Transcript Airway and Respiratory Emergencies

Airway and Respiratory
Emergencies
EMD CE Presentation
Silver Cross EMSS
March 2012

Two most important lifesaving skills:
◦ Airway care
◦ Rescue breathing
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The ABCs consist of:
◦ Airway
◦ Breathing
◦ Circulation
Life Threats
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To maintain life, all humans must have
food, water, and oxygen.
◦ Lack of oxygen, even for a few minutes, can
result in irreversible damage and death.
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The main purpose of the respiratory
system is to work with the circulatory
system to provide oxygen and remove
carbon dioxide via the red blood cells.
Respiratory System
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Eventually all cells will die if deprived of
oxygen. Brain and heart are the most
sensitive.
Time is Critical!
◦ At the back of the throat are two passages:
 The esophagus
 The trachea
◦ The epiglottis helps prevent food or water
from entering the airway.
◦ The airway divides into the bronchi.
◦ The lungs are located on either side of the
heart. The right lung has 3 lobes, the left has
2 and the heart sits slightly more towards the
left side.
Anatomy of the
Respiratory System
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Other parts of the respiratory system:
(cont’d)
◦ The smaller airways that branch from the
bronchi are called bronchioles.
◦ At the end of the bronchioles are tiny air sacs
called alveoli.
◦ The exchange of oxygen and carbon dioxide
occurs in the alveoli.
Anatomy of the
Respiratory System
Anatomy of the
Respiratory System
Anatomy of the
Respiratory System
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The lungs consist of soft, spongy tissue with no
muscles.
◦ Movement of air into the lungs depends on movement
of the rib cage and the diaphragm muscles.
◦ When the diaphragm contracts during inhalation, it
flattens and moves downward, increasing the size of the
chest cavity.
◦ Air moves in and out of the lungs because of pressure
changes, moving from high to low pressure to equalize.
◦ On exhalation, the diaphragm relaxes and once again
becomes dome shaped, decreasing the size of the chest
cavity.
Anatomy of the
Respiratory System
Ask callers to:
◦ Evaluate the victim’s
responsiveness. If
there’s a response,
assume that the
patient is conscious
and has an open
airway.
◦ If there is no
response, advise
callers to gently
shake the patient’s
shoulder and repeat
questions.
Check for Responsiveness

In healthy individuals, the airway
automatically stays open.

An injured or seriously ill person is not
able to protect the airway and it may
become blocked.
◦ You must take steps to have callers check the
airway and correct any problems.
“A” Is for Airway
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In an unconscious patient lying on his or
her back, the passage of air through both
nose and mouth may be blocked by the
tongue.
◦ The tongue is attached to the lower jaw.
◦ A partially blocked airway often produces a
snoring sound.
◦ The head tilt chin lift will fix the problem.
Correct the Blocked Airway

Head tilt–chin lift
maneuver
◦ Place the patient on his
or her back.
◦ Place one hand on the
patient’s forehead and
apply firm pressure
backward.
◦ Place the tips of your
fingers under the bony
part of the lower jaw.
◦ Lift the chin forward and
tilt the head back.
Correct the Blocked Airway

Potential blocks include:
◦ Secretions such as vomit, mucus, or blood
◦ Foreign objects such as candy, food, or dirt
◦ Dentures or false teeth

If there is anything in the patient’s
mouth, remove it.
Finger sweeps can be done quickly and require no
special equipment.
Correct the Blocked Airway

If an unconscious patient is breathing and has
not suffered trauma, place the patient in the
recovery position.
◦ Helps keep the patient’s airway open
◦ Allows secretions to drain out of the mouth
◦ Uses gravity to help keep the patient’s tongue
and lower jaw from blocking the airway
Recovery Position

Use the look, listen, and feel technique.
◦ Look for the rise and fall of the patient’s chest.
◦ Listen for the sounds of air passing into and
out of the patient’s nose or mouth.
◦ Feel the air moving on the side of your face.
Adults have a normal breathing rate of 12
to 20 breaths per minute, children 15 to
30 and infants 25 to 50.
“B” is for Breathing

