Chapter 19 - Respiratory Emergencies

changes in pressure within chest cavity

What do inhalation and exhalation require?

negative pressure

What pressure do the lungs use to bring air in?

positive pressure

What pressure do the lungs use to bring air out?

by contraction and relaxation of respiratory system muscles

How are the changes in pressure generated?

active

What type of process is inspiration?

diaphgram and intercostal muscles

What contracts to increase size of the chest cavity?

relax

What do the diaphgram and intercostal muscles do to decrease the size of the chest cavity?

inspiration

What is the term for breathing in (inhaling)?

expiration

What is the term for breathing out (exhaling)?

adequate breathing

What is the breathing required to support life?

normal mental status

adequate air movement

ability to speak normally

normal skin color

normal oxygen saturation

What are the signs of adequate breathing?

12-20/minute

What is the normal breathing rate for an adult?

18-30/minute

What is the normal breathing rate for a school-age child?

30-60/minute

What is the normal breathing rate for an infant (0-6 months)?

inadequate breathing

What is breathing not sufficient to support life?

tachypnea or bradypnea

inability to speak

no air movement on auscultation of lungs

poor tidal volume

diminished/absent lung sounds

hypoxia

What are the signs of inadequate breathing?

smaller airway diameter, larger tongues

smaller, softer + more flexible trachea

less developed and less rigid cricoid cartilage

How are the structures of a pediatric patient's airway different from an adult?

nasal flaring

grunting

seesaw breathing

retractions

What are the signs of inadequate airway in pediatric patients (in addition to the signs of an adult PT)?

assist ventilations with supplemental oxygen

How should you assist with inadequate breathing?

chest rise and fall should be visible with each breath

How can you tell if there is an adequate tidal volume with assisted ventilations?

once every 6 seconds

How often should you give assisted ventilations for an adult?

once every 4 seconds

How often should you give assisted ventilations for a pediatric patient?

increasing pulse rates

What can indicate inadequate artificial ventilations in adults?

decreasing pulse rates

What can indicate inadequate artificial ventilations in pediatric patients?

breathing difficulty (shortness of breath)

What is a frequent chief complaint that describes a PT's feeling of labored or difficult breathing?

AMS

unusual anatomy ("barrel chest")

work of breathing

pale, cyanotic, or flushed skin

pedal or sacral edema

SpO2 less than 94%

What are observations seen in a patient with breathing difficulty?

retractions

use of accessory muscles

flared nostrils

pursed lips

What signs show a patient is having labored breathing, an increased difficulty of breathing?

tripod position

What position might a patient with breathing difficulty take?

any lung sounds on both sides during inspiration and expiration

What should you be listening for when auscultating a PT with breathing difficulties?

rales (or "crackles")

What is a fine, crackling or bubbling sound that is heard best on inspiration and is caused by fluid in the alveoli or by the opening of closed alveoli?

congestive heart failure, hypervolemia, or pneumonia

What do rales ("crackles") typically indicate?

ronchi

What are lower-pitched sounds resembling snoring or rattling, caused by secretions?

ronchi are heard in the bronchi

Where are ronchi heard?

stridor

What are high-pitched upper airway sounds indicating partial obstruction of the trachea or larynx?

foreign body obstruction, burns, or anaphylaxis

What typically causes tridor?

with a bag valve mask at 10-15 liters per minute

If you need to assist ventilations, how will you do so?

nasal cannula (1-6 LPM) or non-rebreather (10-15 LPM)

If applying oxygen to a PT who is breathing adequately, what are your options?

place patient in position of comfort (sitting up in a high-fowler's position)

apply appropriate oxygen therapy, if needed

consider albuterol if PT has prescription and is wheezing

consider application of CPAP

How should you care for a patient having breathing difficulty?

continous positive airway pressure (CPAP)

What is a form of non-invasive, positive pressure ventilation that consists of a mask and a means of blowing oxygen or air into the mask to prevent airway collapse or to help alleviate difficulty breathing?

by blowing oxygen or air continously at low pressures

How does a CPAP device prevent the alveoli from collapsing?

prevent fluid from entering alveoli

What does a CPAP do in the event of pulmonary edema?

pulmonary edema (from CHF or hypervolemia)

drowning

asthma and COPD

pneumonia

What are common indications of a CPAP device?

