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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