Chapter 19 - Respiratory Emergencies

Inspiration/inhalation

breathing in

Expiration/exhalation

breathing out

Adequate breathing

-normal rate-12-20breaths/min

-regular pattern on inhale/exhale

-clear and equal lung sounds on both sides of the chest

-regular and equal chest rise and fall

adequate depth (tidal volume)

Inadequate breathing

breathing effort; increased use of accessory muscles especially in infants and children; cyanotic skin, cool, clammy; agonal respirations

Signs of hypoxia

Blue or gray skin, decreased LOC, confusion, restlessness.

tachypnea

rapid breathing

irregular respiration

When the depth of breathing changes & the rate of the rise & fall of the chest is not steady, it is called?

Silent chest

no lung sounds

*sign of respiratory failure

agonal respirations

Slow, shallow, irregular respirations or occasional gasping breaths; sometimes seen in dying patients.

Seesaw breathing

chest and abdomen work in opposite directions

Signs and symptoms of difficulty breathing

altered mental status, anxious or restless, resp rate to fast or slow, irregular breathing, skin is pale cool or clammy, cyanosis, wheezing, coughing, decreased or noisy breath sounds , unequal chest rise,

Wheezing

A high-pitched, whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of the lower airways; occurs in asthma and bronchiolitis.

crackles (rales)

Short and intermittent clicking, rattling, or popping sounds heard during inhalation when air is forced through an airway narrowed by fluid.

Rhonchi

Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways.

Stridor

A high pitched sound generated from partially obstructed air flow in the upper airway.

Where to listen to lung sounds

upper and lower chest, upper and lower back, and midaxillary line

signs of respiratory distress in pediatric patients

nasal flaring, retractions, grunting, stridor, decreased muscle tone, altered mental status, decreased heart rate, decreased cap refill time

CPAP (continuous positive airway pressure)

A method of ventilation used primarily in the treatment of critically ill patients with respiratory distress; can prevent the need for endotracheal intubation.

PEEP

positive end-expiratory pressure - common mechanical ventilator setting in which airway pressure is maintained above atmospheric pressure

Common uses for CPAP

- Pulmonary edema

- Drowning

- Asthma and COPD

- Respiratory failure in general

Contraindication of CPAP

Untreated pneumothorax

Hemodynamically unstable patient

Severely apneic patients

Systolic pressure of 90 or below

Inability to maintain mask seal

Recent GI bleed or surgery

Vomiting

COPD

chronic obstructive pulmonary disease

chronic bronchitis

inflammation of bronchi persisting over a long time; type of chronic obstructive pulmonary disease (COPD)

Emphysema

a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness.

Asthma

A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing.

Pulmonary Edema

accumulation of fluid in the lungs

Left sided heart failure results in

pulmonary edema

Right sided heart failure results in

peripheral edema

JVD (jugular vein distention)

bulging of blood veins on the sides of the neck

Dyspnea

difficult or labored breathing

Congestive heart failure

A condition resulting from the heart's inability to pump out all the blood that returns to it; blood backs up in the veins leading to the heart, causing an accumulation of fluid in various parts of the body

orthopnea

difficulty breathing when lying down

pneumonia

Bacterial infection of the lungs

signs of pneumonia

Pleuritic chest pain, productive cough with rust or green sputum, dyspnea, tachynea, fatigue, fever, generalized aches.

Spontaneous Pneumothorax

the rupture of a weakened area of the lung, which allows air to escape into the pleural space

lung sounds with pneumothorax

diminished or absent

Late signs of pneumothorax

JVD and hypotension

Pulmonary Embolism

A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing obstruction of blood flow.

Deep Vein Thrombosis

blood clot forms in a large vein, usually in a lower limb

pleuritic chest pain

Sharp, stabbing pain in the chest that is worsened by a deep breath or other chest wall movement; often caused by inflammation or irritation of the pleura.

tachypnea

rapid breathing

tachycardia

fast heart rate

epiglottitis

severe, life-threatening infection of the epiglottis and supraglottic structures that occurs most commonly in children between 2 and 12 years of age

Presentation of epiglottitis

Dysphagia, drooling, respiratory distress

Tripod position

Stridor

Croup

acute viral infection of infants and children with obstruction of the larynx, accompanied by barking cough and stridor

Brochiolitis

inflammation of the small bronchioles

Most common cause of bronchiolitis

RSV (respiratory syncytial virus)

Cystic Fibrosis

A genetic disorder that is present at birth and affects both the respiratory and digestive systems.

Bronchoconstriction

reduction in diameter of a bronchus

Inhaler

A spray device with a mouthpiece that contains an aerosol form of a medication that a patient can spray into his airway.

Spacer

a chamber that is connected to the metered-dose inhaler to collect the medication until it is inhaled

Small Volume nebulizer

-can be used to deliver respiratory meds through a fine mist that patient inhales

-albuterol usually (bronchodilator)

-can treat asthma and COPD

Albuterol

Bronchodilator

Albuterol Dose

2.5-5mg Neb

Xopenex (Levalbuterol)

Bronchodilator

Xopenex dose

1.25 mg Neb

Side effect of albuterol

tremors and tachycardia

Nebulizer

device that creates a mist used to deliver medication for giving respiratory treatment

Nebulizer flow rate

6-8 lpm

Nasal Cannula

An oxygen-delivery device in which oxygen flows through two small, tubelike prongs that fit into the patient's nostrils; delivers 24% to 44% supplemental oxygen, depending on the flow rate.

Nasal cannula flow rate

1-6 lpm

Nonrebreather Mask

A face mask and reservoir bag device that delivers high concentrations of oxygen. The patient's exhaled air escapes through a valve and is not rebreathed.

Flow rate for a nonrebreather mask

10-15 LPM

BVM

Bag-Valve-Mask Resuscitator

hand held device attached to a resuscitation mask that is used to ventilate a victim in respiratory arrest or when performing CPR. It requires two rescuers: one to maintain a tight seal for the mask, one to squeeze the bag

Flow rate for BVM

15-25 LPM