Respiratory Emergencies

⁕ means on WRITTEN study guide

⁕Emphysema⁕

⁕Type of COPD: Permanent enlargement, loss of elasticity and destruction of the alveolar walls (breakdown of alveoli) Causes:

• Smoking - Pollution - Work Environment Signs and Symptoms -

• Short Word Strings - Hyperinflation of Chest - DOE - Prolonged Exhale - Pursed Lip Breathing - Productive Cough (yellow, gray sputum) - Always SOB Vitals: RR: Increased, labored BS: BILATERAL RHONCHI AND WHEEZE SPO2: Decreased ETCO2: Increased Skin: Ashen, cyanotic

• Treatment: Oxygen, Albuterol & Atrovent, CPAP, Watch for changes in LOC

Atelectasis

Alveoli become deflated or filled with fluid, resulting in a complete or partial COLLAPSE OF LUNG

Chronic Bronchitis

TYPE OF COPD: Inflamed bronchial airway, increased mucous production Causes:

• Smoking - Pollution - Work Environment Signs and Symptoms -

• Persistent, productive cough (yellow, white, or gray sputum)

• Fatigue - SOB - Prolonged Exhale Vitals: RR: Increased, Labored HR: Depends on Meds BP: Normal BS: BILATERAL RHONCHI AND WHEEZE SPO2: May be decreased normally ETCO2: Normal Skin: Normal Treatment: Oxygen, Albuterol & Atrovent, CPAP

⁕Asthma⁕

⁕Broncho Constriction, swelling, and mucous production Causes:

• Allergens - Environment - Weather Conditions - Exercise Signs and Symptoms -

• SOB - Tripod - Prolonged Exhale - Accessory Muscle Use - Intubation in the Past? - Children: Dry Hacking Night Cough Vitals: RR: Rapid HR: Rapid BP: Normal - Higher BS: BILATERAL UPPER AND LOWER WHEEZE SPO2: Depends on Severity ETCO2: Depends on Severity Skin: Dry, Pale, Cyanotic Treatment: Oxygen, Albuterol & Atrovent, CPAP Watch for LOC Changes

Status Asthmaticus

When Asthma doesn't get better with typical treatment
Causes:
- Same as Asthma
Signs and Symptoms -
- SOB - Tripod - Prolonged Exhale - Accessory Muscle Use - Intubation in the Past? - Watch for Failure
Vitals:
RR: Could Slow Down HR: Could Slow Down
BP: (same) BS: Absent lung sounds
SPO2: Really low ETCO2: Really high
Skin: Cyanotic
Treatment: Oxygen, Albuterol & Atrovent, CPAP
Watch for LOC Changes

⁕Pneumonia⁕

⁕An infection that inflames the alveoli and alveoli fill with fluid or puss (can be in one or both lungs) Causes:

• Infection (bacterial, viral, fungal, aspiration, etc.) Aspiration Signs and Symptoms -

• Chest pain with inhale - Hacky Cough - Productive Cough (yellow, GREEN sputum) - Fatigue - Fever - Chills Vitals: RR: Increased HR: Increased BP: Normal to Increased BS: RHONCHI (bases) SPO2: Maybe Decreased ETCO2: Maybe elevated Skin: Flushed, fever Treatment: Oxygen, CPAP, Suction

⁕Pulmonary Embolism⁕

⁕Blockage of one or more pulmonary arteries Causes:

• DVT (Deep Vein Thrombosis) - Fat embolism - Abdominal Surgery - Pregnancy - Labor Signs and Symptoms -

• Sudden Onset SOB - Cyanosis - Anxiety - Altered LOC - Vitals: RR: Rapid HR: Rapid BP: Normal to Hypotensive BS: CLEAR SPO2: Low ETCO2: Low (due to rapid ventilation) Skin: Pale, Cyanotic, Diaphoretic Treatment: Oxygen, Rapid transport

Spontaneous Pneumothorax

Accumulation of air in the pleural space (when the alveoli pop) Causes:

• Ruptured bleb - Emphysema - Cystic Fibrosis - PneumoniaSigns and Symptoms -

• Sudden Chest Pain - SOB (usually delayed hours) - DOE Vitals: RR: Normal to Rapid HR: Normal to Rapid BP: Normal BS: UNILATERAL CHANGES (specific lobe) SPO2: Normal to Low ETCO2: Normal Skin: depends on size of pneumo Treatment: Oxygen, Keep in Comfort Positon

Tension Pneumothorax

air in the pleural space causing inadequate oxygenation or ventilation Causes:

• Spontaneous Pneumo - Penetrating Trauma - Lung Damage Signs and Symptoms -

• Severe SOB - Asymmetric Lung Expansion (decreased ventilation on one side) Vitals: RR: Increased HR: Increased BP: Hypotension BS: UNILATERAL, DISTANT, OR ABSENT SOUNDS SPO2: Increased ETCO2: Normal Skin: Cyanotic Treatment: Oxygen, BVM

Hyperventilation Syndrome

Condition in which minute ventilation exceeds metabolic demands Causes:

• Anxiety - Stress - Drugs or Alcohol Signs and Symptoms -

• Cold Extremities due to Vasoconstriction - Deep rapid respirations (Kussmaul) - Sharp Chest Pain - Carpal Pedal Spasms Vitals: RR: Increased HR: Increased BP: Normal to Increased BS: CLEAR SPO2: Normal, possibly low ETCO2: Low Skin: Pale, Pink, Cold Hands Treatment: Non-Rebreather (1-2 L/min) and Comfort + Reassurance

