Transcript Respiratory Emergencies - greene

Respiratory Emergencies
Chapter 11
Respiratory System
Anatomy
and Function
of the Lung
Characteristics of Adequate Breathing
• Normal rate and depth
• Regular breathing pattern
• Good breath sounds on both sides of the
chest
• Equal rise and fall of chest
• Pink, warm, dry skin
Causes of Inadequate Breathing
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Pulmonary vessels become obstructed.
Alveoli are damaged.
Air passages are obstructed.
Blood flow to the lungs is obstructed.
Pleural space is filled.
Signs of Inadequate Breathing
• Slower than 12 breaths/min or faster than 20
breaths/min
• Unequal chest expansion
• Decreased breath sounds
• Muscle retractions
• Pale or cyanotic skin
• Cool, damp (clammy) skin
• Shallow or irregular respirations
• Pursed lips
• Nasal flaring
Dyspnea
• Shortness of breath or difficulty breathing
• Patient may not be alert enough to complain of
shortness of breath.
Upper or Lower Airway Infection
• Infectious diseases may affect all parts of the airway.
• The problem is some form of obstruction to the air flow or
the exchange of gases.
Upper or Lower Airway Infection
(treatment)
• Administer warm, humidified oxygen.
• Do not attempt to suction the airway or insert an
oropharyngeal airway in a patient with suspected
epiglottitis.
• Transport patient in position of comfort.
Acute Pulmonary Edema
• Fluid build-up in the lungs
• Signs and symptoms
– Dyspnea
– Frothy pink sputum
• History of chronic congestive heart failure
• Recurrence high
Acute Pulmonary Edema (treatment)
• Administer 100% oxygen.
• Suction secretions.
• Transport in position of comfort.
Chronic Obstructive Pulmonary
Disease (COPD)
• COPD is the result of direct lung and airway
damage from repeated infections or inhalation
of toxic agents.
• Bronchitis and emphysema are two common
types of COPD.
• Abnormal breath sounds may be present.
– Rhonchi and wheezes
COPD Patients
• COPD patients cannot handle pulmonary
infections well
• Usually age 50 or older
• History of recurring lung problems
• Long-term smokers
• Tightness in chest/constant fatigue
Chronic Obstructive Pulmonary
Disease (COPD) (treatment)
• Assist with prescribed inhaler if patient has
one.
• Transport promptly in position of comfort.
Asthma
• Common but serious disease
• Asthma is an acute spasm of the bronchioles.
• Wheezing may be audible without a
stethoscope.
Asthma (treatment)
• Obtain history.
• Assess vital signs.
• Assist with inhaler if patient has one.
• Administer oxygen.
• Transport promptly.
Spontaneous Pneumothorax
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Accumulation of air in the pleural space
Caused by trauma or some medical conditions
Dyspnea and sharp chest pain on one side
Absent or decreased breath sounds on one side
Spontaneous Pneumothorax
(treatment)
• Administer oxygen.
• Transport in position of comfort.
• Monitor closely.
Anaphylactic Reactions
• An allergen can trigger an asthma attack.
• Asthma and anaphylactic (allergic) reactions
can be similar.
• Hay fever is a seasonal response to allergens.
Pleural Effusion
• Collection of fluid outside lung
• Causes dyspnea
• Caused by irritation, infection,
or cancer
• Decreased breath sounds over
region of the chest where fluid
has moved the lung away from
the chest wall
• Eased if patient is sitting up
Pleural Effusion (treatment)
• Definitive treatment is performed in a
hospital.
• Administer oxygen and support measures.
• Transport promptly.
Mechanical Obstruction of the Airway
• Be prepared to treat quickly.
• Obstruction may result from the position of head,
the tongue, aspiration of vomitus, or a foreign body.
• Opening the airway with the head tilt-chin lift
maneuver may solve the problem.
Obstruction of the Airway (treatment)
• Clear airway.
• Administer oxygen.
• Transport promptly.
Pulmonary Embolism
• A blood clot that breaks
off and circulates through
the venous system
• Signs and symptoms
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Dyspnea
Acute pleuritic pain
Hemoptysis
Cyanosis
Tachypnea
Varying degrees of hypoxia
Pulmonary Embolism (treatment)
• Administer oxygen.
• Place patient in comfortable position, usually
sitting.
• Assist breathing as necessary.
• Keep airway clear.
• Transport promptly.
