Download Respiratory Emergencies

Respiratory
Emergencies
Chapter 8
Topic Overview
 Anatomy and Physiology
 Adequate and Inadequate breathing
 Airway positioning
 Head/tilt-Chin/lift
 Jaw Thrust
Topic Overview
 Techniques of Artificial Ventilation.
 Rescue Breathing (adult, child, infant)
 Mouth-to-Mask, Bag-Valve Mask, Mouthto-mouth, Mouth-to-nose, Mouth-tostoma rescue breathing.
 Foreign Body Airway Obstruction
 Conscious (adult, child, infant)
 Unconscious (adult, child, infant)
Respiratory Emergencies
 Respiratory Anatomy
 You are responsible for this information
 Respiratory Physiology
 You are responsible for this information
Respiratory Emergencies
 Introduction
 Oxygen
 Essential component
 Inadequate perfusion can have irreversible
effects from organ failure, loss of brain function to
death.
 Any and all Patient Care Situations You Must
 Evaluate, establish and maintain a patent airway
Respiratory Emergencies
 Adequate Respirations
 Inhalation of oxygen and exhalation of
CO2
 Rate and depth are adequate
 Adult - Normal range 12-20 breaths/minute
 Child – Normal range 15-30 breaths/minute
 Infant – Normal range 25-50 breaths/minute
 No abnormal breath sounds
 Air moves freely
 Skin color normal
Respiratory Emergencies
 Inadequate Respirations
 Respiratory failure
 Reduction of breathing to the point where
oxygen intake in insufficient to support life.
 Respiratory Arrest
 Breathing stops completely
Respiratory Emergencies
 Inadequate Breathing
 Signs of breathing but inadequate to support
life
 Rate of breathing or depth of breathing or both
fall outside normal ranges.
 Shallow ventilations
 Diminished or absent breath sounds
 Decreased minute volume
Respiratory Emergencies
 Inadequate Breathing
 General Signs and Symptoms
 Nasal Flaring
 Grunting
 Retractions between the ribs, above the clavicles and
above the sternum
 Increased Pulse Rate
 Decreased Pulse Rate (infants and children)
 Changes in the rate
 Changes in the rhythm
Respiratory Emergencies
 Skin Color
 Central Cyanosis (Lips and Mouth)
 Peripheral Cyanosis (fingers, toes, tip of nose)
 Gray skin color
 Diaphoresis
 Restlessness, anxiety, irritability, drowsiness
 Coughing up sputum
 Clubbing
Respiratory Emergencies
 Noisy breathing
 Crackles (rales)
 Fine, wet, crackling sounds. Air passing through fluid
 Rhonchi
 Coarse, rattling sounds, air passing through mucus
 Wheezes
 High-pitched, musical sounds of narrowed airways
Respiratory Emergencies
 Stridor
 Harsh sounding respirations indicating narrowing or
obstruction
 Pleural friction rub
 Continuous low-pitched, rubbing sound
 Inability to speak full sentences
 Use of accessory muscles to breathe
 Gasping for air
Respiratory Emergencies





Altered mental status
Breathing through pursed lips
Tripod position
Unusual anatomy (barrel chest)
Unusually Slow
 less than 8 bpm in adults or less than 10bpm
for children
Respiratory Emergencies
 Infants and Children
 Can be a very serious problem
 Statistically respiratory conditions are the leading
killer of infants and children
 Airway is smaller thus more easily obstructed
 The tongue is proportionately larger and take up more
space in the mouth
 Trachea is smaller, softer and more flexible in
 More dependant on the diaphragm for respirations.
exhibit a seesaw breathing pattern
Respiratory Emergencies
 Breathing Difficulty Patient Care
 Assessment
 Oxygen
 If breathing adequately – nonrebreather at 12-15
liters per minute.
 Inadequate breathing – BVM or resuscitation
mask with supplement oxygen.
 Positoning
 Sitting up
 Prescribed inhaler
Respiratory Emergencies
 Most Commonly Encountered
Problems
 COPD
 Emphysema
 Chronic Bronchitis
 Asthma
 Hyperventilation
 Anaphylaxis (also covered under shock)
Respiratory Emergencies
 COPD
 Chronic Bronchitis
 Excessive mucus in the airways
 Cilia in bronchioles damaged or destroyed
 Patient typically overweight and cyanotic
 “blue bloater”
Respiratory Emergencies
 Emphysema
 Destroys alveoli
 Decreased ability to exchange oxygen and
wastes
 Lungs lose elasticity and excessive mucus is
formed
 Patient becomes barrel-chested over time
 Typically thin, uses pursed lip breathing and have
pink or reddish skin
 “pink puffer”
Respiratory Emergencies
 COPD
 Hypoxic Drive
 Respirations regulated by the level of oxygen in
the body (they have developed a tolerance to
higher than normal levels of CO2)
 Only a SMALL percentage of COPD patients use
hypoxic drive
 High flow O2 for extended periods of time, could
result in decreased respiratory function - RARE
Respiratory Emergencies
 Asthma
 Bronchioles spasm during exhalation
 Air trapping during exhalation
 Forceful exhalation producing classic
wheezing sound
 Hyper production of thick mucus
 Affects both young and old
Respiratory Emergencies
 Status Asthmatics
 Severe prolonged asthma attack that cannot be
broken despite repeated dosages of epinephrine
 Activate EMS rapidly
 THESE PATIENTS OFTEN DIE
Respiratory Emergencies
 Hyperventilation Syndrome




