Respiratory Emergencies: Anatomy and Physiology

• Respiratory emergencies impair the body's ability to exchange oxygen and carbon dioxide effectively.
• These emergencies range from mild breathing difficulties to complete respiratory arrest.
• Prompt recognition and intervention by Emergency Medical Technicians (EMTs) is crucial.

Anatomy and Physiology Review

• The respiratory system includes the upper and lower airways, lungs, and associated muscles.
• The upper airway consists of the nose, mouth, pharynx, and larynx, warming, filtering, and humidifying incoming air.
• The lower airway contains the trachea, bronchi, bronchioles, and alveoli, where gas exchange occurs.
• Ventilation is the mechanical process of moving air in and out of the lungs.
• Respiration is the physiological process of gas exchange at the alveolar level.
• Adequate breathing necessitates both sufficient ventilation and respiration for delivering oxygen to cells and removing carbon dioxide.

Common Causes of Respiratory Emergencies

• Asthma is a chronic inflammatory disorder characterized by reversible airway obstruction, bronchial hyperresponsiveness, and inflammation.
• COPD (Chronic Obstructive Pulmonary Disease) includes emphysema and chronic bronchitis, causing airflow obstruction.
• Pneumonia is a lung infection causing inflammation and fluid or pus-filled alveoli.
• Pulmonary Embolism involves a blood clot blocking a pulmonary artery, impairing blood flow and gas exchange.
• Hyperventilation Syndrome involves rapid, deep breathing, often due to anxiety or panic, leading to excessive carbon dioxide elimination.
• Airway Obstruction involves blockage of the upper or lower airway (foreign object, swelling, or secretions).
• Trauma to the chest, lungs, or airway can impair respiratory function.
• Allergic Reactions (anaphylaxis) can cause airway swelling and bronchoconstriction.

Assessment of Respiratory Emergencies

• During scene size-up, evaluate the scene for safety hazards and clues to the nature of the illness or injury.
• For the initial assessment, form a general impression of the patient's condition, level of consciousness, and signs of respiratory distress.
• Assess the airway's patency and intervene to open and maintain it.
• Evaluate breathing rate, rhythm, and quality; look for respiratory distress signs (accessory muscle use, nasal flaring, and cyanosis).
• Assess pulse rate, strength, and skin color, temperature, and condition to evaluate perfusion.
• Obtain a SAMPLE history (Signs/Symptoms, Allergies, Medications, Past history, Last oral intake, Events) to gather information.
• During a physical examination, auscultate lung sounds, assess chest wall movement, and look for signs of trauma or underlying conditions.
• Measure and record vital signs, including respiratory rate, heart rate, blood pressure, oxygen saturation, and temperature.
• Pulse oximetry measures the percentage of hemoglobin saturated with oxygen (SpO2).
• Normal SpO2 is typically 95-100%, but acceptable levels may vary.
• Capnography measures carbon dioxide in exhaled air, providing information about ventilation and perfusion.

Signs and Symptoms of Respiratory Distress

• Dyspnea is shortness of breath or difficulty breathing.
• An increased respiratory rate (tachypnea) is a common sign of respiratory distress.
• An altered respiratory rhythm (irregular or uneven breathing patterns) may indicate a serious respiratory problem.
• The use of accessory muscles involves the neck, chest, or abdominal muscles assisting breathing.
• Nasal flaring involves widening of the nostrils during inhalation, especially in infants and children.
• Cyanosis is a bluish discoloration of the skin and mucous membranes due to inadequate oxygenation.
• Wheezing is a high-pitched whistling sound during exhalation, associated with asthma or bronchospasm.
• Stridor is a high-pitched crowing sound during inhalation, indicating upper airway obstruction.
• A cough may be productive (with sputum) or non-productive (dry).
• Chest pain may indicate a pulmonary embolism, pneumonia, or other respiratory or cardiac problem.
• Altered mental status presents as confusion, agitation, or decreased level of consciousness due to hypoxia or hypercapnia.

Treatment of Respiratory Emergencies

• Ensure a patent airway, using manual maneuvers (head-tilt/chin-lift or jaw-thrust) or airway adjuncts (oropharyngeal or nasopharyngeal airway).
• Suction the airway to clear secretions, blood, or vomit using a suction device.
• Administer supplemental oxygen to increase the patient's oxygen saturation.
• Non-Invasive Positive Pressure Ventilation (NPPV), like CPAP or BiPAP, may assist ventilation in patients with respiratory distress.
• Administer medications per local protocols and medical direction (bronchodilators for asthma or epinephrine for anaphylaxis).
• Position the patient to facilitate breathing, usually the semi-Fowler's position.
• Continuously monitor the patient's vital signs, oxygen saturation, and response to treatment.
• Provide psychological support to reassure and calm the patient to reduce anxiety and improve breathing.

Specific Respiratory Conditions and Management

• For Asthma, administer oxygen, assist with bronchodilator inhalers, and monitor respiratory status closely.
• For COPD, administer oxygen cautiously (excessive oxygen can suppress the hypoxic drive); assist with bronchodilator inhalers and monitor respiratory status.
• For Pneumonia, administer oxygen, monitor respiratory status, and transport to the hospital.
• For Pulmonary Embolism, administer oxygen, monitor respiratory status, and transport to the hospital.
• For Hyperventilation Syndrome, provide reassurance and coach the patient to slow their breathing; consider oxygen therapy if SpO2 is low.
• For Airway Obstruction, perform abdominal thrusts (Heimlich maneuver) for conscious patients or chest thrusts for pregnant or obese patients; use direct laryngoscopy and Magill forceps to remove the obstruction in unconscious patients, if visible.
• For Anaphylaxis, administer epinephrine via intramuscular injection, administer oxygen, and monitor respiratory status closely.

Pediatric Considerations

• Respiratory distress is a common emergency in children and requires special attention.
• Children have smaller airways and higher metabolic rates, making them more susceptible to respiratory problems.
• Signs of respiratory distress in children include nasal flaring, retractions, grunting, and head bobbing.
• Management of pediatric respiratory emergencies includes ensuring a patent airway, administering oxygen, and providing ventilatory support as needed.
• Use appropriately sized equipment and adjust medication dosages based on the child's weight.

Documentation

• Document all assessment findings, interventions, and patient responses thoroughly and accurately.
• Include information such as the patient's history, physical examination findings, vital signs, oxygen saturation, medications administered, and any changes in condition.
• Proper documentation is essential for continuity of care and legal protection.

Legal and Ethical Considerations

• Obtain consent from the patient or legal guardian before providing treatment, if possible.
• Follow local protocols and medical direction when providing care.
• Respect the patient's autonomy and right to refuse treatment.
• Maintain patient confidentiality and protect their privacy.

Overview of respiratory emergencies, including anatomy and physiology. Covering upper and lower airways, ventilation, and respiration. Essential knowledge for Emergency Medical Technicians (EMTs) to recognize and intervene in respiratory distress cases.