Respiratory System (2019) PDF

Back to Objectives Upper Airway Nose and mouth Pharynx Epiglottis Larynx  Trachea Bronchi Bronchiole s Lungs Lower Airway Lungs  The muscles of the respiratory system include:  Sternocleidomastoid  The diaphragm  The intercost...

Back to Objectives Upper Airway Nose and mouth Pharynx Epiglottis Larynx  Trachea Bronchi Bronchiole s Lungs Lower Airway Lungs  The muscles of the respiratory system include:  Sternocleidomastoid  The diaphragm  The intercostals DIFFUSION  Active inspiration PERFUSION  Passive exhalation  The process of going from a high concentration to a low concentration though a semi-permeable membrane.  The process that allows for the exchange of oxygen and carbon dioxide at the capillary level is diffusion.  Tidal Volume=One inhalation and one exhalation  The earliest sign of hypoxia is anxiety/agitation.  Hypoxemia  Decreased oxygen in blood stream  Hypoxia  Decreased oxygen in the tissues  Dyspnea  Shortness of breath  Apnea  Respiratory arrest Back to Objectives Assessing Breath Sounds Back to Objectives  Wheezing  High-pitched, musical, whistling  Constriction of bronchioles  Are usually associated with Asthma Rhonchi Snoring or rattling noises Caused by thick mucous secretions  RALES (Crackles) Bubbly or crackling sounds Associated with fluid around the alveoli Respiratory Distress Fast or slow respiratory rate Cool, clammy skin Retractions Irregular rhythm Cyanosis Increased effort to breathe Shallow breaths Nasal flaring Use of accessory muscles Tripod position Signs of Respiratory Distress  Patients that are short of breath are typically more comfortable sitting upright or in the semi-fowlers position.  Nasal cannulas may be used if indicated but do not set any higher than 6 liters / min.  When using a Non Re-breather mask be sure to fill the reservoir before placing it on the patient.  Pathophysiology of Conditions That Cause Respiratory Distress COPD Emphysema Chronic Bronchitis Emphysema Back to Objectives COPD Lung tissue loses elasticity, alveoli become distended with trapped air, and the walls of the alveoli are destroyed. Drastic reduction in gas exchange occurs, and the patient becomes hypoxic and retains carbon dioxide. Decreased O2 is their respiratory drive. Exhaling becomes an active rather than a passive process. The patient may have a rapid resp. rate, labored breathing and wheezing lung sounds Barrel-chest appearance is typical with the disease.  Usually thin  Sometimes a pink color to their skin  Pursed lip breathing (creating positive end expiratory pressure (PEEP)  Wheezing or diminished lung sounds  Dry cough  May see home O2  May have a history of smoking  Chronically short of breath  EMPHYSEMA Normal Emphysema Often caused by smoking Destruction of alveolar walls Carbon dioxide retained  Assessment Thin, barrel-chest appearance Coughing, nonproductive Prolonged exhalation Diminished breath sounds Wheezing Assessment Pursed-lip breathing Difficulty of breathing Pink complexion Tachypnea Tachycardia Diaphoresis Tripod position May be on home oxygen Chronic Bronchitis  Chronic Bronchitis Caused by smoking Inflammation, swelling, and thickening of the bronchi and bronchioles Excessive mucous production  Usually heavier  Sometimes a bluish color to their skin  Excessive sputum production  Pedal Edema  May see home O2  Chronically short of breath  Will have a decreased tidal volume  Tidal volume is defined as the amount of air a person inhales and exhales  Rhonchi or diminished lung sounds  Place the patient in high fowlers position and apply oxygen via non rebreather mask at 15 lpm HIGH UPRIGHT FOWLERS SEMI FOWLERS  Emergency Medical Care Treat the same as any patient experiencing shortness of breath Hypoxic drive a rare complication As a general rule, never withhold oxygen from any patient who requires it. Asthma  Bronchospasm, edema, mucus in the lower airways Reversible Acute, irregular, periodic attacks Asthma  Dyspnea Nonproductive cough Wheezing Tachypnea Tachycardia Anxiety and apprehension Chest tightness SpO2 < 95 percent Assessment  Extreme fatigue or exhaustion Inability to speak Quiet or absent breath sounds SpO2 < 90 percent with patient on oxygen Symptoms that Require Ventilation 1 of 2 a.Characterized by an increased sensitivity of the lower airways to irritants and allergens b.Conditions contributing to the increasing resistance to air flow and difficulty in breathing i. Brochospasm ii.Edema iii.Increased secretion of mucus that causes plugging of the smaller airways  acute onset of shortness of breath  history of asthma  wheezing lung sounds  (ominous if you hear no lung sounds) A silent chest is a bad thing  tripoding  accessory muscle use  tachypnea  tachycardia  Oxygen Beta agonist medication Ventilation, in severe cases Transport and reassess Emergency Medical Care  Status Asthmaticus occurs when the asthma attack can not be broken with the patient’s normal asthma treatments.  