Lecture #2- Breathing Emergencies.ppt

Breathing Emergencies Terminology Dyspnea- shortness of breath Tachypnea- rapid breathing Bradypnea- slow breathing Apnea- absence of breath Hypocapnia- low arterial carbon dioxide Adequate/Inadequate Breathing Normal range  Adult 12-20, Child 15-30, Infant 25-50 Two m...

Breathing Emergencies Terminology Dyspnea- shortness of breath Tachypnea- rapid breathing Bradypnea- slow breathing Apnea- absence of breath Hypocapnia- low arterial carbon dioxide Adequate/Inadequate Breathing Normal range  Adult 12-20, Child 15-30, Infant 25-50 Two major considerations  Rate of breathing  Depth of breathing Adequate breathing?  4 - 6 breaths/minute- may need BVM.  (bradypnea)  40 breaths/minute- may need to BVM to slow rate.  (tachypnea) Signs of Inadequate breathing Chest movements are absent, minimal, or uneven Movement associated with breathing is limited to abdomen (abdominal breathing) No air can be felt or heard at the nose or mouth, or the amount of air exchanged is below normal Breath sounds are diminished or absent Noises such as wheezing, crowing, stridor, snoring, gurgling, or gasping are heard during breathing Rate of breathing is too rapid or too slow Breathing is very shallow, very deep, or appears labored Signs of Inadequate breathing Patient’s skin, lips, tongue, ear lobes, or nail beds are blue or gray (cyanosis) Inspirations are prolonged (upper airway obstruction) or expirations are prolonged (lower airway obstruction) Patient is unable to speak, or cannot speak full sentences because of SOB- (shortness of breath) In children, there may be retractions (a pulling in of the muscles) above the clavicles and between and below the ribs (see-saw breathing) Nasal flaring especially in infants and children Causes of Breathing Emergencies Obstructed Airway AMI- acute myocardio infarction (choking) Chest/lung injury Illness Allergic reactions Respiratory diseases Anaphylaxis  Emphysema, asthma, Drugs Electrocution Poisoning Shock Hyperventilation Drowning Asthma Condition in which air passages narrow making it difficult to breath (bronchiole spasm) Often times triggered by an allergen, emotional stress, or exercise Most Asthmatics have prescribed inhalers or other medications to treat the condition Key sign of Asthma is wheezing with exhalation. Exhalation cycle lasting longer than inhalation  Emergency Bronchodilator Use (Know Four Indications Rights (all criteria mustfor be Administering met)  Medication) Patient exhibits signs and symptoms of respiratory emergency (asthma attack)  Patient has a physician prescribed inhaler Contraindications  Patient is unable to use device  Inhaler is not prescribed for patient  Patient has already taken maximum prescribed dose Dosage  Pre-measured based upon physicians order Emergency Bronchodilator Use Actions  Beta agonist bronchodilator dilates bronchioles, reducing airway resistance Side Effects  Increased pulse rate  Tremors  Nervousness Reassessment  Make sure to gather Vital Signs if needed  Reassess lung sounds  Use peak flow meter to determine tidal volume  Monitor patient, if worsens call 911 The four “rights” for medication administration Right patient Right medication Right dose Right route  Emergency Bronchodilator Use Determine need for emergency inhaler use (Rx) Check exp. date and med. name Shake well, remove cap, and inspect mouthpiece for debris Instruct patient to fully exhale Place the mouthpiece into the mouth while holding the inhaler upright Instruct patient to deeply and slowly inhale through the mouth while depressing the canister Instruct patient to hold breath as long as possible, wait one minute, and repeat puffs as directed by a physician Clean inhaler and replace the cap. Store inhaler between 59-86° F Hyperventilation Occurs when someone breaths faster than normal Person exhales too much CO2 upsetting the O2/CO2 balance Results from fear and anxiety Key signs/symptoms  Rapid, shallow breathing  Patients cannot get enough air and think they are suffocating  Can be fearful and apprehensive or confused  May feel dizzy  May complain of numbness and tingling in lips, fingers, and toes Hyperventilation Care  Calm and reassure them  Coach them to slow their breathing  Can try to have patient inhale/exhale through nose – may try pinching one nostril  Last resort – breath slowly into paper or plastic bag (make sure not asthmatic related) Anaphylaxis A severe or life-threatening allergic reaction causing blood vessel dilation resulting in a drop in blood pressure and respiratory system swelling interfering with the airway Body recognizes the substance as foreign (allergen) causing an immune response  Immediately produces antigens marking the allergen as foreign causing the release of antibodies to destroy the allergen  This production of antigens/antibodies causes release of histamine  In a true anaphylactic emergency, the release of this histamine is explosive causing respiratory swelling and blood vessel dilation. Anaphylaxis Possible causes of Anaphylaxis  Food Peanuts, shellfish  Medications  Insect stings  Plants Poison Oak, Poison Ivy, Poison Sumac  Other Dust, pollen, animal dander, soaps, etc. Signs and Symptoms of Anaphylaxis Swelling and redness Rapid or difficulty  Facial swelling breathing  Swollen tongue Burning skin and eyes Hives Restlessness Itching Difficulty talking Rash  Horseness Weakness Dilated pupils Nausea or vomiting Chest discomfort or Dizziness pain Difficulty swallowing Weak or rapid pulse Coughing or wheezing “EpiPen” Auto-Injector AKA Epinephrine Comes in two sizes (dosages)  Adult “Epi-Pen”,.3 mg  Infant/Child “Epi-Pen Jr.”,.15 mg “EpiPen” Indications (both must be met)  Patient exhibits signs of severe allergic reaction, including either respiratory distress or shock (hypoperfusion)  Medication is prescribed for the patient by a physician Contraindications  No contraindications when used in a life- threatening situation “EpiPen” Administration Ensure the 4 “rights” Pull off grey activation cap Place tip of auto-injector against patient’s thigh (lateral thigh midway between waist and knee) Push or jab (no more than 5 cm from thigh) the injector firmly against the thigh until the injector activates Hold the injector in place for at least 10 seconds Remove injector and massage thigh Document activity and time Dispose of injector in sharps container “Epi-Pen” Actions Reassessment  Dilates the bronchioles  Immediately call 911 if you  Constricts the blood vessels haven’t already done so to transport to hospital Side Effects  Assess vital signs  Increased heart rate  Treat for shock  Pallor (hypoperfusion)  Dizziness  Be prepared to administer  Chest pain CPR/AED  Headache  Nausea  Vomiting  Excitability, anxiety Care for Respiratory Distress Complete initial assessment Call 911 Help the victim rest comfortable (keep them calm by reassuring them) Obtain a SAMPLE history Do a physical exam (lung sounds) Assist with any medications that may be prescribed according to physician protocol Keep victim from getting chilled or overheated Monitor Vital Signs Respiratory Arrest Breathing Stops Special considerations for Rescue breathing  Air in stomach (gastric distention)  Vomiting  Mouth-to-nose breathing  Mouth-to-stoma breathing  Victims with dentures  Suspected injury to the spine