Respiratory Emergencies for EMS
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Questions and Answers

What is the primary goal of pre-hospital care in acute respiratory distress?

  • To treat reversible bronchial constriction (correct)
  • To stabilize the patient's blood pressure
  • To administer high doses of oxygen
  • To minimize patient fluid intake
  • Which of the following is NOT a medication used in the treatment of asthma?

  • Salbutamol (albuterol)
  • Aspirin (correct)
  • Bronchodilator agents
  • Ipratropium bromide
  • In which condition is oxygen use carefully titrated to prescribed saturation levels?

  • Chronic obstructive pulmonary disease (COPD) exacerbations (correct)
  • Anaphylactic shock
  • Acute pulmonary edema
  • Pneumonia
  • What is a benefit of using a metered-dose inhaler during a respiratory emergency?

    <p>It allows for precise dosing of medication (D)</p> Signup and view all the answers

    What type of mask is used for providing oxygen with controlled flow rates?

    <p>Venturi mask (C)</p> Signup and view all the answers

    What is the most common disease classified under Chronic Obstructive Pulmonary Disease (COPD)?

    <p>Chronic bronchitis (D)</p> Signup and view all the answers

    Why do chronic COPD patients require a mild degree of hypoxia to continue breathing?

    <p>They have a hypoxic respiratory drive. (C)</p> Signup and view all the answers

    What is an adequate SpO2 level for patients with COPD?

    <p>In the low 90s (C)</p> Signup and view all the answers

    Which medications are commonly used to manage COPD?

    <p>Steroids and bronchodilators (C)</p> Signup and view all the answers

    What is a potential risk of administering too much oxygen to COPD patients?

    <p>Decreased respiratory drive (C)</p> Signup and view all the answers

    What primarily characterizes asthma?

    <p>Typically reversible airway obstruction (C)</p> Signup and view all the answers

    Which phase is NOT a part of asthma?

    <p>Broadening of airways (B)</p> Signup and view all the answers

    What is the main purpose of selective bronchodilators?

    <p>To specifically target bronchial smooth muscle (A)</p> Signup and view all the answers

    What does a metered-dose inhaler (MDI) deliver?

    <p>Predetermined amounts of medication (A)</p> Signup and view all the answers

    What can occur if an MDI is used improperly?

    <p>Medication will not reach intended site in lung (C)</p> Signup and view all the answers

    What is the function of a spacer device when using an MDI?

    <p>To slow the forward movement of particles (D)</p> Signup and view all the answers

    What is the most common inhaled drug used to treat reversible bronchospasm in asthma?

    <p>Salbutamol (albuterol) (B)</p> Signup and view all the answers

    Which type of nebulizer uses gas to drive medication conversion?

    <p>Pneumatic nebulizer (D)</p> Signup and view all the answers

    What condition may require the administration of Ipratropium bromide?

    <p>Acute severe or life-threatening asthma (B)</p> Signup and view all the answers

    What is a key factor in respiratory distress associated with asthma?

    <p>Edema of respiratory tract mucosa (D)</p> Signup and view all the answers

    At what pressure is oxygen stored in green/aluminum cylinders?

    <p>1,800-2,400 psi (B)</p> Signup and view all the answers

    What is the concentration of inspired oxygen (FiO2) in normal room air?

    <p>21% (C)</p> Signup and view all the answers

    Which of the following is an intrinsic trigger for asthma?

    <p>Stress-related anxiety (B)</p> Signup and view all the answers

    Which oxygen delivery device can provide an oxygen concentration of 90%?

    <p>Nonrebreather face mask (D)</p> Signup and view all the answers

    When should corticosteroids be considered during an acute exacerbation of asthma?

    <p>If prolonged transport time is likely and PEFR does not improve (C)</p> Signup and view all the answers

    What role does Adrenaline play in treating life-threatening asthma?

    <p>It stimulates alpha and beta cells, relieving bronchospasm. (D)</p> Signup and view all the answers

    What is the flow rate range for a nasal cannula?

    <p>1-6 L/min (D)</p> Signup and view all the answers

    How does a Venturi mask alter oxygen concentration?

    <p>By adjusting plastic inserts (D)</p> Signup and view all the answers

    What are the indications for administering Hydrocortisone during an acute exacerbation of asthma?

    <p>To suppress inflammation and immune response (C)</p> Signup and view all the answers

    What is a primary symptom indicating an acute exacerbation of asthma?

    <p>Gasping for breath and use of accessory muscles (D)</p> Signup and view all the answers

    What percentage of oxygen can a simple/partial rebreather mask deliver?

    <p>35-60% (D)</p> Signup and view all the answers

    How far should a metered-dose inhaler (MDI) be held from the mouth when it is not available?

    <p>2 inches (C)</p> Signup and view all the answers

    What type of mask is often used by COPD patients?

    <p>Venturi mask (B)</p> Signup and view all the answers

    What method do nebulisers use to deliver medication to the lungs?

    <p>Compressed air or ultrasonic power (A)</p> Signup and view all the answers

    Flashcards

    Acute Respiratory Distress

    A condition affecting many people, characterized by difficulty breathing.