If the patient is having a sever asthma attack they may not have lung sounds because they are so tight that they are not moving air. This is called a silent chest- that’s bad! You may begin to hear lung sounds after treatment- that would be better. Pneumonia  Fever  Productive cough  Diminished or rhonchi for lung sounds  Recent history or illness  Green or yellow sputum production  Painful to breath  tacypnea Pneumonia Common disease of the elderly and those with suppressed immune systems Acute infectious disease Caused by bacteria or virus Need image 16-05 here – we don’t have it - WDS Assessment Malaise Decreased appetite Fever Cough—productive or nonproductive Dyspnea Altered mental status  Emergency Medical Care Treat the same as any patient experiencing shortness of breath May administer metered-dose inhaler or small-volume nebulizer Pulmonary Embolism  Pulmonary Embolism Obstruction of blood flow Caused by – A blood clot – Air bubble – Fat particle Severity depends on location  Sudden onset of  Tachypnea  Dyspnea with no  Tachycardia Hx.  Cool, moist skin  Respiratory  Restlessness, distress anxiety  Stabbing chest pain  Cough (may cough up blood) Acute Pulmonary Edema Acute Pulmonary Edema Fluid collects in the spaces Cardiogenic versus noncardiogenic Assessment Tachycardia Anxiety Tripod position Crackles Cyanosis Pale skin Swollen lower extremities Cough  May have a history of heart disease  Acute onset of shortness of breath  Crackles for lung sounds  Pink frothy sputum in severe cases  May suffer from orthopnea (inability to lay flat)  May also see JVD (congestive heart failure)  May also see pedal edema (congestive heart failure)  Exertional dyspna  Tachypnea  tachycardia Manage the patient’s airway Positive pressure ventilation may be necessary May improve the patient’s status Dangling legs off stretcher might be beneficial Emergency Medical Care Spontaneous Pneumothorax  Spontaneous Pneumothorax Sudden rupture of the visceral lining More likely in tall, thin males Change in pressure causes lung to collapse  Assessment Tachypnea Diaphoresis Sudden onset of – Shortness of breath – Chest pain or shoulder pain Decreased breath sounds on one side Hyperventilation Syndrome  Rapid shallow (sometimes deep) respirations  Carpal Pedal spasms  Numbness and tingling (especially to the face and extremities)  Situation causing emotional upset  May lead to a syncopal episode  Emergency Medical Care Coach patient to slow down breathing Reassure them NEVER use a paper bag If possible, remove the source of anxiety Viral Respiratory Infections  Viral Respiratory Infections Common to all age groups; most serious in children Caused by many viruses Can lead to more serious infections  Epiglottitis Inflammation of upper airway Swelling of the Epiglottitis Can be life threatening  Assessment High fever Sore throat Drooling Anxiety and apprehension Tripod position Fatigue Inspiratory stridor  Emergency Medical Care Administer O2 Keep patient calm Rapid transport Consider ALS intercept BVM if necessary  Rapid onset SOB  High fever  Sore throat  Unable to swallow/drooling  Stridor- High pitch upper airway noise  Anxiety  Trouble speaking  Tripod with jaw jutted out  Whooping Cough  Upper airway bacteria  Uncontrolled cough  Mostly Children  Starts off as a cold  2 weeks after onset coughing episodes of 15-24  Can lead to pneumonia  Ear infections  Seizure  Death  Crowing/Whooping cough  Sneezing, running nose, low grade fever  Coughing fits at night  Possible cyanosis during fits  SOB  Fowlers position-sitting up  O2 15lpm via NRB  Rapid Transport  Cheyne-Stokes  Gradually increase and decrease in depth and rate with a period of apnea  Traumatic brain injury  Kussmaul  Abnormally slow and deep respirations  Diabetic Ketoacidosis (DKA)  Age-Related Variations: Pediatrics and Geriatrics Back to Objectives  Respiratory compromise.  The most common cause of cardiac arrest in infants and children is respiratory compromise  Begin immediate positive pressure ventilations. Altered mental status Bradycardia RESPIRATO Hypotension RY FAILURE Irregular breathing pattern RESPIRATORY DISTRESS  Retractions  Accessory muscle use  Tachypnea  Tachycardia  Nasal flaring   Diminished or absent lung sounds  Altered mental status  Irregular breathing pattern  Cyanosis RESPIRATORY FAILURE Assessment and Care: General Guidelines Scene size-up Primary assessment ABCs Transport priority Secondary assessment Emergency care Reassessment Back to Objectives  If your patient is presenting with signs and symptoms of a partial foreign body airway obstruction and is able to maintain their airway and is moving air you should transport ASAP