Download SECTION 2 - Sam Scheller

Section 4: Medical
Emergencies
Chapter 10
Respiratory
Emergencies
Chapter 10: Respiratory Emergencies
Objectives (1 of 2)
• List the structure and function of the
respiratory system.
• State the signs and symptoms of a
patient with difficulty breathing.
• Describe the emergency medical care
of the patient with breathing difficulty.
3
Chapter 10: Respiratory Emergencies
Objectives (2 of 2)
• Distinguish between the emergency medical
care of the infant, child, and adult patient with
breathing difficulty.
• Describe the special considerations due to
high altitude.
• Defend OEC treatment regimens for various
respiratory emergencies.
• Demonstrate the emergency medical care for
breathing difficulty.
4
Chapter 10: Respiratory Emergencies
Respiratory System
5
Chapter 10: Respiratory Emergencies
Anatomy and Function of the Lung
6
Chapter 10: Respiratory Emergencies
Characteristics of Poor
Breathing
• Pulmonary vessels become
obstructed.
• Alveoli are damaged.
• Air passages are obstructed.
• Blood flow to the lungs is obstructed.
• Pleural space is filled.
7
Chapter 10: Respiratory Emergencies
Characteristics of
Normal Breathing
• Normal rate and depth
• Regular breathing pattern
• Good breath sounds on both
sides of the chest
• Equal rise and fall of chest
• Movement of the abdomen
8
Chapter 10: Respiratory Emergencies
Signs of Abnormal Breathing
• Slower than 8 breaths/min or faster
than 24 breaths/min
• Muscle retractions
• Pale or cyanotic skin
• Cool, damp (clammy) skin
• Shallow or irregular respirations
• Pursed lips
• Nasal flaring
9
Chapter 10: Respiratory Emergencies
Dyspnea
• Shortness of breath or difficulty
breathing
• Patient may not be alert enough to
complain of shortness of breath.
10
Chapter 10: Respiratory Emergencies
Upper or Lower Airway
Infection
• Infectious diseases may affect all
parts of the airway.
• The problem is some form of
obstruction to the air flow or the
exchange of gases.
11
Chapter 10: Respiratory Emergencies
Acute Pulmonary Edema
• Fluid build-up in the lungs
• Signs and symptoms
– Dyspnea
– Frothy pink sputum
• History of chronic congestive
heart failure
• Recurrence high
12
Chapter 10: Respiratory Emergencies
Chronic Obstructive
Pulmonary Disease (COPD)
• COPD is the result of direct lung and
airway damage from repeated infections
or inhalation of toxic agents.
• Bronchitis and emphysema are two
common types of COPD.
• Abnormal breath sounds may be
present.
– Rhonchi and wheezes
13
Chapter 10: Respiratory Emergencies
Spontaneous Pneumothorax
• Accumulation of air in
the pleural space
• Caused by trauma or
some medical conditions
• Dyspnea and sharp
chest pain on one side
• Absent or decreased
breath sounds on one
side
14
Chapter 10: Respiratory Emergencies
Asthma or Allergic Reactions
• Asthma is an acute spasm of the
bronchioles.
• Wheezing may be audible without a
stethoscope.
• An allergen can trigger an asthma
attack.
• Asthma and anaphylactic reactions can
be similar.
15
Chapter 10: Respiratory Emergencies
Pleural Effusion
• Collection of fluid outside lung
• Causes dyspnea
• Caused by irritation, infection, or cancer
• Decreased breath sounds over region of
the chest where fluid has moved the lung
away from the chest wall
• Eased if patient is sitting up
16
Chapter 10: Respiratory Emergencies
Mechanical Obstruction of the
Airway
• Be prepared to treat quickly.
• Obstruction may result from the position
of the head, the tongue, aspiration of
vomitus, or a foreign body.
• Opening the airway with the head tiltchin lift maneuver may solve the
problem.
17
Chapter 10: Respiratory Emergencies
Pulmonary Embolism
• A blood clot that breaks off and circulates
through the venous system
• Signs and symptoms
• Dyspnea
• Acute pleuritic pain
• Hemoptysis
• Cyanosis
• Tachypnea
• Varying degrees of hypoxia
18
Chapter 10: Respiratory Emergencies
Hyperventilation
• Overbreathing resulting in a decrease in
the level of carbon dioxide
• Signs and symptoms
–Anxiety
–Numbness
–A sense of dyspnea despite rapid
breathing
–Dizziness
–Tingling in hands and feet
19
Chapter 10: Respiratory Emergencies
Treatment of Dyspnea
• Perform initial assessment.
• Place the patient on oxygen.
• If patient is in respiratory
distress, ventilate.
• Check pulse.