Causes of respiratory arrest
◦ Heart attacks
◦ Mechanical blockage or obstruction caused by the
tongue
◦ Vomitus, particularly in a patient weakened by a
condition such as a stroke
◦ Foreign objects
◦ Illness or disease
◦ Drug overdose
◦ Poisoning
◦ Severe loss of blood
◦ Electrocution by electrical current or lightning
No Breathing….. Start CPR
30 compressions in the center of the chest,
2 inches deep. Pushing hard and fast, 100
times per minute.
As you perform breathing, keep the patient’s
airway open. (head-tilt)
◦ Pinch the nose, take a deep breath, and blow
slowly into the mouth for 1 second.
◦ Remove your mouth and let the lungs deflate.
◦ Breathe for the patient a second time.
◦ Alternate 30:2 compressions and breaths, until the
patient responds or experienced help takes over.
C–A-B
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The most common airway obstruction is
the tongue.
◦ If the tongue is blocking the airway, the head
tilt–chin lift maneuver will clear the patch for
air movement.

Food is the most common foreign object
that causes an airway obstruction.
◦ If a foreign body is lodged in the air passage,
you must use other techniques to remove it.
Causes of Airway Obstruction
•
If conscious:Ask the patient, “Are you
choking?”
◦ If the patient can reply, the airway is not
completely blocked.
◦ If the patient cannot speak or cough, the airway is
completely blocked.

Mild airway obstruction
◦ The patient coughs and gags.
◦ The patient may be able to speak, but with
difficulty. Encourage the patient to cough.
Are You Choking?

Severe airway obstruction
◦ The patient is unable to breathe in or out and
speech is impossible.
◦ Other symptoms may include:
 Poor air exchange
 Increased breathing difficulty
 A silent cough
 Loss of consciousness in 3 to 4 minutes
◦ Treatment involves abdominal thrusts.
Are You Choking?

Airway obstruction in an adult or child
◦ If the patient is conscious, stand behind him
or her and perform abdominal thrusts.
◦ Perform CPR on a patient who has become
unresponsive.
Are You Choking?

Airway obstruction in an infant
◦ If the infant has an audible cry, the airway is
not completely obstructed.
◦ Use a combination of 5 back slaps and 5 chest
thrusts, if the infant is awake but not
breathing from airway obstruction.
◦ If the infant becomes unresponsive:
 Begin CPR.
 Continue CPR until EMS personnel arrive.
Are You Choking?
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Check every patient for the presence of a
stoma.
If you locate a stoma, keep the patient’s neck
straight.
Examine the stoma and clean away any mucus
in it.
Place your mouth directly over the stoma and
use the same procedures as in mouth-to-mouth
breathing.
If the patient’s chest does not rise, seal the
mouth and nose with one hand and then
breathe through the stoma.
Breathing for Patients With
Stomas

Occurs when air is forced into the
stomach instead of the lungs

Increases the chance that the patient will
vomit

Breathe slowly into the patient’s mouth,
just enough to make the chest rise.

Make sure airway is properly tilted open.
Gastric Distention
There are a variety of problems that
can cause Difficulty in Breathing
(DIB) or Shortness of Breath (SOB).
The rest of the presentation will
cover some of those conditions.
Respiratory Emergencies

Noisy respirations, wheezing, or gurgling (rales or
crackles)
◦ http://www.easyauscultation.com/lung-sounds-referenceguide.aspx click on this link to listen to abnormal lung sounds
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Rapid or gasping respirations
Pale or blue skin
Increased work of breathing
Talking in 1 or 2 word sentences
The most critical sign is respiratory arrest, which is
characterized by:
◦ Lack of chest movements
◦ Lack of breath sounds
◦ Lack of air against the side of your face
Signs of Inadequate Breathing

Causes:
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Upper or lower airway infection
Acute pulmonary edema (Fluid in lungs)
Chronic obstructive pulmonary disease (COPD)
Asthma
Hay fever
Hyperventilation syndrome
Environmental/industrial exposure
Carbon monoxide poisoning
Infectious diseases
DIB