AMS

apnea or inadequate ventilations

inability to sit up

hypotension

nausea and vomiting

chest trauma

GI bleed or recent gastric surgery

What are contraindications for a CPAP device?

reduced blood pressure

pneumothorax

increased risk of aspiration

What are some side effects of using a CPAP device?

explain procedure to patient

reassess patient's MS, vitals, and dyspnea levels frequently

start pressure at 7.5 cm H2O

What are the steps for using a CPAP device?

5 cm H2O

What is the normal pressure that we breathe on?

remove the device immediately and transition to ventilating with a bag valve mask

If the patient deteiorates while on a CPAP device, what should you do?

BVM ventilations are not continous

What is the difference between a CPAP and BVM ventilations?

chronic bronchitis

What is when the bronchiole lining becomes inflamed?

excessive mucus production, mucus unable to be cleared

What is caused by the bronchiole lining inflammation in chronic bronchitis?

emphysema

What is when the alveoli walls break down?

surface area for gas exchange is reduced

What is caused by the alveoli walls breaking down in emphysema?

chronic obstructive pulmonary disease (COPD)

What is an umbrella term that classifies emphysema and chronic bronchitis?

cigarette smoking

What causes most cases of COPD?

asthma

What is a chronic disease with episodic exacerbations that involves bronchoconstriction and overproduction of mucus?

expiratory wheezing

What does asthma typically present with?

insect stings, air pollutants, infection, strenuous exercise, or emotional stress

What can cause an asthma attack?

air is able to flow into the lungs, but bronchoconstriction occurs upon exhalation, trapping stale air inside the lungs

How is air affected during an asthma attack?

apply oxygen

ask if PT is prescribed an albuterol inhaler

• if YES, administer albuterol

• if NO, contact medical direction for orders

How should you treat an asthmatic PT with shortness of breath and/or wheezing?

pulmonary edema

What is the abnormal accumulation of fluid in the alveoli?

patients with CHF or kidney dease (hypervolemia)

What patients are especially prone to pulmonary edema?

dyspnea

rales on auscultation

anxiety

pale, diaphoretic skin

tachycardia

hypertension

labored + rapid respirations

hypoxia

gurgling may be heard without auscultation in severe cases

coughing up on pink, frothy sputum

What are common signs and symptoms of pulmonary edema?

assess and treat any inadequate breathing

apply high-concentration oxygen (15LPM via NRB)

consider CPAP application

call ALS early

How do you treat pulmonary edema?

pneumonia

What is an infection in one or both lungs that may be caused by bacteria, viruses, or fungi?

from the inhalation of certain microbes with the inability to effectively clear them

How does pneumonia result?

by growing inside the lungs

How do microbes cause the inflammation present in pneumonia?

shortness of breath

coughing

fever + chills

chest pain (oft. sharp and related to breathing, worse on inhalation)

headache

fatigue

confusion (esp. in elderly patients)

rales on auscultation

What are some signs + symptoms of pneumonia?

assess + treat for inadequate breathing

apply supplemental oxygen if PT has dyspnea or hypoxia

consider application of CPAP in severe shortness of breath

How do you treat pneumonia?

spontaneous pneumothorax

What is a condition where the lung collapses without injury or other obvious cause?

