respiratory emergencies and interventions

Chronic Obstructive Pulmonary Disease (COPD)

Broad classification of chronic lung diseases

– Includes emphysema, chronic bronchitis, and many

undetermined respiratory illnesses

• Overwhelming majority of cases are caused by cigarette

smoking

Chronic bronchitis

– Bronchiole lining inflamed

– Excess mucus produced

– Cells in bronchioles that normally clear away mucus

accumulations are unable to do so.

Emphysema

– Alveoli walls break down.

▪ Surface area for respiratory exchange is greatly

reduced.

– Lungs lose elasticity.

– Results in air laden with carbon dioxide being trapped

in lungs, reducing effectiveness of normal breathing

asthma

Chronic disease with episodic exacerbations

• During attack, small bronchioles narrow

(bronchoconstriction); mucus is overproduced.

• Results in small airway passages practically closing down,

severely restricting air flow

airflow during asthma

• Inhalation

– Expanding lungs exert outward pull, increasing

diameter of airway and allowing air flow into lungs.

• Exhalation

– Opposite occurs and air becomes trapped in lungs.

pulmonary edema

Abnormal accumulation of fluid in alveoli

Pressure builds up in pulmonary capillaries.

• Fluid crosses the thin barrier and accumulates in the

alveoli.

• Fluid occupying lower airways makes it difficult for oxygen

to reach blood.

signs and symptoms of pulmonary edema

Dyspnea

– Anxiety

– Pale and sweaty skin

– Tachycardia

– Hypertension

– Respirations are rapid and labored.

– Low oxygen saturation

Patients may cough up frothy sputum, usually white,

but sometimes tinged pink.

pulmonary edema treatment

Assess for and treat inadequate breathing.

– High-concentration oxygen

– If possible, keep patient’s legs in dependent position.

– CPAP may be used to push fluid back out of lungs and

into capillaries.

pneumonia

Infection of one or both lungs caused by bacteria, viruses,

or fungi

• Results from inhalation of certain microbes

• Microbes grow in lungs and cause inflammation.

pneumonia signs and symptoms

Shortness of breath with or without exertion

– Coughing

– Fever and severe chills

– Chest pain (often sharp and pleuritic, worsening on

inhalation)
Headache

– Pale, sweaty skin

– Fatigue

– Confusion

pneumonia treatment

Care mostly supportive

– Assess for and treat inadequate breathing.

– If the patient is hypoxic, administer supplemental

oxygen.

– In some EMS systems, EMTs apply CPAP to these

patients.

– In some cases, pneumonia can be severe enough to

cause inadequate breathing, and will require artificial

respirations.

spontaneous pneumothorax

Lung collapses without injury or other obvious cause.

• Higher risk for this condition

– Patients with COPD and history of smoking at highest

risk

– Tall, thin people

signs of a spontaneous pneumothorax

Sharp, pleuritic chest pain

– Shortness of breath

– Easily tired

– Low oxygen saturation, cyanosis

– Tachycardia

– Fast breathing

– Decreased or absent lung sounds on side with injured

lung

– With worsening, JVD and hypotension

treating a spontaneous pneumothorax

Contact ALS immediately if pneumothorax is suspected

and patient has significant respiratory distress.

– Administer oxygen.

– CPAP contraindicated

– Transport for definitive care, as patients frequently

require a small catheter or larger chest tube

pulmonary embolism

Blockage in blood supply to lungs

• Commonly caused by deep vein thrombosis (DVT)

• Common reasons for DVT

– Lying down or sitting in the same position for an

extended period

– Having active cancer

– Having a limb immobilized in a cast

pulmonary embolism signs

Sharp, pleuritic chest pain

– Shortness of breath

– Anxiety

– Coughing

– Tachycardia

– Tachypnea

– Lightheadedness/dizziness

– Pain and swelling in one or both legs

– Hypotension and cardiac arrest

pulmonary embolism treatment

Difficult to differentiate in field

– Administer oxygen and treat patient like anyone else

with shortness of breath.

– Transport to definitive care.

epiglottitis

Infection causing swelling around and above the epiglottis

• In severe cases, swelling can cause airway obstruction.

epiglottitis symptoms

Sore throat, painful or difficult swallowing

– Tripod position

– Sick appearance

– Muffled voice

– Fever

– Drooling

– Stridor

epiglottitis treatment

Keep patient calm and comfortable.

– Do not inspect throat.

– Administer high-concentration oxygen if possible

without alarming patient.

– Transport.

croup

caused by a group of viral illnesses that result in

inflammation of the larynx, trachea, and bronchi

• Tissues in the airway (particularly the upper airway)

become swollen and restrict the passage of air

croup signs and symptoms

Loud, barking cough

– Hoarse voice

– Associated breathing difficulty typically resolves when

the child moves to an upright position.

– Inadequate breathing, indicated by signs of hypoxia

(cyanosis, altered mental status, etc.)

– Signs of significant breathing difficulty (inspiratory

stridor)

croup treatment

If signs of inadequate breathing are present, initiate

artificial respirations and transport immediately.

– If the patient is in respiratory distress but is breathing

adequately, call advanced life support (ALS) and initiate

gentle transport.

– Consider supplemental oxygen if the patient is hypoxic.

– Allow the patient to remain in a position of comfort.

bronchiolitis

Small airways become inflamed because of viral

infection.

• Most common cause is the respiratory syncytial virus, or

RSV

bronchiolitis signs

Commonly associated with other cold-like symptoms

such as a runny nose, fever, and general illness

– Symptoms typically progress over a few days and

worsen to include respiratory distress.

– Common for multiple children in the house to be sick

with similar symptoms

– Can cause significant respiratory distress and

progress to inadequate breathing

bronchiolitis treatment

Artificial ventilation may be necessary.

– If the patient is hypoxic or shows signs of hypoxia,

treat with supplemental oxygen.

– Consider using a bulb syringe to suction the nose if it

is obstructed by mucus.

– Clearing the nose of an infant can significantly

improve minute ventilation

cystic fibrosis

Genetic disease typically appearing in childhood

• Causes thick, sticky mucus accumulating in the lungs and

digestive system

• Mucus can cause life-threatening lung infections and

serious digestion problems.

cystic fibrosis signs

Coughing with large amounts of mucus

– Fatigue

– Frequent occurrences of pneumonia

– Abdominal pain and distention

– Coughing up blood

– Nausea

– Weight loss

respiratory infection