    Bronchospasm Treatement

    In most respiratory emergencies, reversible bronchial constriction is targeted for treatment.

    Oxygen use in Respiratory Emergencies

    Oxygen is a common medication in pre-hospital care, but its use in respiratory emergencies should be carefully monitored and individualized to each patient.

    Bronchodilator agents

    Medical substances that relax the bronchial muscles to improve breathing.

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    Asthma treatment: Salbutamol (albuterol) and ipratropium bromide

    First-line medications for asthma treatment, used to relax airways during an asthma attack.

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    Oxygen Cylinder Pressure

    Oxygen is stored at high pressure (1800-2400 psi) in cylinders, then reduced to 60 psi for use.

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    Fraction of Inspired Oxygen (FiO2)

    The percentage of oxygen in the air a patient breathes in.

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    Normal Room Air FiO2

    21% in normal room air.

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    Nasal Cannula

    A device that delivers low-flow oxygen through prongs in the nostrils.

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    Nasal Cannula Flow Rate

    1-6 L/min, delivers 24-44% oxygen.

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    Non-rebreather Mask

    Delivers high-flow oxygen (12-15 L/min) with a reservoir to prevent exhaled oxygen reentry.

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    Venturi Mask

    Delivers specific oxygen concentrations (24%, 28%, 35%, or 40%) using adjustable inserts.

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    Nebuliser

    Uses oxygen or compressed air to convert liquid medicine into a mist for lung treatment.

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    COPD

    A group of lung diseases that cause airflow obstruction and breathing difficulties.

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    Hypoxic Drive

    A situation where someone's breathing is triggered by low oxygen levels in the blood, rather than increased carbon dioxide levels.

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    Why shouldn't COPD patients receive too much oxygen?

    Because COPD patients rely on low oxygen levels to stimulate breathing. Too much oxygen can suppress this drive, leading to respiratory failure.

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    Salbutamol

    A common medication used to treat asthma and other respiratory conditions by relaxing the muscles in the airways, opening them up.

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    Ipratropium Bromide

    A bronchodilator medication used to relax the muscles in the airways, often used in combination with salbutamol to treat asthma and COPD.

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    MDI Distance

    When a Metered Dose Inhaler (MDI) is not available, hold it 2 inches away from the patient's mouth.

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    Asthma Triggers

    Asthma can be triggered by factors inside (intrinsic) or outside (extrinsic) the body.

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    First-line Asthma Medication

    Inhaled beta2 drugs are the first-line treatment for asthma.

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    Salbutamol (Albuterol)

    Salbutamol (Albuterol) is a commonly used inhaled drug to treat reversible bronchospasm.

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    Second-line Asthma Therapy

    If asthma symptoms persist despite bronchodilators, corticosteroids may be considered in the prehospital setting.

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    Peak Expiratory Flow Rate (PEFR)

    PEFR measures the maximum speed of air exhaled, helping assess asthma severity and response to treatment.

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    Severe Asthma Medications

    In severe or life-threatening asthma, hydrocortisone and adrenaline are administered to suppress inflammation and relieve bronchospasm respectively.

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    What is Asthma?

    Asthma is a chronic lung condition characterized by reversible airway obstruction due to inflammation and bronchospasm. This means the airways become narrower, making it difficult to breathe.

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    What causes Bronchospasm?

    Bronchospasm is a rapid tightening of the muscles around the airways in the lungs, causing them to constrict and narrow. This can be triggered by allergens, irritants, exercise, or other factors.

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    Phases of Asthma

    Asthma involves three distinct phases: 1) Airway narrowing due to inflammation, 2) Bronchial spasm (muscle tightening), and 3) Increased mucus production. These combined make breathing difficult.

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    What is edema in Asthma?

    Edema in asthma refers to swelling of the lining of the airways. This swelling adds to the airway narrowing, further restricting airflow and making breathing difficult.

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    Nonselective Bronchodilators

    Nonselective bronchodilators act on multiple types of receptors in the body, including alpha, beta1, and beta2. They can cause side effects like increased heart rate and blood pressure.

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    Selective Bronchodilators

    Selective bronchodilators primarily target beta2 receptors in the lungs, causing relaxation of the airways and improving breathing. They produce fewer side effects.

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    What is Nebulization?

    Nebulization converts liquid medication into a fine mist that can be inhaled. It is a common method for delivering bronchodilators in respiratory emergencies.

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    What is a 'Spacer' device?

    A spacer device is used with a metered-dose inhaler (MDI) to slow down the delivery of medication, allowing it to reach deeper into the lungs more effectively.

