Respiratory Emergencies (Ch. 19)

Where is hypoxia typically first shown?

Hypoxia is often first shown in the brain, this is because it requires lots of oxygen but can’t store it.

What is Somnolence

A state of excessive sleepiness

What is Agonal

What are Agonal Respirations

Agonal means occurring at or right before death

Agonal Respirations are the types of breath that occur right before death. These are irregular, shallow, and gasping.

What’s a new dangerous sign discussed in this chapter that can be found when auscultating a patient’s lungs.

Silent Chest. In asthmatics, even if they’re breathing, the bronchoconstriction leads to silent chest.

Why are respiratory emergencies more severe for pediatric patients

When compensation fails and respiratory arrest occurs, children’s hearts often just slow and stop leading to cardiac arrest.

I’d assume that choking is sorta an exception to this because they don’t immediately die obviously

What kind of devices do we not use on children and why?

We don’t use Oxygen-Powered Ventilation Devices,

Because their lungs are small and fragile.

What should always be checked when before and after oxygen/ventilation?

What’s the reading we get before oxygen called?

Why do we take the reading after oxygen?

Oxygen Saturation and pulse.

The reading we get before we put the patient on oxygen is called the “room air” reading.

Because if the pulse stays abnormal or becomes more abnormal it means the breathing is not adequate

Wheezing.

What’s the cause?

Where is it indicative of problems?

Is it heard on Inspiration or Expiration?

I ask all of these, but if you know the 1st you know all 3.

The cause is air being forced through narrowed airways in the lungs.

Lower airway problem

Expiration

Crackles

What’s the sound?

What’s the cause?

It’s a bubbly sound.

Caused by fluid buildup in the alveoli

Rhonci

What’s the sound?

What’s the cause?

The sound is a rattle or snoring sound.

Caused by secretions in the larger airways (trachea and mainstem bronchi)

Stridor

What’s the sound?

What’s the cause?

Where is it indicative of problems?

Is it heard on Inspiration or Expiration?

Harsh, high pitched inhale

Caused by partial obstructions of the upper airways.

Indicative of problems in the upper airways

Heard on inhalation.

Is an improvement in the breathing sounds always a sign of the patient’s condition improving?

Not always because if they push less air through their airways there will be less sounds.

What are the use cases of CPAP Machines?

1. Pulmonary Edema

2. Drowning

3. Asthma

4. COPD

5. Intermediary step between supplemental oxygen and artificial ventilation (potentially avoiding the need for artificial ventilation)

How is the flow rate of CPAP machines?

How do we measure pressure in someone’s respiratory system

How much of this pressure do CPAP machines provide?

They use a much higher 70 liters per minute,

We measure the pressure in someone’s respiratory system with PEEP (Positive and Expiratory Pressure). Which is what it sounds like, it’s the pressure in someone’s system at the end of exhalation.

CPAP machines provide 7-15 cm of water PEEP.

Contraindications for CPAP machines

1. Inability to get and maintain a good mask seal

2. Depressed mental status (or other potential or imminent airway blockers)

3. Lack of a normal respiratory rate

4. Hypotension

5. Unable to sit up (increases risk of aspiration)

6. Nausea/vomiting

7. GI Bleeding (or any internal bleeding i would assume)

8. Possible chest wall injury.

Is it more important to give oxygen or keep pressure when giving CPAP?

The point of CPAP is the pressure, so it’s more important to keep the pressure.

Describe 2 major causes of COPD.

Describe who COPD is more common in and why

1. Emphysema. Walls of bubbles broke down, reducing surface area and elasticity, leading to incomplete exhales and stale air stuck in lungs.

2. Chronic Bronchitis. Cilia unable to do job, bubble entrances inflamed and blocked by mucous.

COPD is more common in middle aged and older people because it is caused by irritants over time and the irritants need time to do the damage.

Pulmonary Edema

What are the causes?

What do we look for?

A lot of the signs we look for are the signs of heart failure, because it is a major cause of pulmonary edema. (Other than that high altitudes, drowning, and toxins/drugs)

Cackles and wheezes are heard when auscultating patient’s lungs.

Heart failure causes it because it receives blood from the lungs to pump out, but if it can’t pump this out then it gets blocked up

Pneumonia

What is it?

What is the unique symptom?

Pneumonia is an infection that inflames the air sacs

Unique symptoms is fever

Spontaneous Pneumothorax

What is the name of the weak sections?

Signs and Symptoms?

Blebs are smalls sections of the lungs which are weak.

Listen for unequal chest sounds and chest pain

Pulmonary Embolism

Caused by something blocking blood flow in the lungs, typically caused by deep vein thrombosis so look for swelling in the legs.

Patients who would have blood clots (history of DVT, or immobile) are at higher risk for PE.

Epiglottitis

What’s the unique symptom?

Who’s it limited to for children?

What’s important to do to the patient?

The unique symptom is painful or difficult swallowing.

For children it’s normally limited to unvaccinated

Keep the patient calm.

Croup

What’s the unique symptom?

Who and when does it usually occur?

What’s the cause?

The unique symptom is a loud barking cough and hoarse voice.

Usually occurs in children after bed time.

Caused by a group of viruses which lead to inflammation in larynx, trachea, and bronchi.

Bronchiolitis

What is it caused by?

What are the general symptoms?

What treatment to consider?

When does it usually occur?

It is caused by RSV (Respiratory Syncytial Virus)

General symptoms are flu-like.

Should consider bulb syringe to suction mucus from nose.

Usually occurs in the fall and early winter.

Cystic Fibrosis

What does this disease cause?

How do you know if the patient has it?

Causes a thick and sticky mucus which accumulates in the lungs and digestive system.

Patient’s typically know they have cystic fibrosis.

Do you need permission to assist a patient in using their own inhaler?

Yes

What are spacer devices and what is the advantage?

Spacer devices put the medicine into breathable air which helps so you don’t have to time your inhale.

What are the steps for giving inhaler to patient?

1. 5 Rights

2. Expiration date, room temperature, shake and prime if priming is needed

3. Make sure patient is alert enough to use inhaler.

4. Exhale fully, insert mouthpiece, inhale slowly.

5. Hold breath if possible

6. If medical direction ordered multiple wait 15-30 seconds between uses.

Small-Volume Nebulizer

What is nebulizing?

Nebulizing is converting a medicine into a fine spray.

Small-volume nebulizers create a continuous flow that can be breathed in over many breaths

What are the asthma medications?

Albuterol is the quick acting engages sympathetic nervous system

Ipratropium Bromide blocks bronchoconstriction associated with parasympathetic nervous system.

DuoNeb combines both.