AAP Respiratory Conditions Aug24 v5.pdf

Respiratory System Conditions, Pathophysiology and Management Component 5 © Department of Clinical Education & 1 Standards  Respiratory Conditions - Component 5 Objective Ha...

Respiratory System Conditions, Pathophysiology and Management Component 5 © Department of Clinical Education & 1 Standards  Respiratory Conditions - Component 5 Objective Have an understanding of the following respiratory conditions Basic chest infection Pneumonia Asthma Emphysema Bronchitis Pulmonary embolism Respiratory distress © Department of Clinical Education & 2 Standards  Respiratory Conditions - Component 5 A chest infection is an infection of the lungs or airways. The main types of chest infection are bronchitis and pneumonia. Most bronchitis cases are caused by viruses, whereas most pneumonia cases are due to bacteria. These infections are usually spread when an infected person coughs or sneezes. The infections can also be spread to others by touching a surface that the virus or bacteria has landed on. © Department of Clinical Education & 3 Standards  High Risk Groups: Babies and very young children Children with developmental problems People who are very overweight Elderly people Pregnant women People who smoke Long-term health conditions (asthma, heart disease, diabetes, kidney disease, CF, COPD) Weakened immune system (Recent illness, a transplant, high- dose steroids, chemotherapy or a health condition, such as an undiagnosed HIV infection) © Department of Clinical Education & 4 Standards  Basic Chest Infection Symptoms can often include Persistent cough Coughing up yellow or green phlegm (thick mucus) or coughing up blood Breathlessness or rapid and shallow breathing Wheezing High temperature (fever) Rapid heartbeat Chest pain or tightness Feeling confused and disorientated © Department of Clinical Education & 5 Standards  Management Most chest infections are not serious and the patient will recover within a few days or weeks. Most patients will not require hospital treatment and should be encouraged to self treat by: Resting and drinking plenty of fluids to avoid dehydration and to loosen mucus in the lungs to make it easier to cough up Use painkillers such as paracetamol or ibuprofen to alleviate any headaches, aches and pains © Department of Clinical Education & 6 Standards Pneumonia  Pneumonia pathophysiology Inhaled bacterial or viral infectious agents result in an inflammatory response. If the body’s lung defences cannot overcome the infection a build up of fluid and blood cells occurs. This is known as consolidation. © Department of Clinical Education & Standards  Pneumonia : Clinical Features Signs: Symptoms: Fever High temperature Productive cough Increased respiratory rate with ‘added’ breath sounds – bronchial or crackles Pain in chest, muscles Increased heart rate and joints © Department of Clinical Education & Standards  Auscultation for Breath Sounds © Department of Clinical Education & Standards  Normal Breath Sounds Heard over lung / chest wall: Inspiration louder Expiration quieter and much shorter No gap between I & E © Department of Clinical Education & Standards  Management of Pneumonia Patient is time critical if they present with: Major ABC problems Respiratory rate 30 bpm Correct A and B problems Alert hospital and go Monitor en route © Department of Clinical Education & Standards  Management of Pneumonia If no time critical features present: Obtain ECG, senior clinician to determine if chest pain has cardiac origin Consider accompanying features: nausea, vomiting, sweating, pallor, cough, pain Oxygen therapy targeted to achieve SpO2 of 94-98% Position of comfort (sit up unless blood pressure low) Monitor & record – respiratory rate, pulse, blood pressure, pain score © Department of Clinical Education & Standards Pulmonary Embolism  Pulmonary Embolism (PE) Pathophysiology Blood clots form (most commonly in the deep veins of the calf). The clot breaks off and travels upwards via femoral and iliac veins to the inferior vena cava. It then ascends to the heart entering at the right atrium and is expelled to the pulmonary arteries from the right ventricle. © Department of Clinical Education & Standards  Pulmonary Embolism (PE) Pathophysiology The clot lodges in a vein obstructing the vascular bed. The location of the obstruction depends on the size of the clot and vessel. The patient’s respiratory distress relates to the extent of obstruction. © Department of Clinical Education & Standards  PE: Clinical Features Signs and Symptoms Dyspnoea/ Tachypnoea Respiratory rate >20 Cough/Haemoptysis Heart rate >100 Syncope SpO2 3 days, prolonged immobility (e.g. air travel), increased age, obesity, pregnancy, varicose veins. © Department of Clinical Education & Standards  Management of Pulmonary Embolism Patient is time critical if they present with: Extreme difficulty in breathing Cyanosis Severe hypoxia SpO2 35 years who are, or were previously, smokers The two main types are: Bronchitis Emphysema © Department of Clinical Education & Standards  BRONCHITIS An inflammatory condition affecting the airways Acute bronchitis is caused by viruses or bacteria and is usually a short lived infection common in the young and elderly Chronic bronchitis results from long term infection and lung damage, common in elderly © Department of Clinical Education & Standards  Bronchitis Signs and symptoms Productive cough/ Dyspnoea Cyanotic Tachycardia/ Tachypnoea Use of accessory muscles of respiration Reduced SpO2 / Wheezes on auscultation Pupils dilated, slow to react Normal to high blood pressure Slow capillary refill/ Oedema Reduced levels of consciousness in cases