PTs with COPD and a history of smoking

those who are tall and thin

Who is at highest risk of developing spontaneous pneumothorax?

sharp, pleuritic chest pain

shortness of breath

hypoxia

tachycardia/tachypnea

decreased or absent lung sounds on one side

JVD or hypotension (severe sign)

What are some signs + symptoms of spontaneous pneumothorax?

contact ALS immediately if significant respiratory distress

administer supplamental oxygen

CPAP IS CONTRAINDICATED

transport to definite care

How should you treat spontaneous pneumothorax?

pulmonary embolism

What occurs when there is a blockage in the pulmonary arteries that deliver blood to the lungs?

a deep vein thrombosis (DVT) in lower etremities that travels to the vena cava, into the right atrium, through the right ventricle, and then lodges in a pulmonary artery

What commonly causes pulmonary embolism?

lying down or being in the same position for an extended period of time

having cancer

having a limb immobilized (like after a surgery)

What are common risk factors for a pulmonary embolism?

sharp, pleuritic chest pain

shortness of breath

anxiety

coughing

tachycardia/tachypnea

dizziness or lightheadedness

pain + swelling in one or both legs

hypotension and cardiac arrest

What are some signs and symptoms of a pulmonary embolism?

ask about long travel

ask about smoking history

ask about use of oral contraceptive pills

ask about a history of clotting disorder and any known history of blood clots

ask about pain in the legs

What PT history questions should you ask to differentiate a pulmonary embolism?

titrate oxygen administration to treat shortness of breath and hypoxia

Transport + pass along relevant history

How should you treat a pulmonary embolism?

epiglottitis

What is an infection that causes swelling around and above the epiglottis, mostly in children?

airway obstruction

What can severe cases of epiglottitis result in?

H. influenza

What is the likely causal bug of epiglottitis?

unvaccinated children

What type of PT is epiglottitis mostly seen in?

sore throat, painful or difficult swallowing

tripod position

muffled voice

fever

drooling

stridor

What are S+S of epiglottitis?

consider ALS intercept

keep patient calm + comfortable

avoid inspecting throat w/ tongue depressor

administer high-concentration oxygen (15LPM via NRB)

transport

How should you treat epiglottitis?

croup

What is caused by a group of viral illnesses that result in inflammation of the larynx, trachea, and bronchi?

laryngotracheobronchitis

What is inflammation of the larynx, trachea, and bronchi?

parainfluenza virus

What is the most common cause of croup?

tissues become swollen and restrict air passage

What occurs in the airway when a PT has croup?

loud, barking cough

hoarse voice

associated breathing difficulty (improves when child moved to an upright position)

signs of significant breathing difficulty (inspiratory stridor)

What are the S+S of croup?

support inadequate breathing w/ BVM ventilation

consider calling ALS early

supplemental oxygen if hypoxic

allow PT to remain in position of comfort

How should you treat croup?

bronchiolitis

What occurs when the small airways become inflamed due to viral infection?

RSV

What is the most common cause of bronchiolitis?

cold symptoms (runny nose, fever, malaise)

symptoms worsen over few days to include respiratory distress

common for multiple children to be sick at same time in same household w/ similar symptoms

What are the S+S of bronchiolitis?

support ventilations w/ BVM if necessary

if PT is hypoxic, treat w/ supplemental oxygen

consider bulb syringe to suction mucus, if present

How should you treat bronchiolitis?

cystic fibrosis

What is a genetic disase that causes a thick, sticky mucus to accumulate in the lungs and digestive system?

life-threatening lung infections and serious digestion problems

What is the the mucus in cystic fibrosis able to cause?

coughing w/ large amount of mucus

fatigue

frequent occurrences of pneumonia

abdominal pain + distention

coughing up blood (hemopytsis)

nausea

weight loss

What are the S+S of cystic fibrosis?

ask PT or caregiver what PT baseline is and typical interventions required

treat w/ BVM ventilation if needed

apply supplemental oxygen if hypoxic

How should you treat cystic fibrosis?

viral respiratory infection

What is an infection of the respiratory tract?

often starts w/ sore or scratchy throat with cold symptoms

fever + chills

shortness of breath + pneumonia (if spreads to lungs)

cough can be persistent w/ yellow or greenish sputum

What are the S+S of a viral respiratory infection?