Transcript CH10_Respiratory

Chapter 10
Respiratory Emergencies
Lesson Objectives
• Describe the anatomy and physiology of the
respiratory system.
• Assess and treat chest injuries, including rib
fractures, pneumothorax, hemothorax, and
open injuries.
• Assess and manage respiratory illnesses,
including chest pain, asthma, colds,
bronchitis, pneumonia, and hyperventilation.
Anatomy and Physiology (1 of 2)
• Respiratory system includes:
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Air passages
Lungs
Chest wall
Diaphragm
Anatomy and Physiology (2 of 2)
• Chest is bounded by the collarbones and
lower margin of the rib cage.
• Main structures in the chest
– Lungs
– Heart
– Arteries and veins
• Respiratory emergencies can be caused
by injury or illness.
Chest Injury (1 of 15)
• Usually result from high-energy incidents.
• Always consider the mechanism of injury.
Chest Injury (2 of 15)
• Assessment and treatment of chest
injuries
– What to look for:
• Abnormal breathing and obstruction
• Painful breathing and coughing
• Noisy breathing
• Bluish lips or fingernails
• Coughing up blood or pink froth
• Wounds
Chest Injury (3 of 15)
• Assessment and treatment of chest injuries
– What to look for:
• Sucking noise from moving air in and out of
wound
• Decreased movement on one or both sides
of the chest
• Grating or clicking sound
• Increased pulse rate
• Signs of internal bleeding and shock
Chest Injury (4 of 15)
• Assessment and treatment of chest injuries
– What to look do:
• Keep airway open.
• Help victim into a comfortable position.
• Encourage deep breathing.
• If breathing or coughing is painful, splint
affected area.
• Evacuate if victim cannot speak in complete
sentences, is cyanotic, or if condition worsens.
Chest Injury (5 of 15)
• Rib fractures
– Can be isolated or associated with internal
organ damage.
– Flail chest: Chest wall loses support for
breathing.
Chest Injury (6 of 15)
• Rib fractures
– What to look for:
• Severe, localized chest pain
• Tenderness directly over ribs
• Deformity
• Grating or clicking sound
• Shortness of breath
• Coughing up blood or pink froth
• Abdominal pain, distention, and tenderness
Chest Injury (7 of 15)
• Rib fractures
– What to do:
• Give painkillers.
• Hold a pillow against the painful area.
• Tape or strap a bulky pad over area for
flail chest.
• Evacuate all severe injuries.
Chest Injury (8 of 15)
• Pneumothorax and
hemothorax
– Pneumothorax: Air
enters pleural space.
– Hemothorax: Blood
enters pleural space.
Chest Injury (9 of 15)
• Pneumothorax and hemothorax
– What to look for:
• Signs of serious chest injury
• Progressively worsening shortness
of breath
• Possible penetrating injury
Chest Injury (10 of 15)
• Pneumothorax and hemothorax
– What to do:
• Allow victim to assume position of comfort.
• Evacuate immediately.
Chest Injury (11 of 15)
• Tension pneumothorax
– Flap-like tear on surface of the lung acts as a
one-way valve.
– Air enters pleural space and becomes trapped.
– Pressure in the chest builds rapidly.
– Condition quickly becomes life threatening.
Chest Injury (12 of 15)
• Tension pneumothorax
– What to look for:
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Gasping, labored breathing
Cyanosis
Severe shortness of breath
Bulging of the affected chest
Trachea shifted away from affected side
Bulging veins in face and neck
Shock
Chest Injury (13 of 15)
• Open injury
– A wound large enough for air to
enter chest from outside
– The lung collapses.
– Wound must be sealed.
– “Sucking chest wound”
Chest Injury (14 of 15)
• Open injury
– What to look for:
• Injury after a severe blow or fall
• Broken skin with an obvious hole
• Signs of pneumothorax
Chest Injury (15 of 15)
• Open injury
– What to do:
• Seal the wound with an impermeable
dressing.
• If condition worsens, release a corner
of dressing to allow escape of air with
expiration.