of severe hypoxia © Department of Clinical Education & Standards  Emphysema Characterised by distension and destruction of the alveoli Lung tissue loses its elasticity and as the airways lose their muscular integrity they collapse The chest is sometimes “ barrel shaped” due to air being trapped in the lungs by the collapse of air passages © Department of Clinical Education & Standards  Respiratory Conditions - Component 5 © Department of Clinical Education & Standards  Emphysema Signd and symptoms Pursed lips on expiration Barrel- chested/ Usually thin Skin colour is perfused Tachycardia Tachypnoea/ Dyspnoea Use of accessory muscles of respiration and wheezing Confusion/ Anxiety/ Fear Cardiac arrhythmias Elevated BP Evidence of oedema (Percussion normally reveals a hollow sound) © Department of Clinical Education & Standards  Respiratory Conditions - Component 5 Features of an acute exacerbation of COPD Conditions with similar features of COPD Assessment and management of COPD Remember COPD may have lower O2 saturations Remember pre and post intervention observations including PEF and Sp02 Oxygen – Measure oxygen Saturation. Administer supplemental oxygen as per JRCALC (COPD) Caution: Hypoxic Drive © Department of Clinical Education & Standards Asthma  Incidence Asthma is one of the most common medical conditions but can become fatal with very little warning From the National Review of Asthma Deaths (NRAD) ©Department of Clinical Education & Standards  Incidence Patients can present with one of four presentations Moderate, Severe, Life-Threatening, Near Fatal Asthma is rare in the older population Practitioners should be aware that some people will describe a range of other respiratory conditions as ‘asthma’. Therefore other causes of breathlessness should be considered in the older patient ©Department of Clinical Education & Standards  Pathophysiology Airways almost continuously sensitive and inflamed Trigger causes bronchospasm Inflammation increases and excess mucus secreted Bronchial muscles become irritated and contract ©Department of Clinical Education & Standards  Pathophysiology ©Department of Clinical Education & Standards  Triggers Pollen Cigarette smoke Dust mites Pets Mould Exercise Stress Sudden change in temperature Patients should know and be encouraged to recognise their triggers ©Department of Clinical Education & Standards  Moderate Exacerbation Acute Severe Life-threatening Able to talk in sentences Can’t complete sentences Silent Chest in one breath or too breathless to talk Cyanosis SPO2 ≥92% SPO2 5 >125/min aged >5 years years Respiratory Rate: Respiratory Rate: Exhaustion ≤40/min ages 2-5 >40/min ages 2-5 years years Confusion ≤30/min aged >5 years >30/min aged >5 years ©Department of Clinical Education & Standards  Severe and Life Threatening Asthma Information gathering: Assess: History from patient; collateral history from relatives, friends etc. Risks include numerous ED attendances, previous admission to intensive care, poor compliance with medications, no annual asthma review How do they normally respond? Could there be an allergy trigger? Targeted physical assessment including accurate respiratory rate, saturations, peak flow and EtCO2 ©Department of Clinical Education & Standards  Severe and Life Threatening Asthma Time Decision Point: Severe difficulty in breathing, difficulty speaking full sentences or exhaustion. Severe wheeze or a silent chest with minimal air entry. Oxygen saturations below 92% (although a high sats reading should not provide false reassurance). Hypotension may be a sign of life threatening asthma Check JRCALC which indicate level of asthma severity ©Department of Clinical Education & Standards  Severe and Life Threatening Asthma Stationary ambulance Interventions on scene Provide high-flow oxygen Assist senior clinician to initiate nebulised salbutamol. Assist senior clinician to administer Intramuscular (IM) adrenaline 1:1000 for life-threatening asthma or where anaphylaxis is a possible underlying cause Do not delay on scene for further investigations or for prolonged attempts at difficult intravenous access. ©Department of Clinical Education & Standards  Severe and Life Threatening Asthma Hospital Triage: Nearest Emergency Department with Pre-alert call through PD09 ©Department of Clinical Education & Standards  Severe and Life Threatening Asthma Severe asthma is a time-critical emergency Aim to have completed a targeted assessment initiated immediate interventions reached a triage decision Within 10 minutes and to keep on-scene time to less than 30 minutes. ©Department of Clinical Education & Standards  Peak Flow measurement Fig 3.7 ©Department of Clinical Education & Standards  How to take a PEF 1. Check the pointer is at zero 2. Preferably stand or sit in a comfortable upright position 3. Hold the peak flow level horizontally 4. Keep fingers away from the pointer 5. Take a deep breath and hold it in 6. Close lips around the mouthpiece and blow as hard as you can 7. Look at the pointer and check the reading 8. Reset the pointer to zero 9. Repeat 3 times and record the highest 10. Record the results on a PRF ©Department of Clinical Education & Standards  Key Points Asthma is a common life-threatening condition The severity is often not recognised Accurate documentation is essential A silent chest is a pre-terminal sign ©Department of Clinical Education & Standards  Respiratory Distress Often known as Hyperventilation Requires a differential diagnosis to rule out being caused by a medical condition In children it’s more likely to be caused by an underlying medical condition than anxiety Oxygen therapy is required if hypoxaemic (SpO2