Untitled Quiz

Respiratory Emergencies

• BLS stands for basic life support
• CPR stands for cardiopulmonary resuscitation
• AED stands for Automated External Defibrillator
• ALS stands for Advance Life Support

Overview

• Respiratory System Review
  • Anatomy
  • Physiology
• Breathing Assessment
  • Adequate Breathing
  • Breathing Difficulty
  • Focused History and Physical Examination
• Emergency Medical Care
  • Oxygen
  • Position and Transport
  • Artificial Ventilation
  • Inhalers

The Respiratory System

• The respiratory system takes oxygen from the air and makes it available for the bloodstream to transport to every cell and then removes excess carbon dioxide from the body.

The Airway

• Upper airway
  • Extends from the nose and mouth to the trachea
• Lower airway
  • Extends from the trachea to the alveoli

The Upper Airway

• Nose and mouth
• Pharynx
• Oropharynx
• Nasopharynx
• Epiglottis (leaf-shaped structure that prevents substances like food and liquid from entering the trachea during swallowing)

The Lower Airway

• Trachea (windpipe)
• Cricoid cartilage (firm ring forming the lower portion of the larynx)
• Larynx (voice box)
• Bronchi (two major branches of the trachea that subdivide into smaller air passages, ending at the alveoli)
• Lungs
• Diaphragm

Respiratory Terminology

• Ventilation: The movement of air.
• Respiration: The exchange of gases.

Ventilation

• Inhalation (active)
  • Diaphragm and intercostal muscles contract, increasing the thoracic cavity size
  • Diaphragm moves slightly downward, rib cage flares
  • Ribs move upward/outward
  • This creates negative pressure in the chest cavity and air flows into the lungs
• Exhalation
  • Diaphragm and intercostal muscles relax, decreasing the thoracic cavity size
  • Diaphragm moves upward
  • Ribs move downward/inward
  • Air is expelled from the lungs

Respiration

• Alveolar Respiration:
  • Gas exchange in the lungs
  • Alveolar/capillary exchange: Oxygen-rich air enters the alveoli during inspiration. Oxygen-poor blood passes into the alveoli, oxygen enters the capillaries as CO2 enters the alveoli
• Cellular Respiration:
  • Gas exchange in the tissues of the body
  • Capillary/cellular exchange: Cells give up CO2 to the capillaries; capillaries give oxygen to the cells

Normal Breathing

• Normal respiration should be effortless

Normal Respiratory Rates

• Adult: 12-20 breaths per minute
• Child: 15-30 breaths per minute
• Infant: 25-50 breaths per minute

Assessing Breathing

• Rate
• Rhythm
• Quality
• Breath sounds
• Chest expansion
• Effort of breathing
• Depth (tidal volume)

Effort of Breathing

• Accessory muscles
  • Additional muscles used to draw air into the chest
  • Includes the muscles of the neck, abdomen, and chest
  • Use of accessory muscles is a sign of respiratory distress

Tidal Volume

• The amount of air exchanged in one breath

Considerations for Infants and Children

• Mouth and nose: Generally all structures are smaller and more easily obstructed than in adults.
• Tongue: Infants' and children's tongues take up proportionately more space in the mouth than adults.
• Trachea: Narrower tracheas that are obstructed more easily by swelling; softer and more flexible in infants and children
• Cricoid cartilage: Less developed and less rigid
• Chest wall: Softer
• Breathing: Tend to depend more heavily on the diaphragm for breathing

Focused History and Physical Examination

• OPQRST

  • Onset
  • Provocation
  • Quality
  • Radiation
  • Severity
  • Time

• SAMPLE

  • Signs and symptoms
  • Allergies
  • Medications
  • Past medical history
  • Last oral intake
  • Events leading to injury or illness

• Remember that a physical exam is required for all patients

• In responsive patients, assess the body systems associated with the chief complaint

Hematemesis and Hemoptysis

• Hematemesis: Vomiting of blood (dark red or coffee ground); shows upper gastrointestinal bleeding
• Hemoptysis: Coughing out blood (bright red mixed with sputum); seen in severe pneumonia, terminal stages of cancer and tuberculosis

Emergency Medical Care

• Administer high-flow oxygen
• Oxygen is the most important medication you can administer to a patient with respiratory distress
• Position and Transport: Patients should be transported in a position most comfortable for them
• Artificial Ventilation:
  • Preferred ventilation techniques
    • Mouth-to-mask
    • Two-person bag-valve-mask
    • Flow-restricted, oxygen-powered ventilation device
    • One-person bag-valve-mask.

Chronic Obstructive Pulmonary Disease (COPD)

• COPD encompasses several disease processes:
  • Emphysema
  • Chronic bronchitis
  • Asthma

Emphysema

• An abnormal condition of the lungs characterized by overinflation and destructive changes in the alveoli, resulting in decreased lung elasticity and impaired gas exchange

Chronic Bronchitis

• A chronic condition characterized by excessive mucous secretions and inflammatory changes in the bronchial tree

Asthma

• A lung disorder characterized by recurring episodes of breathing difficulty, wheezing due to constriction and spasm of the bronchi, coughing, and lung secretions

Inhalers

• Typical inhaler devices

• Most inhalers used to treat respiratory distress are beta-agonist inhalers

  • List of trade names and generic names for common inhalers given

• Indications

  • Exhibits signs and symptoms of respiratory emergency
  • Has physician-prescribed, hand-held inhaler
  • Specific authorization by medical direction

• Contraindications

  • Inability of patient to use device
  • Inhaler is not prescribed for the patient
  • No permission from medical direction
  • Patient has already met maximum prescribed dose prior to EMT-Basic's arrival

• Assisting with an inhaler

  • Check inhaler's expiration date
  • Determine if patient has previously taken any doses
  • Make sure the inhaler is at room temperature
  • Shake inhaler vigorously several times
  • Remove oxygen mask
  • Nasal cannula can be left in place
  • Have patient place inhaler in mouth
  • Have patient inhale slowly and deeply while depressing the inhaler
  • Have the patient inhale deeply and hold his or her breath so medication can be absorbed
  • Allow patient to breath a few times, then repeat the dose if it is ordered
  • Record time, dose, medication name, vital signs, and any changes in the patient's condition

• Side effects

  • Increased heart rate
  • Tremors
  • Nervousness
  • Nausea or vomiting