⁕Anaphylaxis⁕

⁕A multiorgan system reaction cause by an extreme allergic reaction Causes:

• Allergens Signs and Symptoms -

• SOB - Hives - Swelling - Vomiting - Diarrhea Vitals: RR: Rapid HR: Rapid BP: Low BS: BILATERAL WHEEZING SPO2: Decreased ETCO2: Increased Skin: Cyanotic Treatment: Oxygen, EPI, Albuterol & Atrovent, Airway Management

Cystic Fibrosis

Genetic Disease, affects glands that produce mucous and sweat (causing mucus to become thick and sticky and excessive sweating) Causes:

• (genetics) Signs and Symptoms - Mucous Builds Up in BRONCHI AND BRONCHIOLES

• Pneumonia - Electrolyte Imbalance - Dehydration - Fatigue - Heat Stroke Vitals: RR: (normal) HR: (normal) BP: Low BS: BILATERAL RHONCHI SPO2: (normal) ETCO2: (normal) Treatment: Oxygen, Albuterol & Atrovent, Saline Nebulizer - CPAP Watch for Changes in LOC

ARDS
(Acute Respiratory Distress Syndrome)

Increased capillary permeability (when fluid fills the alveoli) Causes:

• Sepsis - Severe Pneumonia Signs and Symptoms -

• Severe SOB - Low BP - Altered LOC - Pneumothorax Vitals: RR: (normal) HR: (normal) BP: (normal BS: BILATERAL RALES SPO2: (normal) ETCO2: (normal) Treatment: Oxygen (94-99%)

Anemia

Not enough healthy red blood cells to carry adequate oxygen to the bodies tissues Causes:

• Bleeding - Iron Deficiency - Sickle Cells (red-blood cells become misshapen and break down) - HIV/AIDS -Pregnancy Signs and Symptoms -

• Fatigue - Weakness - DOE -SOB - Chest Pain - Cold Extremities Vitals: RR: (normal) HR: (normal) BP: (normal BS: CLEAR SPO2: NORMAL ETCO2: NORMAL Skin: Pale, Cool/Cold Treatment: Oxygen, Keep Warm

Croup

A viral infection that causes inflammation of the upper airway (larynx, trachea, (among bronchi, bronchioles) Causes:

• URI - Influenza - Measles - RSV Signs and Symptoms -

• Stridor - Barking Cough at Night - Fever - Flush

• Nasal Secretions - Anxiety Vitals: RR: Increased HR: Increased BP: Normal BS: STRIDOR (listen at trachea) SPO2: Normal to Decreased ETCO2: Normal Skin: Flush, Fever Treatment: Oxygen, Nebulized Saline (NO ALBUTEROL OR ATROVENT)

Bronchiolitis

An infection causing inflammation and congestion of the bronchioles (an acute infection of the epithelial cells lining the bronchioles) Causes:

• RSV - Virus Signs and Symptoms -

• Fussy - Fever - Nasal Secretions - Tachypnea - Nasal Flaring - Retractions - Pulling at Ears - Pneumonia Vitals: RR: Increased HR: Increased BP: Normal BS: WHEEZE AND RALES SPO2: Normal ETCO2: Normal Treatment: Nebulized saline, Suction, Possible A&A, BVM

Epiglottitis

Inflammation and swelling of the epiglottis Causes:

• Infection with HIB (Haemophilus Influenza Type B) Signs and Symptoms -

• Severe Sore Throat - Drooling - Stridor - Difficulty Swallowing - Leaning forward/Sitting Up (to improve airflow) Vitals: RR: Increased HR: Increased BP: Normal BS: STRIDOR (listen at trachea) SPO2: Normal to Low ETCO2: Normal Skin: Fever, Flush Treatment: Expeditious Transport, Oxygen, BVM

Tuberculosis

Chronic bacterial disease, caused by myobacterium tuberculosis and affects the lungs but can also affect other organs Causes:

• Active Disease Patients - Droplet Transmission Signs and Symptoms -

• Persistant Cough - Coughing Blood - Chest Pain w/ Breathing - Weight Loss - Fatigue - Chills - Night Sweats Vitals: RR: Normal to Increase HR: Normal to Increase BP: Normal BS: Maybe Crackles SPO2: Normal to Low. ETCO2: Normal Skin: Rash, Lesions, Purpura Treatment: Oxygen, Place N95 on Patient

What are the 2 Upper Airway Diseases?

Epiglottitis and Croup

Acidosis

TOO MUCH CARBON DIOXIDE IN THE BODY when acid builds up in the body

• Causes: Rapid Breathing 2 types: Respiratory (CO2) and Metabolic

Adventitious Breath Sounds

abnormal breath sounds

Alkalosis

the buildup of excess base (lack of acid) in bodily fluids

COPD

Chronic Obstructive Pulmonary Disorder
- a group of diseases that cause blockage of airflow and breathing related problems

Orthopnea

Severe dyspnea when lying down; relieved by sitting up
- also called Paroxysmal Nocturnal Dyspnea

Pertussis

highly contagious respiratory infection caused by bacteria
- Whooping Cough

Pleuritic Chest Pain

sharp, stabbing pain the the chest
- worsened by movement of the chest wall

Respiratory Syncytial Virus (RSV)

common respiratory virus, that can cause bronchiolitis and pneumonia (especially seen in children)

Vesicular Breath Sounds

normal breath sounds

Embolus

a moving clot, that blocks bloodflow

What do you do after SPO2 on a patient is 100%?

Titrate volume of oxygen so SPO2 = 94-99%