20
Chapter 10: Respiratory Emergencies
Signs and Symptoms (1 of 2)
•
•
•
•
•
•
•
Difficulty breathing
Anxiety or restlessness
Decreased respirations
Cyanosis
Abnormal breath sounds
Difficulty speaking
Accessory muscles
21
Chapter 10: Respiratory Emergencies
Signs and Symptoms (2 of 2)
•
•
•
•
•
•
•
Altered mental status
Coughing
Irregular breathing rhythm
Tripod position
Barrel chest
Pale conjunctivae
Increased pulse and
respirations
22
Chapter 10: Respiratory Emergencies
Emergency Medical Care
• Give supplemental oxygen at 10 to
15 L/min via nonrebreathing mask.
• Patients with longstanding COPD
may be started on low-flow oxygen
(2 L/min).
• Assist with inhaler if available.
• Consult medical control.
23
Chapter 10: Respiratory Emergencies
Inhaler Medications
• Trade names
– Proventil
– Ventolin
– Alupent
– Metaprel
– Brethine
• Generic names
– Albuterol
– Metaproterenol
– Terbutaline
24
Chapter 10: Respiratory Emergencies
Prescribed Inhalers
• Actions
– Relax the muscles surrounding the
bronchioles
– Enlarge the airways leading to easier
passage of air
• Side effects
– Increased pulse rate
– Nervousness
– Muscle tremors
25
Chapter 10: Respiratory Emergencies
Prior to Administration
• Read label carefully.
• Verify it has been prescribed by a
physician for this patient.
• Consult medical control.
• Make sure the medication is indicated.
• Check for contraindications.
26
Chapter 10: Respiratory Emergencies
Contraindications for MDI
• Patient unable to help coordinate
inhalation
• Inhaler not prescribed for patient
• No permission from medical control
• Maximum dose prescribed has been
taken
27
Chapter 10: Respiratory Emergencies
Administration of MDI (1 of 3)
• Obtain order from medical control or local
protocol.
• Check for right medication, right patient,
right route.
• Make sure the patient is alert.
• Check the expiration date.
• Check how many doses have been taken.
28
Chapter 10: Respiratory Emergencies
Administration of MDI (2 of 3)
• Make sure inhaler is at room
temperature or warmer.
• Shake inhaler.
• Stop administration of oxygen.
• Ask the patient to exhale deeply and
put lips around opening.
• If the inhaler has a spacer, use it.
29
Chapter 10: Respiratory Emergencies
Administration of MDI (3 of 3)
• Have the patient depress the inhaler and
inhale deeply.
• Instruct the patient to hold his or her
breath.
• Continue administration of oxygen.
• Allow the patient to breathe a few times,
then repeat dose according to protocol.
30
Chapter 10: Respiratory Emergencies
Reassessment
• Carefully watch for shortness of breath.
• 5 minutes after administration:
– Obtain vital signs again.
– Perform focused reassessment.
• Transport and continue to assess
breathing.
31
Chapter 10: Respiratory Emergencies
Upper or Lower Airway
Infection
• Administer warm, humidified oxygen.
• Do not attempt to suction the airway
or insert an oropharyngeal airway in a
patient with suspected epiglottitis.
• Transport patient in position of
comfort.
32
Chapter 10: Respiratory Emergencies
Acute Pulmonary Edema
• Administer 100% oxygen.
• Suction secretions.
• Transport in position of comfort.
33
Chapter 10: Respiratory Emergencies
Chronic Obstructive
Pulmonary Disease (COPD)
• Assist with prescribed inhaler if
patient has one.
• Transport promptly in position of
comfort.
34
Chapter 10: Respiratory Emergencies
Spontaneous Pneumothorax
• Administer oxygen.
• Transport in position of
comfort.
• Monitor closely.
35
Chapter 10: Respiratory Emergencies
Asthma or Allergic Reactions
• Obtain history.
• Assess vitals signs.
• Assist with inhaler if patient has
one.
• Administer oxygen.
• Transport promptly.
36
Chapter 10: Respiratory Emergencies
Pleural Effusion
• Definitive treatment is
performed in a hospital.
• Administer oxygen and support
measures.
• Transport promptly.
37
Chapter 10: Respiratory Emergencies
Mechanical Obstruction of
the Airway
• Clear airway.
• Administer oxygen.
• Transport promptly.
38
Chapter 10: Respiratory Emergencies
Pulmonary Embolism
• Administer oxygen.
• Place patient in comfortable
position, usually sitting.
• Assist breathing as necessary.
• Keep airway clear.
• Transport promptly.
39
Chapter 10: Respiratory Emergencies
Hyperventilation
• Complete initial assessment and
history of the event.
• Assume underlying problems.
• Do not have patient breathe into
a paper bag.
• Give oxygen.
• Reassure patient and transport.
40