen in order
for the blood to deliver oxygen to all parts of the body. The respiratory system does this
through breathing. When we breathe, we inhale oxygen and exhale carbon dioxide. This
exchange of gases is the respiratory system's means of getting oxygen to the blood.
Respiration is achieved through the mouth, nose, trachea, lungs, and diaphragm. Oxygen
enters the respiratory system through the mouth and the nose. The oxygen then passes
through the larynx (where speech sounds are produced) and the trachea which is a tube that
enters the chest cavity. In the chest cavity, the trachea splits into two smaller tubes called the
bronchi. Each bronchus then divides again forming the bronchial tubes. The bronchial tubes
lead directly into the lungs where they divide into many smaller tubes which connect to tiny
sacs called alveoli. The average adult's lungs contain about 600 million of these spongy, airfilled sacs that are surrounded by capillaries. The inhaled oxygen passes into the alveoli and
then diffuses through the capillaries into the arterial blood. Meanwhile, the waste-rich blood
from the veins releases its carbon dioxide into the alveoli. The carbon dioxide follows the
same path out of the lungs when you exhale.
The diaphragm's job is to help pump the carbon dioxide out of the lungs and pull the oxygen
into the lungs. The diaphragm is a sheet of muscles that lies across the bottom of the chest
cavity. As the diaphragm contracts and relaxes, breathing takes place.When the diaphragm
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Occupational First Aid. Fetac Level 5
contracts, oxygen is pulled into the lungs. When the diaphragm relaxes, carbon dioxide is
pumped out of the lungs.
3.4 List the percentage of oxygen in inspired and expired air
Air is breathed in through the nostrils and mouth before entering the left and right bronchi of
the lungs. Gas exchange in the lungs occurs in the 150 million alveoli humans have in each
bronchi. The average adult male can inhale approximately 4 litres (close to 4 quarts) of air
with each breath, from which the oxygen is diffused into the alveoli, passes into the blood
through capillaries, and enters the haemoglobin in red blood cells. At the same time, carbon
dioxide in the blood passes to the alveoli and is exhaled. The oxygen content of air is
approximately 21 percent, and the oxygen content of expired air is approximately 15
percent, indicating that only a small proportion of the oxygen in air is captured by the
lungs. The typical water content of air is .5 percent, while the water content of expired air is
approximately 6 percent, demonstrating why rapid respiration is a major route of water loss
in athletes.
The rate of cellular respiration increases with exercise intensity, with vigorous high-intensity
exercise causing a 25-fold increase in the demand for oxygen in working muscles. This
increase in oxygen requirement is satisfied by an increase in the rate and depth of breathing.
However, it is the rising rate of carbon dioxide, rather than the higher demand for oxygen,
that triggers the increased breathing rate. A higher carbon dioxide level causes the medulla to
stimulate the motor nerves controlling the intercostal and diaphragm muscles to increase their
activity.
3.5 State the signs and symptoms of a patient with respiratory difficulties
Persons having difficulty breathing often show signs that they are not getting enough oxygen,
indicating respiratory distress. Below is a list of some of the signs that may indicate that a
person is not getting enough oxygen. It is important to learn the symptoms of respiratory
distress to know how to respond appropriately. Always consult your physician for a
diagnosis.
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breathing rate
An increase in the number of breaths per minute may indicate that a person is having
trouble breathing or not getting enough oxygen.
colour changes
A bluish colour seen around the mouth, on the inside of the lips, or on the fingernails
may occur when a person is not getting as much oxygen as needed. The color of the
skin may also appear pale or gray.
grunting
A grunting sound can be heard each time the person exhales. This grunting is the
body's way of trying to keep air in the lungs so they will stay open.
nose flaring
The openings of the nose spreading open while breathing may indicate that a person is
having to work harder to breathe.
retractions
The chest appears to sink in just below the neck and/or under the breastbone with
each breath - one way of trying to bring more air into the lungs.
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Occupational First Aid. Fetac Level 5
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sweating
There may be increased sweat on the head, but the skin does not feel warm to the
touch. More often, the skin may feel cool or clammy. This may happen when the
breathing rate is very fast.
wheezing
A tight, whistling or musical sound heard with each breath may indicate that the air
passages may be smaller, making it more difficult to breathe.
3.6 List the signs of adequate air exchange
Rate
Rhythm
Quality
Breath Sounds
Chest Expansion
Effort
Adequate Breathing
Inadequate Breathing
Adult: 12-20/minute Child:
15-30/minute Infant: 2550/minute
Above or below normal rate
for patient age group.
Regular
Irregular
Sounds: Diminished, unequal,
or absent. Expansion:
Sounds: Present & equal.
Inadequate or unequal. Effort:
Expansion: Adequate & equal. Labored; increased effort;
Effort: Unlabored; normal
uses accessory muscles;
effort.
seesaw; grunting; retractions
between ribs & above
clavicle.
Inadequate breathing is breathing that is insufficient to support life or normal, healthy
function of the body.
3.7 List the signs of respiratory arrest
Symptoms and Signs
With respiratory arrest, the patient is unconscious, or about to become so, and cyanotic
(unless markedly anaemic). If uncorrected, cardiac arrest follows within minutes from onset
of hypoxia.
Before complete respiratory arrest, patients with intact neurologic function may be agitated,
confused, and struggling to breathe. Patients with respiratory muscle weakness exhibit feeble,
gasping, or irregular respirations and paradoxical breathing movements. Patients with a
foreign body in the airway may choke and point to their necks.