Rapid breathing (Tachypnea)
Dyspnea
Chest pain
Numbness or tingling in the fingers, toes
and around lips.
 Carpal/Pedal spasms
 Dry mouth
 Lightheadedness
Respiratory Emergencies
 Emotional stress, some medications and
trauma can cause hyperventilation syndrome
 Treatment
 Calm patient
 Oxygen
 End Result
Respiratory Emergencies
 Anaphylaxis
 Severe Allergic Reaction
 A life-threatening problem which requires
immediate attention
 Covered in detail under shock
Respiratory Emergencies
 General Care for Respiratory
Emergencies






Summon more advanced medical personnel
Place patient in a sitting position
Provide Oxygen if available
Maintain body temperature
Help with meds
Monitor vital signs, LOC and initial
assessment
Respiratory Emergencies
 NEVER DENY OXYGEN TO
ANY PATIENT WHO NEEDS IT!
Respiratory Emergencies
 Additional Problems
 Pneumothorax or Hemothorax
 Lung on affected side collapses
 If untreated, a Tension Pneumothorax is created
whereby the mediastinum is shifted over and other lung
is affected
 Sudden dyspnea, chest pain, tachypnea,
diminished breath sounds on one side,
subcutaneous emphysema, progressing to
tracheal deviation
 If due to trauma, sucking chest wound may be
present
Respiratory Emergencies
 Pulmonary Edema
 Causes





Congestive heart failure
Inhaled substances
Narcotic overdose
High altitudes
Compression injuries
 Rapid shallow breathing, crackles, JVD, pink
frothy sputum
Respiratory Emergencies
 Toxic Inhalation
 If the patient has been exposed to a
hazardous chemical or substance
 You should not deal with this patient until
after decontamination has taken place.
 The symptoms you see will depend on what
substance the patient has been exposed to
Respiratory Emergencies
 Carbon Monoxide Inhalation
 Odorless, colorless, tasteless
 Binds 200 times faster to hemoglobin than O2
 Signs and Symptoms






Headache
Seizures
Vomiting
Chest pain
Confusion
Initially cyanosis / near death cherry red lips and nail
beds
Respiratory Emergencies
 Carbon Monoxide Inhalation
 Treatment
 Activation of EMS
 High flow oxygen
 Hyperbaric oxygen therapy
Respiratory Emergencies
 Pickwickian Syndrome
 Very obese patient
 Periods of apnea and somnolence (extreme
drowsiness)
 Complaints of headache, inappropriate dozing,
cyanosis, muscle twitching
 Treatment is supportive, assist ventilations as
needed
Respiratory Emergencies





Injury
Electrocution
Poisoning
Drowning or near-drowning
Infectious Diseases
 Influenza
 Tuberculosis
Respiratory Emergencies
 Dysfunction of the Spinal Cord, Nerves, or
Respiratory Muscles
 Several disease processes can effect spinal cord,
nerves, and or respiratory muscles
 Spinal cord trauma
 Polio
 Myasthenia gravis
 Often times this group of patients require assisted
breathing
 Establish an open airway
 Provide respiratory support
 High flow oxygen
Respiratory Emergencies
 General Care
 Primary Goal
 Establish and maintain an adequate airway







Provide supplemental oxygen
Assist with ventilations
Place patient in a sitting position
Maintain body temperature
Help with meds
Summon more advanced medical personnel
Monitor vital signs, LOC and initial
assessment
Respiratory Emergencies
 It is not enough to
simply make sure the
patient is breathing.
 The patient must be
breathing adequately.
Respiratory Emergencies
Never Deny any
Patient Oxygen Who
Needs It!
Respiratory Emergencies
 Basic Airway Management




Heimlich Maneuver
Chest Thrusts
Infant Airway Obstruction
Manual Airway
 Head-tilt/Chin-lift
 Jaw-Thrust Maneuver
 Application of a cervical collar
Respiratory Emergencies
 Sellick’s Maneuver (Cricoid Pressure)
 Apply slight pressure using the thumb and index
finger to the lateral and anterior aspects of the
cricoid cartilage.
Respiratory Emergencies
 Special Considerations in Rescue
Breathing






Air in the stomach
Vomiting
Mouth-to-nose breathing
Mouth-to-stoma breathing
Victims with dentures
Suspected spinal injuries