Respiratory Emergencies PDF

college of nursing and allied health sciences Slide 0 CHAPTER 18 RESPIRATORY EMERGENCIES  BLS: basic life support CPR: cardiopulmonary resuscitation. AED: Automated external defibrillato...

college of nursing and allied health sciences Slide 0 CHAPTER 18 RESPIRATORY EMERGENCIES  BLS: basic life support CPR: cardiopulmonary resuscitation. AED: Automated external defibrillator. ALS: Advance life support.  college of nursing and allied health sciences Slide 2 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  college of nursing and allied health sciences Slide 3 THE RESPIRATORY SYSTEM The respiratory system takes oxygen from the air and makes it available for the blood to transport to every cell and rids the body of excess carbon dioxide  college of nursing and allied health sciences Slide 4 THE RESPIRATORY SYSTEM The Airway Upper airway Extends from the mouth and nose to the trachea Lower airway Extends from the trachea to the alveoli  college of nursing and allied health sciences Slide 5 THE UPPER AIRWAY  college of nursing and allied health sciences Slide 6 THE UPPER AIRWAY Nose and mouth Pharynx Oropharynx Nasopharynx Epiglottis Leaf-shaped structure that prevents food and liquid from entering the trachea during swallowing  college of nursing and allied health sciences Slide 7 THE LOWER AIRWAY  college of nursing and allied health sciences Slide 8 THE LOWER AIRWAY Trachea (windpipe) Cricoid cartilage  Firm cartilage ring forming the lower portion of the larynx  Larynx (voice box)  Bronchi  Two major branches of the trachea to the lungs; bronchus subdivides into smaller air passages ending at the alveoli  Lungs  Diaphragm  college of nursing and allied health sciences Slide 9 RESPIRATORY TERMINOLOGY Ventilation The movement of air Respiration The exchange of gases  college of nursing and allied health sciences Slide 10 VENTILATION Inhalation (active) Diaphragm and intercostal muscles contract, increasing the size of the thoracic cavity Diaphragm moves slightly downward, flares lower portion of rib cage Ribs move upward/outward This creates a negative pressure in the chest cavity.  VENTILATION Air flows into the lungs because of the negative pressure college of nursing and allied health sciences Slide 11  VENTILATION Exhalation Diaphragm and intercostal muscles relax, decreasing the size of the thoracic cavity Diaphragm moves upward Ribs move downward/inward Air is expelled from the lungs college of nursing and allied health sciences Slide 12  college of nursing and allied health sciences Slide 13 RESPIRATION Alveolar respiration Gas exchange in the lungs Cellular respiration Gas exchange in the tissues of the body  college of nursing and allied health sciences Slide 14 ALVEOLAR RESPIRATION Alveolar/capillary exchange Oxygen-rich air enters the alveoli during each inspiration Oxygen-poor blood in the capillaries passes into the alveoli Oxygen enters the capillaries as carbon dioxide enters the alveoli  college of nursing and allied health sciences Slide 15 CELLULAR RESPIRATION Capillary/cellular exchange Cells give up carbon dioxide to the capillaries Capillaries give up oxygen to the cells ALVEOLAR AND CELLULAR RESPIRATION Slide 16  college of nursing and allied health sciences Slide 17 NORMAL BREATHING Normal respiration should be effortless  college of nursing and allied health sciences Slide 18 NORMAL RESPIRATORY RATES Adult—12-20/minute Child—15-30/minute Infant—25-50/minute  college of nursing and allied health sciences Slide 19 ASSESSING BREATHING Rate Chest expansion Rhythm Effort of breathing Quality Depth (tidal volume) Breath sounds  college of nursing and allied health sciences Slide 20 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!  