Transcript Slide 1

Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
Prepared by: CPT A. Amin, RRT, RCP and CPT W. Williams, RRT, RCP
HMRG - Galveston Company
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Objectives - at the end of this review, the TMR
should be able to demonstrate an understanding
of
• Common Environmental problems found in
disasters that affect the Respiratory System
• Common Injuries affecting Respiratory System
• Common Respiratory problems found in disasters
• Common Respiratory Equipment likely to be found
in residences - clues to problems
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
What is a chronic illness?
A chronic illness is a medical problem that lasts a year or
longer, limits what a person can do, and calls for ongoing
care. Examples of common chronic illnesses include:
Diabetes
Chronic Obstructive Pulmonary Disease (COPD)
Heart disease
Chronic pain syndromes
Inflammatory diseases, such as rheumatoid arthritis
*More than 90 million Americans live with some form of chronic illness.
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
Background:
Surviving a natural or man-made disaster is no small
feat, especially for those who have a chronic illness.
During a disaster access to health care, personal
support and medication are lessened.
This leaves people with chronic medical conditions at
risk for serious medical complications—even to the
point of death.
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
Background:
Data collected by the Children's Health Fund and the
Columbia University Mailman School of Public Health,
post Hurricane Katrina revealed the usual minor
injuries,
skin conditions and vaccination adminstrations.
However it also revealed high incidences of:
• Diabetes
• Hypertension
• Asthma
• CHF
• COPD
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
Background:
The most frequent diagnoses in those individuals who
had at least one diagnosis documented were:
•Respiratory:
•URI
•Asthma
•COPD
•Circulatory:
•Hypertension
•CHF
•Minor injury and Skin conditions
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
Background:
During a disaster, access to healthcare, personal
support and medication may be limited. Many problems
post disaster include:
• Lost medications
• Loss of electrical power
• Home care equipment damage/misplaced
As disaster responders, these are potential medical
problems/issues that may occur and should be planned
for.
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
Background:
As disaster medical responders, life support skills
are essential. For the patient with respiratory
problems, these skills include:
• Physical and Environmental Assessment
• Airway management
• Ventilatory support
.
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
Background:
As disaster medical responders, we will more
than likely contribute significantly to:
• Stabilization and monitoring efforts
• Assessment, treatment and consultation
throughout the entire medical response
continuum
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
Environmental Issues
Common Diseases of the Lung
Common Injuries affecting the Respiratory
Systems
Common Equipment found in the residence
of the patient with Pulmonary disease
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Environmental Issues
• Water - drowning or near drowning
• Dust and other airborne particulates
• Humidity (too much or too little)
• Mold and fungi
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Common Diseases of the Lung
• Asthma (small airways and secretions)
• Emphysema - COPD (deformed air sacks
(air trapping) and secretions)
• Bronchitis (large airways and secretions)
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Asthma
– a chronic inflammatory
disorder involving many cell
types
– manifesting with episodes of
chest tightness
– coughing
– labored breathing and
wheezing
– all of which are related to
bronchiole inflammation
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Asthma
– Need to keep the airway
patent (open)
– Prevent collapse of the
airway when exhaling to help
decrease work of breathing
– Why the straws?
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Bronchitis & Emphysema
– Walls between the air sacs
are destroyed (no longer
grape clusters)
– Airways inflamed &
thickened
– Copious amounts of
secretions
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Typical injuries that can be sustained in
traumatic disasters affecting
respiration: Head injuries
• Loss of consciousness
• Upper airway injuries
– facial fractures
– neck injuries
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Facial Fractures
– Nose
• bridge
– Jaw / mouth
• displacement of jaw
• inflammation of the
tongue (airway closure)
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Neck injuries
– Cervical injuries
• paralysis
– Wounds
• soft tissue of neck
– swollen tongue
• Loss of upper airway
– need to establish viable
airway (trach or
endotube)
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Typical injuries that can be sustained in
traumatic disasters affecting respiration:
– Chest injuries
• flail chest (multiple broken ribs on one / both sides of
thorax)
• pneumothroax - chest wounds the penetrate the lung
• abdominal injuries affecting diaphragm movement
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Chest injuries
Broken Ribs on
both sides
– Broken ribs (one or
both sides of chest)
– May or may not
puncture the lung(s)
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Chest injuries
– Pneumothorax
• lung(s) penetrated
• collapse of lung(s)
Both lungs
collasped
– Internal organs can
begin to shift (heart,
diaphragm)
– Must release pressure
• chest tube(s)
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
We should become familiar with at least the most
commonly prescribed respiratory medications and
treatments during an emergency. For example, some
patients with lung disease require:
• Breathing treatments
• Nebulizer
• MDI
• Supplementary oxygen
• Mechanical ventilation
These are usually performed by a respiratory therapist
but some of these skills can be easily learned by a
non therapist health professional.
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Respiratory Care Issues in
Disasters
• Common Equipment found in the
residence of the patient with Pulmonary
disease
• Clues there may be an impending
patient care issue
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
• Nasal Cannula
– Low flow device (2 to 6
lpm) Oxygen % varies
from breath to breath.
– Approximate O2%
range = 24 to ~ 40 %
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
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Venti Mask - Total Gas Flow to Patient
is determined by variable orifice
venturi at varying liter flows (draws in
air to combine with Oxygen to give
approximate O2 %)
Setting
Suggested Oxygen
Flow
Total Gas Flow
24% 3 LPM
79 LPM
26% 3 LPM
47 LPM
28% 6 LPM
68 LPM
30% 6 LPM
53 LPM
35% 9 LPM
50 LPM
40% 12 LPM
50 LPM
50% 15 LPM
41 LPM
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
• (Non)Rebreather Mask
– Moderate to High O2
concentrations (60% +)
– Bag holds additional
Oxygen - flows with
each breath
– Bag movement is
important
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
• Trach(eostomy) Collar
– Requires high flows
– Produces high humidity
– Usually find an “H”
cylinder of Oxygen
– Unable to verbalize*
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
• Oxygen Cylinders
– Oxygen Therapy
• cannula
• mask
– Different sizes are used
• D, E or H size
– Support combustion things that burn, burn
hotter and faster
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
• Liquid Oxygen Systems
– Dewars
• Liquid that vaporizes to a
gas
– Depending on size of
vessel, can be equivalent
of several “H” cylinders
– Extreme freeze burns
• loss of limb(s)
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
• Medication Nebulizer
– Metered Dose Inhaler
• Bronchodilator
• Steroid
– Some are rescue meds
• Fast acting
– Others are maintenance
meds – do not use
during breathing / airway
emergency
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
• Medication Nebulizer
– Fixed, Low flow device (6 to 8
lpm)
– Generally 21% Oxygen
• unless run from alternate
Oxygen source
– Electrically powered
– Aerosolizes liquid medications
into small particles that are
inhaled into lung
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
• Home care ventilator
– Pt unable to breathe
without assistance
– May / May not require
O2
– Usually find an “H”
cylinder of Oxygen
– Unable to verbalize*
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
• Home care ventilator
– Various models and types
– Most require use of
electricity
• check for backup power
source
– Some are pneumatic
• look for cylinders or
compressor
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Common Respiratory
Equipment
• Home care ventilator
– May / May not require
O2
• Look for cylinder gases
• Be aware of cylinder
safety
– fire hazards
– electrical hazards
Texas State Guard
Texas Medical Rangers
HMRG - Galveston Company
Final Thoughts - Recommendations
• Observe situation and surroundings
– findings may lead you to seek possible
problems
• Assess patient and ask questions
– current or previous respiratory health issues
• Provide care
– arrange care by appropriate provider