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    Study Notes

    Respiratory Emergencies: Pharmacology for EMS

    • Acute respiratory distress affects many people
    • Pre-hospital care aims to treat reversible bronchial constriction (bronchospasm)
    • The exception to this is acute pulmonary edema
    • Advanced life support (ALS) interventions significantly reduce mortality in patients with respiratory distress

    Learning Objectives

    • Define nasal cannula, rebreather face mask, non-rebreather face mask, and venturi mask
    • Discuss the use of oxygen in a respiratory emergency
    • Describe bronchodilator agents
    • Discuss the benefits of the metered-dose inhaler (MDI)
    • Discuss medications used in the treatment of asthma: salbutamol (albuterol) and ipratropium bromide
    • Discuss medications used as second-line therapy for acute asthma exacerbation
    • Describe the key treatment for patients with chronic obstructive pulmonary disease (COPD)

    Oxygen

    • Oxygen is a common medication used in pre-hospital settings
    • Provided to trauma and medical patients
    • In situations like neonatal resuscitation, COPD exacerbations, and acute coronary/stroke patients, oxygen use is carefully titrated to prescribed saturation levels (rather than indiscriminately applied)
    • Oxygen is stored in green/aluminum cylinders at 1,800-2,400 psi, decreasing to 60 psi as it passes through the regulator

    Oxygen Cylinders: Capacity and Duration of Use

    • Cylinder capacities and duration of use are tabulated (see slide 6 for specific values)

    Oxygen

    • Oxygen delivery is measured in terms of concentration of inspired oxygen (FiO2) and flow
    • Normal room air is 21% FiO2
    • Increasing administered FiO2 increases the oxygen content delivered to the body

    Oxygen Delivery

    • Oxygen delivery devices include nasal cannula, face masks (simple, partial rebreather, non-rebreather) and the venturi mask
    • Deliver oxygen concentrations from 24-90% depending on device and settings
    • Nasal cannula: low-flow; simple/partial rebreather masks do not have reservoir bags or one-directional side ports; non-rebreather masks have a reservoir bag and one-way valves prevent exhaled oxygen from re-entering the bag; venturi masks deliver specific FiO2 concentrations via changeable inserts

    Nebulizer

    • Nebulisers use oxygen, compressed air, or ultrasonic power to break up medication solutions and deliver aerosolized particles directly to the lungs

    Management of Wheezing

    • This section details the management of wheezing.

    Bronchodilators

    • Asthma involves: narrowing of airways, bronchial spasm, increased mucus production.
    • Respiratory distress can also include edema of the respiratory tract mucosa which thickens the lining restricting airway diameter.
    • Bronchodilators are split into selective and non-selective agents acting on alpha and beta adrenergic receptors.
    • Bronchodilators act on bronchial smooth muscle and improve patients' conditions (side effects minimised)

    Inhalation Delivery of Medications

    • Beta2-specific medications can be delivered via nebulization, parenteral or oral administration.
    • Nebulization involves conversion of liquid medication into a mist
    • Various nebulizer types including pneumatic or ultrasonic types exist
    • Metered-dose inhalers (MDIs) deliver medication in a propellant spray

    Metered-Dose Inhaler (MDI)

    • MDIs deliver a predetermined amount of medication in the correct particle size propelled by gas.
    • Improper use may result in medication not reaching the lungs.
    • A spacer device can help slow down the medication movement to improve delivery.

    Asthma

    • Asthma is caused by a trigger reaction (intrinsic/extrinsic).
      • Intrinsic triggers are within the body (eg., exertion, anxiety).
      • Extrinsic triggers are outside the body (eg., animal dander, dust, pollen, cleaning chemicals, animal droppings).

    Asthma Management

    • First-line treatment for asthma is inhaled beta2 drugs, followed by IV medications if inhaled drugs fail.
    • Salbutamol (albuterol) is the most common inhaled drug used to treat reversible bronchospasm.
    • Ipratropium bromide is used for severe asthma/COPD when salbutamol is ineffective
    • It's a cholinergic receptor blocker that decreases smooth muscle contraction

    Second-Line Therapy for Acute Exacerbation of Asthma

    • Clinical picture of asthma or COPD (eg., gasping for breath, accessory muscle use, wheezing) indicates the need for treatment.
    • Consider corticosteroids if transport time is prolonged
    • A Peak Expiratory Flow Rate (PEFR) can indicate the severity of the exacerbation, response to therapy, and potential need for further intervention
    • Severe/life-threatening asthma requires immediate administration of hydrocortisone IV or IM
    • Adrenaline is used in severe cases to stimulate alpha/beta cells and relieve bronchospasm

    COPD Management

    • COPD is a classification of diseases that obstruct the pulmonary system.
    • Common COPD diseases include emphysema and chronic bronchitis
    • In severe COPD exacerbations, treatment focuses on oxygenation and ventilation.
    • Chronic COPD patients breathe with a hypoxic drive
    • Mild hypoxia is required for breathing
    • SpO2 levels in the low 90s are often adequate
    • Steroids and bronchodilators are used to manage COPD similar to asthma

    Hypoxic Drive

    • Discusses why COPD patients should not be given too much oxygen and the potential consequences and appropriate oxygen regimes for these patients.

    Medication Review for Next Week's Quiz

    • Salbutamol, Ipratropium bromide, Hydrocortisone, and Dexamethasone are listed for review.

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    Description

    This quiz covers essential pharmacology for managing respiratory emergencies in pre-hospital settings. Participants will learn about various oxygen delivery systems, bronchodilator agents, and specific medications used for treating conditions like asthma and COPD. Understanding these concepts can enhance the care provided to patients in acute respiratory distress.

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