Infants, especially if < 3 months old, may develop acute apnea without warning, secondary to
overwhelming infection, metabolic disorders, or respiratory fatigue.
During apnea there is no movement of the muscles of respiration and the volume of the lungs
initially remains unchanged
3.8 Define asthma
Asthma is characterized by a predisposition to chronic inflammation of the lungs in which
the airways (bronchi) are reversibly narrowed. Asthma affects 7% of the population of the
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Occupational First Aid. Fetac Level 5
United States, 6.5% of British people and a total of 300 million worldwide. During asthma
attacks (exacerbations of asthma), the smooth muscle cells in the bronchi constrict, the
airways become inflamed and swollen, and breathing becomes difficult.
3.9 Define foreign body airway obstruction
Foreign body airway obstruction: Partial or complete blockage of the breathing tubes to the
lungs due to a foreign body (e.g., food, a bead, toy, etc.)
The onset of respiratory distress may be sudden with cough. There is often agitation in the
early stage of airway obstruction. The signs of respiratory distress include labored, ineffective
breathing until the person is not longer breathing (apneic). Loss of consciousness occurs if
the obstruction is not relieved.
3.10 Explain the functions of a barrier device
A barrier device is placed in the casualty’s mouth or over the casualty’s mouth and nose as a
precaution against infection. There are several different types of barrier devices, and all are
easy to use with little modification to the mouth-to-mouth method.
3.11 Describe the correct use of a face shield or facemask
A facemask is a loose-fitting, disposable device that creates a physical barrier between the
mouth and nose of the wearer and potential contaminants in the immediate environment.
Facemasks may be labelled as surgical, laser, isolation, dental or medical procedure masks.
They may come with or without a face shield.
Facemasks are made in different thicknesses and with different ability to protect you from
contact with liquids. These properties may also affect how easily you can breathe through the
facemask and how well the facemask protects you.
If worn properly, a facemask is meant to help block large-particle droplets, splashes, sprays
or splatter that may contain germs (viruses and bacteria) from reaching your mouth and nose.
Facemasks may also help reduce exposure of your saliva and respiratory secretions to others.
While a facemask may be effective in blocking splashes and large-particle droplets, a
facemask, by design, does not filter or block very small particles in the air that may be
transmitted by coughs, sneezes or certain medical procedures. Facemasks also do not provide
complete protection from germs and other contaminants because of the loose fit between the
surface of the facemask and your face.
Facemasks are not intended to be used more than once. If your mask is damaged or soiled, or
if breathing through the mask becomes difficult, you should remove the facemask, discard it
safely, and replace it with a new one. To safely discard your mask, place it in a plastic bag
and put it in the trash. Wash your hands after handling the used mask.
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Patient without suspected Spine Injury: Use of the Pocket face mask
Position yourself beside the patient’s head
Apply the mask to the patient. Use the ridge of the nose as a guide for correct position
Seal the mask by placing your index finger and thumb of the hand closer to the top of
the patient’s head along the top border of the mask.
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Occupational First Aid. Fetac Level 5
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Place the thumb of the hand closer to the patient’s feet on the lower margin of the
mask. Place the remaining fingers of this hand along the bony margin of the jaw.
Lift the jaw while performing a head-tilt, chin-lift manoeuvre
Compress the outer margins of the mask against the face to obtain a seal
Give slow full breaths into the one way valve on the mask
Patient with suspected spine injury
 Position yourself directly above (at the top of) the patient’s head
 Apply the mask to the patient. Use the bridge of the nose as a guide for correct
position
 Place the thumb sides of your hands along the mask to hold it firmly on the face
 Use your remaining fingers to lift the angle of the jaw. Do not tilt the head backward.
 While lifting the jaw squeeze the mask with your thumbs and fingers to achieve a
seal.
 Give slow full breaths into the one way valve on the mask
3.12 Describe the steps in the management of a foreign body airway obstruction in the
responsive and unresponsive adult (child and infant where appropriate)
See Cardiac First Response Training Manual; Pre-Hospital Emergency Care Council pages
21-24
3.13 Demonstrate an open airway using the head tilt technique
See Cardiac First Response Training Manual; Pre-Hospital Emergency Care Council page7
3.14 Demonstrate rescue breathing using mouth-to-mouth, mouth-to-mask or mouth-to-nose
(infants only) techniques
AAOS 2009:Chapter 4
3.15 Recognise the signs of choking in an adult (child and infant where appropriate) and take
the appropriate steps to clear the airway obstruction
See Cardiac First Response Training Manual; Pre-Hospital Emergency Care Council:
Choking Section
3.16 Demonstrate the relief of a foreign body airway obstruction in an unresponsive adult
(child and infant where appropriate)
See Cardiac First Response Training Manual; Pre-Hospital Emergency Care Council:
Choking Section and CPR Section
3.17 Demonstrate the treatment of the patient with respiratory difficulties
When a patient is suffering from breathing difficulty, the following care should be provided:
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assessment of airway and assist respiration with two rescue breaths if unresponsive
position the patient in the most comfortable position which is usually sitting up if
responsives
prescribed inhalers may be used if the patient has one with them. The patient may be
assisted in using this after consultation with medical direction.
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Occupational First Aid. Fetac Level 5
3.18 Demonstrate the treatment of the patient in respiratory arrest
Choking- encourage to cough-Back slaps-Abdominal Thrusts-CPR.
Not Breathing- do ABCs