Respiratory Illnesses (1 of 19)
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Relatively common
Mild or severe
Upper and lower respiratory infections
Non-infectious problems
Chest wall problems
Respiratory Illnesses (2 of 19)
• What to look for:
– Shortness of breath, cough, pain
– History of asthma, smoking, heart problems,
or respiratory illnesses
– Pain with movement of arms and tenderness
of chest
– Fever and generalized muscle aches
Respiratory Illnesses (3 of 19)
• What to look for:
– Chest pain with exertion, suggesting
heart problems
– Coughing up sputum, runny nose, sore
throat, stuffy nose
– Headache
– Severe breathing problems
– Swollen lymph nodes
Respiratory Illnesses (4 of 19)
• Serious when there is:
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Shortness of breath, weakness, cold, clammy skin
History of lung disease or heart disease
Difficulty with breathing
Noisy breathing
Blood in sputum
Cyanosis
Respiratory Illnesses (5 of 19)
• What to do:
– Serious respiratory problems:
• Keep victim warm.
• Allow victim to assume position of comfort.
• Administer pain medication or assist victim
with his or her own respiratory medications.
• Evacuate immediately.
Respiratory Illnesses (6 of 19)
• What to do: Non-urgent problems
– Allow patient to assume position of comfort.
– Encourage rest and fluids.
– Have victim breathe vapors from boiling pan
of water.
– Encourage use of acetaminophen or
ibuprofen (except in children).
– Use decongestants for upper respiratory
symptoms.
Respiratory Illnesses (7 of 19)
• Chest pain
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Common
Usually not serious
Should not be ignored
Seek immediate medical attention immediately
for chest pain due to exertion or associated
with shortness of breath.
Respiratory Illnesses (8 of 19)
• Chest wall pain
– Can be caused by exercise or minor injury
– Treat symptoms with activity modification,
stretching, and painkillers
Respiratory Illnesses (9 of 19)
• Asthma
– Lung condition characterized by recurring
spells of shortness of breath, wheezing,
and cough due to spasm and swelling of
the small air passages.
Respiratory Illnesses (10 of 19)
• Asthma
– What to look for:
• Shortness of breath
• Difficulty exhaling
• Audible wheezing
• Exposure to environmental triggers
Respiratory Illnesses (11 of 19)
• Asthma: What to do
– Place victim in
comfortable, upright
position.
– Assist with medication.
– Give clear fluids.
– Evacuate if medication
does not help.
Respiratory Illnesses (12 of 19)
• Cold
– What to look for:
• Runny nose
• Headache
• Malaise
• Fever and chills
• Cough
Respiratory Illnesses (13 of 19)
• Cold
– What to do:
• Rest
• Fluids
• Decongestants
• Painkillers
Respiratory Illnesses (14 of 19)
• Bronchitis
– What to look for:
• Productive cough
• Fever
• Malaise
• Congestion
Respiratory Illnesses (15 of 19)
• Bronchitis
– What to do:
• Treat as for a cold.
• Keep victim away from smoke.
• Evacuate if there is shortness of
breath or signs of pneumonia.
Respiratory Illnesses (16 of 19)
• Pneumonia
– What to look for:
• Ill victim
• Productive cough
• High fever
• Localized chest pain
• Possible shortness of breath
• One side of chest may not expand fully.
Respiratory Illnesses (17 of 19)
• Pneumonia
– What to do:
• Treat as for bronchitis or cold.
• Evacuate if victim does not improve.
Respiratory Illnesses (18 of 19)
• Benign hyperventilation
– What to look for:
• Dizziness or light-headedness
• Increasing shortness of breath
• Numbness, coldness, tingling of
the mouth, hands, and feet
• Chest tightness or discomfort
Respiratory Illnesses (19 of 19)
• Benign hyperventilation
– What to do:
• Reassure the victim.
• Remove from cause of anxiety.
• Encourage slow, regular breathing.
• If hyperventilation persists, consider
other causes and plan to evacuate.