Respiratory Distress Emergencies

Medical Respiratory Emergencies

• Obtain and document pulse oximetry reading and waveform capnography reading during assessment and after treatment for all patients with respiratory emergencies.
• Treat any problems as per protocol(s) to address respiratory distress.

Common Presentations of Respiratory Distress

• Rales/Rhonchi
• Wheezing
• Unilateral absence of breath sounds

General Treatment for Respiratory Distress

• Perform Universal Initial Adult Patient Assessment / Care
• Implement Airway Management Protocol
• Initiate ventilation, oxygen, vascular access, and monitoring
• Monitor ECG rhythm, pulse oximetry, waveform capnography, and repeated vital signs assessment.

Medical Respiratory Emergencies

• Obtain and document pulse oximetry reading and waveform capnography reading during assessment and after treatment for all patients with respiratory emergencies.
• Treat any problems as per protocol(s) to address respiratory distress.

Common Presentations of Respiratory Distress

• Rales/Rhonchi
• Wheezing
• Unilateral absence of breath sounds

General Treatment for Respiratory Distress

• Perform Universal Initial Adult Patient Assessment / Care
• Implement Airway Management Protocol
• Initiate ventilation, oxygen, vascular access, and monitoring
• Monitor ECG rhythm, pulse oximetry, waveform capnography, and repeated vital signs assessment.

Respiratory Distress with Rales and/or Rhonchi

• A patient's history is the most useful assessment tool in determining whether respiratory distress with rales and/or rhonchi is due to primarily cardiac or pulmonary causes.

Congestive Heart Failure (CHF)

• Usually a chronic illness with acute exacerbations.
• Patients typically experience SOB for days rather than hours.
• May present with swelling of both lower extremities.
• May be taking diuretics and cardiac medications.
• Patients are frequently more comfortable sitting up.

Cardiac Pulmonary Edema

• Acute pulmonary edema may develop within minutes.
• Patients may have watery, frothy sputum.
• Lung sounds will be progressively absent starting from the bases up as Pulmonary Edema develops.

Treatment for CHF and Cardiac Pulmonary Edema

• Place the patient on CPAP mask device as soon as possible, if available and if the patient is cooperative.
• Administer nitroglycerin:
  • 0.4 mg SL if systolic BP is between 90 mmHg and 160 mmHg, repeat every 3 to 5 minutes if needed as long as the systolic BP remains greater than 90 mmHg or until relief of signs or symptoms.
  • 0.8 mg SL (two tabs) if systolic BP is greater than 160 mmHg, repeat every 3 to 5 minutes if needed as long as the systolic BP remains greater than 160 mmHg or until relief of signs or symptoms.
• Do not administer nitroglycerin if the patient is known or suspected to have taken sexually enhancing drugs and/or drugs prescribed for pulmonary hypertension within the specified time frames (e.g., Viagra/Revatio, Levitra, Cialis/Adcirca).
• Administer furosemide (Lasix) if the patient remains symptomatic after initial interventions and the systolic BP remains above 90 mmHg.
• Administer normal saline, 500 mL IV bolus if the systolic BP is less than 90 mmHg.
• Administer premix dopamine, 400 mg in 250 mL D5W IV/IO, if systolic BP is still below 90 mmHg.

Respiratory Distress with Rales and/or Rhonchi

• A patient's history is the most useful assessment tool in determining whether respiratory distress with rales and/or rhonchi is due to primarily cardiac or pulmonary causes.

Congestive Heart Failure (CHF)

• Usually a chronic illness with acute exacerbations.
• Patients typically experience SOB for days rather than hours.
• May present with swelling of both lower extremities.
• May be taking diuretics and cardiac medications.
• Patients are frequently more comfortable sitting up.

Cardiac Pulmonary Edema

• Acute pulmonary edema may develop within minutes.
• Patients may have watery, frothy sputum.
• Lung sounds will be progressively absent starting from the bases up as Pulmonary Edema develops.

Treatment for CHF and Cardiac Pulmonary Edema

• Place the patient on CPAP mask device as soon as possible, if available and if the patient is cooperative.
• Administer nitroglycerin:
  • 0.4 mg SL if systolic BP is between 90 mmHg and 160 mmHg, repeat every 3 to 5 minutes if needed as long as the systolic BP remains greater than 90 mmHg or until relief of signs or symptoms.
  • 0.8 mg SL (two tabs) if systolic BP is greater than 160 mmHg, repeat every 3 to 5 minutes if needed as long as the systolic BP remains greater than 160 mmHg or until relief of signs or symptoms.
• Do not administer nitroglycerin if the patient is known or suspected to have taken sexually enhancing drugs and/or drugs prescribed for pulmonary hypertension within the specified time frames (e.g., Viagra/Revatio, Levitra, Cialis/Adcirca).
• Administer furosemide (Lasix) if the patient remains symptomatic after initial interventions and the systolic BP remains above 90 mmHg.
• Administer normal saline, 500 mL IV bolus if the systolic BP is less than 90 mmHg.
• Administer premix dopamine, 400 mg in 250 mL D5W IV/IO, if systolic BP is still below 90 mmHg.

This quiz assesses the responder's knowledge of respiratory distress emergencies, including initial assessment, treatment protocols, and common presentations of respiratory distress.