Transcript Care of the person with Respiratory Compromise in disaster

Care of the person with
functional needs in disaster
situations: The respiratory
system
Rachel K. Vanek, RN, BS, BSN, MSN
Acute Care Nurse Practitioner
Medical Intensive Care Unit
University/Case Medical Center
Great Dismal Swamp Fire
Apartment Fire
• Large apartment complex caught fire
• >100 elderly and poor evacuated
• Many had respiratory and other illnesses
making them vulnerable in emergency
situations
• Evacuated to hospitals and nursing homes
for care/access to medical supplies
Heat Waves
Cold Snaps
Floods
Weather
Illness outbreaks
• Flu
• Cold season
• Water-borne illness
• Crowded living situations
Dust/Environmental Disasters
• Dust storms
• Toxic chemical leaks
• Santa Anna winds
• Other exposures that may require
evacuation or special treatment
Purpose
• Learn a bit about normal respiratory
functions
• Determine strategies to plan for the
management vulnerable persons in the
event of an emergency
• Answer YOUR questions
Respiratory Anatomy and
Physiology
• Respiratory system comprised of
conducting system and gas exchange
system
• Upper airway filters and warms air
• Gas exchange occurs at the level of the
alveoli
Functions of Respiratory System
• Warm and humidify air
• Provide oxygen
• Remove carbon dioxide
• Cough and sneeze reflex to clear foreign
material
• Filters blood of small material in the
circulation
• Release and convert special hormones
Respiratory Disorders
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COPD
Asthma
Heart Failure
Pulmonary
Hypertension
Pneumonia
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Pulmonary embolism
Pneumonia
Sleep apnea
Lung Cancer
Fibrosis
Cystic fibrosis
Medical Technologies
• Enabling many people with severe disease
to live longer, better lives
• Patient is dependent on technology to
survive
• May be simple to complex
• Most are fairly compact and portable now
Medications
• Always have a supply on hand
• Always carry a list of medications and
allergies
• Have name and number of pharmacy
Intravenous Medications
• Some medications are infused into veins
• Insulin pumps infuse subcutaneously
• Flolan pumps require cassettes and special
handling and infuse into central line
IV medication safety
• Running out of insulin or medication for
pulmonary hypertension is an emergency
• Patients have premixed supply
• Needs refrigeration
• Needs special handling to prevent
overdose or infection
• Friends, family or aides to assist
Medication Safety
• Child proof caps
• Never mix different medicines in one
container
• Never share or take someone else’s
medications
• Expiration dates should be on the bottle
• Never alter medication unless instructed to
do so
Oxygen
• Used in a variety of health situations
• May be used constantly or as needed, for
example with exercise
• Delivered via nasal cannula
• Can be used with CPAP or BiPap at home
• Can be used with mechanical ventilator
Oxygen Delivery
• Nasal Cannula
• Simple Mask – used for O2 and nebulizer
• Venturi Mask
• Increased O2 needs requires specialty
care
• May have concentrator or storage tank
Oxygen Safety
• Keep tanks 5-10 feet from heat source or
open flames
• Secure an oxygen cylinder to a solidly
fixed object
• No smoking in car or home when O2 in
use
• Do not use petroleum based products near
O2 use
Oxygen Safety
• Be careful when long lengths of tubing in
use to avoid tripping
• If O2 is pressurized avoid touching iced
areas
Oxygen concentrators
Inhalers/Nebulizers
• Medications delivered directly into the lung
• Used in a variety of respiratory illnesses
• Inhalers deliver medications in aerosol
form to effect the airways
• Nebulizer delivers the medication in a mist
• Drugs and method of delivery are
prescribed
Ventilators
• Provides gas movement in and out of
lungs
• Replaces work of breathing for person
who can’t breathe or can’t breathe
effectively
• It is a life critical machine
Ventilators
• Person will have a tracheostomy
• Require specialized training
• People on ventilators have family, friends,
or aides trained in the care and
management
• Battery packs can last up to 8 hours
Mechanical Ventilator Safety
• Airway must be secured
• Machines have alarms
• Airway requires suctioning at times
• If disconnected easy to reconnect
• Bag valve mask can replace the ventilators
work in an emergency
• Back up power source
Ventilator Safety
• Avoid loops of tubing – can be hazardous
• Homes that have patients on ventilators
have special emergency plans
• Same safety precautions for oxygen if they
have it as well
CPAP and BPAP
• CPAP is now a common modality for the
treatment of obstructive sleep apnea
• BPAP is used as an adjunctive modality to
assist in ventilatory support
• Machines have settings preset
• Can be attached to oxygen
CPAP and BPAP
• BPAP is used to assist ventilatory support
when sleeping
• CPAP is used to stent open airways for
obstructive sleep disorders
• May have different uses in the hospital
CPAP and BPAP saftey
• Never use someone else’s machine
• Avoid long loops of tubing
• Most have built in humidity that need to
be maintained and refilled
• Masks and tubing can be cleaned with
soap and water
Key Points
• O2 safety
• People with medical needs will generally
have the equipment they need
• Providing safe haven
• Enlist the assistance of family and friends
Thank you for your kind
attention
Questions????