Causes (cont’d)
◦ Anaphylaxis (Severe Allergic Reaction)
◦ Spontaneous pneumothorax (Collapsed Lung)
◦ Pleural effusion (Fluid around the Lung)
◦ Prolonged seizures
◦ Obstruction of the airway (Choking)
◦ Pulmonary embolism (clot in Lung area)
We will explore some of these problems a little
further, read on………..
DIB
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Bronchitis – inflammation of bronchioles. Patients
will have a productive cough and wheezing.
Common Cold – viral infection with swollen
mucous membranes and excess fluid production
from sinuses and nose.
TB – a respiratory disease that can lay dormant
in the lungs for years. Is spread by respiratory
droplets.
Pneumonia – viral or bacterial infection that can
damage lung tissue. Characterized by productive
cough, fever and congestion.
Diphtheria – A highly contagious disease that
causes a layer of debris to form in the upper
airway and can causes obstruction. This is a rare
problem.
Airway Infections
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Epiglottitis – Bacterial infection that affects mostly school aged
children. Causes swelling of the flap above the larynx. Patients
will have Stridor (a harsh, high pitched sound) as the air moves
past the swelling. They will also have a fever, sore throat and
drooling.
Croup – Viral Infection, usually seen in children under 3years old.
Causes inflammation of the airway and a “seal bark” type of
cough.
RSV – Highly contagious infection that is spread through airborne
droplets. Affect young children and can lead to more serious lund
or heart problems.
Pertussis (Whooping Cough) – Highly contagious bacterial
infection that mostly effects children under 6. Patient will have a
fever and coughing episodes where they can’t catch their breath.
SARS – Potentially life-threatening viral infection that starts with
flu-like symptoms and can progress to death. Spread from
person-to-person contact.
Airway Infections
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Slow process of dilation and disruption of
airways and alveoli
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Caused by chronic bronchial obstruction
Fourth leading cause of death
Tobacco smoke can create chronic bronchitis.
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Emphysema is another type of COPD.
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◦ Loss of elastic material around air spaces
◦ Causes include inflamed airways, smoking.
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Most patients with COPD have elements of both
chronic bronchitis and emphysema.
Chronic Obstructive Pulmonary
Disease (COPD)
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Result of allergic reaction to inhaled, ingested, or injected
substance
◦ In some cases, allergen cannot be identified.
Asthma is acute spasm of smaller air passages
(bronchioles)
◦ Excessive mucus production
◦ Swelling of mucous lining of respiratory passages.
Hay fever causes cold-like symptoms.
◦ Allergens include pollen, dust mites, pet dander.
Anaphylactic reaction can produce severe airway swelling.
◦ Total obstruction is possible.
◦ Reaction occurs within 30 minutes of exposure
Asthma, Hay Fever, and
Anaphylaxis
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Rapid, deep breathing to the point that arterial carbon
dioxide falls below normal
May be indicator of major illness
◦ High blood sugar, overdose of aspirin, respiratory
infection, etc
Acidosis: buildup of excess acid in blood or body
tissues
Alkalosis: buildup of excess base in body fluids
Alkalosis can cause symptoms of panic attack,
including:
◦ Anxiety
◦ Dizziness
◦ Numbness
Hyperventilation
◦ Genetic disorder that affects lungs
and digestive system
◦ Disrupts balance of salt and water
resulting in very thick mucus
◦ Disposed to repeated lung
infections and malabsorption of
nutrients in intestines
Cystic Fibrosis

Cardiac problem that causes fluid to back
up in the lungs
◦ Risk factors include hypertension and a history
of coronary artery disease and/or atrial
fibrillation.
◦ In most cases, patients have a history of
congestive heart failure.
Congestive Heart Failure (CHF)
Have patient assume a comfortable
position, usually sitting up and leaning
forward.
 Loosen any tight clothing.
 Follow their doctor’s orders for any
medication administration.
 If there is oxygen on scene, it is helpful in
cases of DIB.
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Treatment
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AAOS Emergency Medical Responder
5th edition
•
AAOS Emergency Care and Transport of the
Sick and Injured
10th Edition
•
2010 AHA BLS Guidelines
•
Will County 9-1-1 EMDPRS
Resources