college of nursing and allied health sciences Slide 21 TIDAL VOLUME The amount of air exchanged in one breath  college of nursing and allied health sciences Slide 22 CONSIDERATIONS FOR INFANTS AND CHILDREN  college of nursing and allied health sciences Slide 23 ADULTS VERSUS CHILDREN RESPIRATORY ANATOMY Mouth and nose In general, all structures are smaller and more easily obstructed than in adults  college of nursing and allied health sciences Slide 24 ADULTS VERSUS CHILDREN RESPIRATORY ANATOMY Tongue Infants’ and children’s tongues take up proportionately more space in the mouth than adults Trachea (windpipe) 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 is softer Tend to depend more heavily on the diaphragm for breathing  college of nursing and allied health sciences Slide 25 FOCUSED HISTORY AND PHYSICAL EXAMINATION OPQRST SAMPLE O Onset S Signs and Symptoms P Provocation A Allergies Q Quality M Medications R Radiation P Past medical history S Severity L Last Oral Intake T Time E Events leading to injury or illness  Hematemesis: vomiting of blood. blood Hemoptysis: coughing out blood. Blood will be dark red or coffee ground- this is bright red mixed with sputum. in shows upper gastrointestinal bleeding. severe pneumonia, terminal stages of cancer and terminal stages of tuberculosis we may see this.  college of nursing and allied health sciences Slide 27 FOCUSED HISTORY AND PHYSICAL EXAMINATION Remember that a physical exam is required for all patients In the responsive patient, assess the body systems associated with the chief complaint  college of nursing and allied health sciences Slide 28 EMERGENCY MEDICAL CARE  college of nursing and allied health sciences Slide 29 EMERGENCY MEDICAL CARE Administer high-flow oxygen  college of nursing and allied health sciences Slide 30 EMERGENCY MEDICAL CARE Oxygen is the most important medication you can administer to a patient with respiratory distress.  college of nursing and allied health sciences Slide 31 EMERGENCY MEDICAL CARE Position and Transport  college of nursing and allied health sciences Slide 32 EMERGENCY MEDICAL CARE Patients should be transported in a position most comfortable for them.  college of nursing and allied health sciences Slide 33 ARTIFICIAL VENTILATION  college of nursing and allied health sciences Slide 34 ARTIFICIAL VENTILATION Preferred ventilation techniques Mouth-to-mask Two-person bag-valve-mask Flow-restricted, oxygen-powered ventilation device One-person bag-valve-mask  college of nursing and allied health sciences Slide 35 CHRONIC OBSTRUCTIVE PULMONARY DISEASE COPD is a broad category that encompasses several disease processes Emphysema Chronic bronchitis Asthma  college of nursing and allied health sciences Slide 36 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  college of nursing and allied health sciences Slide 37 CHRONIC BRONCHITIS A chronic condition characterized by excessive mucous secretions and inflammatory changes in the bronchial tree  college of nursing and allied health sciences Slide 38 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 college of nursing and allied health sciences Slide 39  INHALERS Typical inhaler devices college of nursing and allied health sciences Slide 40  college of nursing and allied health sciences Slide 41 INHALERS Most inhalers used to treat respiratory distress are drugs classified as beta-agonist inhalers  INHALERS Trade Name Generic Name Proventil albuterol Ventolin albuterol Bronkosol isoetharine Alupent metaproterenol Metaprel metaproterenol Brethine terbutaline Atrovent ipratropium bromide college of nursing and allied health sciences Slide 42  college of nursing and allied health sciences Slide 43 INHALERS Indications Exhibits signs and symptoms of respiratory emergency Has physician-prescribed, hand-held inhaler Specific authorization by medical direction  college of nursing and allied health sciences Slide 44 INHALERS 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  college of nursing and allied health sciences Slide 45 INHALERS Assisting with an inhaler Check inhaler’s expiration date Determine if patient has previously taken any doses Make sure that the inhaler is at room temperature Shake inhaler vigorously several times Remove oxygen mask Nasal cannula can be left in place  college of nursing and allied health sciences Slide 46 INHALERS Have patient place inhaler in mouth Have patient inhale slowly and deeply while depressing the inhaler  college of nursing and allied health sciences Slide 47 INHALERS Have the patient inhale deeply and hold his or her breath so the medication can be absorbed  college of nursing and allied health sciences Slide 48 INHALERS 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  INHALERS college of nursing and allied health sciences Slide 49  college of nursing and allied health sciences Slide 50 INHALERS Side effects Increased heart rate Tremors Nervousness Nausea or vomiting  college of nursing and allied health sciences Slide 51 SUMMARY 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