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CHAPTER 17 Respiratory Emergencies Anyone who has experienced respiratory difficulty knows that the inability to breathe is TERRIFYING! Respiratory System Review Anatomy Respiratory System Anatomy The Upper Airway Nasopharynx Oropharynx Epiglottis Vocal cords Trachea The Lower Airway Upper lobe Middle lobe Lower lobe Trachea Due to their anatomy, Infants and children are more prone to respiratory emergencies. Adult (20 mm) Infant (4 mm) Physiology Breathing Inhalation Exhalation Chest contracts Chest relaxes Gas Exchange Alveolus Alveolar/capillary interface Blood Body cells Cellular/capillary interface Blood Capillary Breathing Assessment Adequate Breathing Normal Respiratory Rates Adult: 12 - 20/minute Children: 15 - 30/minute Infants: 25 - 50/minute Normal Breathing Both lungs expand equally Breath sounds are present and equal Chest wall expands equally on both sides Breathing takes place with little effort Listen for breath sounds at four points. Midclavicular Line Midaxillary Line 2 3 4 5 Use a stethoscope to listen to breath sounds. Tidal volume: Amount of air exchanged in one breath. Breathing Difficulty Patients who are breathing TOO FAST or TOO SLOWLY may not be receiving adequate amounts of oxygen. Difficulty Breathing General Shortness of breath Restlessness or anxiety Patient position (preference for sitting up) Altered mental status Skin cool and/or clammy Increased or decreased breathing rate Increased pulse rate (increased or decreased in infants and children) Difficulty Breathing continued Visual Skin color (blue-gray, pale, flushed) Unusual anatomy Retractions/use of accessory muscles Abdominal breathing Nasal flaring Difficulty Breathing continued Auditory Noisy breathing Inability to speak due to breathing efforts Coughing Irregular breathing rhythm Unequal breath sounds Retractions may indicate labored breathing. Sternal Intercostal Substernal Supraclavicular Nasal Flaring Stridor: A harsh sound heard during breathing (usually inhalation) that indicates an upper airway obstruction. Obstruction may be due to: Swelling Mucous Disease Foreign body Barrel Chest Agonal respirations: Gasping respirations that are sudden, short inspirations with long pauses in between. Often occurs just before death - a grave sign! Focused History and Physical Examination O nset P rovocation Q uality R adiation S everity T ime S igns & symptoms A llergies M edications P ertinent medical history L ast oral intake E vents leading to illness Emergency Medical Care Oxygen Use a NRB mask at 15 L/minute. Ventilate as necessary. Oxygen is the most important medication you can give a patient in respiratory distress! Position and Transport Patients should be transported in a position THEY find most comfortable. Artificial Ventilation Mouth-to-mask Ventilation Two-person BVM Technique One-person BVM Technique Inhalers Typical Inhaler Devices Most inhalers (metered-dose inhalers) administer a medication belonging to a class of drugs known as beta-agonist bronchodilators. Inhaler Medications Trade Name Generic Name Proventil albuterol Ventolin albuterol Bronkosol isoetharine Alupent metaproterenol Brethine terbutaline Metaprel metaproterenol Atrovent ipatropium bromide Indications for an Inhaler Signs and symptoms of respiratory distress Patient has own physician-prescribed inhaler Authorization to aid patients in inhaled medications On-line or off-line medical direction Contraindications for an Inhaler Disoriented patients Medications prescribed for someone else Situations with lack of approval (medical direction) Patient has already taken maximum recommended dose Have patient inhale deeply and hold breath. Inhaler with a Spacer Assisting with an Inhaler Check inhaler’s expiration date Ask if any doses have already been taken Compare with prescribed dosage Make sure inhaler is at room temperature Shake inhaler vigorously several times Remove oxygen mask Nasal cannulas can be left in place Assisting with an Inhaler continued Have patient place inhaler in mouth Have patient inhale slowly and deeply while depressing the inhaler Have patient hold breath for as long as comfortable Allow patient to breath a few times, then repeat second dose, if ordered Record time, dose, medication, vital signs and any changes Inhaler Side Effects Increased heart rate Tremors Nervousness Nausea or vomiting Respiratory Diseases Obstructive Airway Disease Emphysema: An abnormal condition of the lungs characterized by overinflation and destructive changes of the alveoli, resulting in decreased lung elasticity and impaired gas exchange. These patients are sometimes referred to as “pink puffers.” Chronic bronchitis: A chronic condition characterized by excessive mucous secretions and inflammatory changes in the bronchial tree. These patients are sometimes referred to as “blue bloaters.” Chronic Obstructive Emphysema Pulmonary Chronic Bronchitis Disease Asthma: A lung disorder characterized by recurring episodes of breathing difficulty, wheezing on exhalation due to constriction of the bronchi, coughing, and lung secretions. Pneumonia: An infection of the lungs that may be caused by bacteria, viruses or fungi. Characterized by fever, shortness of breath and a cough. Hyperventilation: An abnormally high respiratory rate and depth of breathing. CAUTION! Can be caused by anxiety or actual respiratory problems. Hyperventilation Syndrome Increased respiratory rate Numbness and tingling in hands and feet (paresthesias) Muscle spasms in fingers and toes Chest pain associated with respirations Anxiety and agitation SUMMARY Respiratory System Review Breathing Assessment Emergency Medical Care Respiratory Diseases