Hyperventilation
• Overbreathing resulting in a decrease in the level
of carbon dioxide
• Signs and symptoms
– Anxiety
– Numbness
– A sense of dyspnea despite rapid breathing
– Dizziness
– Tingling in hands and feet
Hyperventilation (treatment)
• Complete initial assessment and history of the
event.
• Assume underlying problems.
• Do not have patient breathe into a paper bag.
• Give oxygen.
• Reassure patient and transport.
You are the provider:
• You and your EMT-B partner are dispatched to a 33-yearold woman with difficulty breathing.
• You arrive at the office building and an upset man identifies
himself as the patient’s coworker.
• He tells you that the patient has had breathing problems
before, but he’s never seen it this bad.
• He leads you to a woman who is standing with her arms
outstretched on the desk with a metered-dose inhaler in
hand.
• She acknowledges your presence with a nod. When you ask
her what is wrong, she answers with a two-word response,
“can’t breathe.”
• You hear audible wheezes.
Scene size up
• How significant is the person’s response to
your question and why?
• What should you do next? Should you
transport this patient or wait for ALS to arrive
on scene?
Initial Assessment
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Perform initial assessment.
Place the patient on oxygen.
If patient is in respiratory distress, ventilate.
Check pulse.
Signs and Symptoms
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Difficulty breathing
Altered mental status
Anxiety or restlessness
Increased or decreased
respirations
• Increased heart rate
• Irregular breathing
• Cyanosis
• Pale conjunctivae
• Abnormal breath
sounds
• Difficulty speaking
• Use of accessory
muscles
• Coughing
• Tripod position
• Barrel chest
You are the provider:
• You arrange to rendezvous with ALS.
• You apply high-flow oxygen and obtain the following vital
signs:
– Respirations: 42 breaths/min
– Pulse oximetry: 90%
• The patient indicates that she has used the inhaler twice
already.
• What can you do before you meet ALS?
• Another pulse oximetry reading reveals a reading of 72%.
• The patient is using accessory muscles to breathe.
• What do these signs indicate?
Focused History and Physical Exam
• Abnormal breath sounds are symptomatic of
COPD
• Long history of dyspnea with sudden increase
in shortness of breath
• Recent chest cold with fever
• Vital signs
– Normal blood pressure
– Rapid, occasionally irregular pulse
– Respirations rapid or very slow
Interventions
• Treat immediate life threats
• Possible interventions
– Oxygen via nonrebreathing mask at 15 L/min
– Positive pressure ventilations
– Airway adjuncts
– Positioning
– Respiratory medications
Detailed Physical Exam
• Performed only once life threats are
addressed.
• May not be able to do if busy treating airway
or breathing problems.
Ongoing assessment
• Carefully watch patients for shortness of
breath.
• Reassess vital signs.
• Ask patient if treatment has made a
difference.
• Check for accessory muscle use.
Emergency Medical Care
• Give supplemental oxygen at 10 to 15 L/min
via nonrebreathing mask.
• Patients with longstanding COPD may be
started on low-flow oxygen (2 L/min).
• Assist with inhaler if available.
• Consult medical control.
Medications in MDI
• Trade names
– Proventil
– Ventolin
– Alupent
– Metaprel
– Brethine
• Generic names
– Albuterol
– Metaproterenol
– Terbutaline
Prescribed Inhalers
• Actions
– Relax the muscles surrounding the bronchioles
– Enlarge the airways leading to easier passage of
air
• Side effects
– Increased pulse rate
– Nervousness
– Muscle tremors
Prior to Administration
• Read label carefully.
• Verify it has been prescribed by a physician for
this patient.
• Consult medical control.
• Make sure the medication is indicated.
• Check for contraindications.
Contraindications for MDI
• Patient unable to help coordinate inhalation
• Inhaler not prescribed for patient
• No permission from medical control
• Maximum dose prescribed has been taken.
Administration of MDI
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Obtain order from medical control or local protocol.
Check for right medication, right patient, right route.
Make sure the patient is alert.
Check the expiration date.
Check how many doses have been taken.
Make sure inhaler is at room temperature or warmer.
Shake inhaler.
Stop administration of oxygen.
Ask the patient to exhale deeply and put lips around opening.
If the inhaler has a spacer, use it.
Have the patient depress the inhaler and inhale deeply.
Instruct the patient to hold his or her breath.
Continue administration of oxygen.
Allow the patient to breathe a few times then repeat dose
according to protocol.
Reassessment
• Carefully watch for shortness of breath.
• 5 minutes after administration:
– Obtain vital signs again.
– Perform focused reassessment.
• Transport and continue to assess breathing.