Pulmonology / Respiratory Emergencies - Chapter 16

What are the two components of the respiratory system that EMTs cover in the Emergency Medical Technician Program?

Pulmonology & Respiratory Emergencies

What is the primary function of the lungs?

The principal function of the lungs is respiration (the exchange of oxygen and carbon dioxide).

What structures are included in the respiratory system?

The respiratory system consists of all structures that contribute to breathing, including:
1. Diaphragm
2. Chest wall muscles
3. Accessory muscles of breathing
4. Nerves from the brain and spinal cord to those muscles

What anatomic structures make up the upper airway?

The upper airway consists of all anatomic structures above the vocal cords, including:
1. Nose and mouth
2. Jaw
3. Oral cavity
4. Pharynx
5. Larynx

Describe the path air takes from the trachea into the lungs.

Air travels through the trachea into the lungs, then on to the bronchi, bronchioles, and alveoli.

What two processes occur during respiration?

The two processes that occur during respiration are inspiration and expiration.

How does gas exchange happen in the alveoli?

In healthy lungs, the exchange of gases takes place rapidly at the level of the alveoli. The alveoli lie against the pulmonary capillary vessels. Oxygen passes freely through tiny passages in the alveolar wall into these capillaries through the process of diffusion, and is carried to the heart and pumped throughout the body. Carbon dioxide returns to the lungs and is exhaled out of the body.

How does the brainstem control the rate and depth of breathing?

The brainstem senses the level of carbon dioxide in the arterial blood.
1. If the level of carbon dioxide drops too low, the person automatically breathes at a slower rate and less deeply.
2. If the level of carbon dioxide rises above normal, the person breathes more rapidly and more deeply.

What conditions can hinder the proper exchange of oxygen and carbon dioxide?

The proper exchange of oxygen and carbon dioxide can be hindered by:
1. Abnormal or pathologic conditions in the anatomy of the airway
2. Disease processes
3. Traumatic conditions
4. Abnormalities in the pulmonary vessels

What is hypoxic drive and in which patients is it often found?

Hypoxic drive is a "backup system" the brain uses to control breathing based on low levels of oxygen, rather than the normal control mechanism based on carbon dioxide. It develops in patients (e.g., those with chronic lung disease) whose respiratory center has accommodated to chronically elevated levels of carbon dioxide in their arterial blood.

What is an important caution to remember when administering oxygen to patients who rely on hypoxic drive?

Use caution when administering oxygen to these patients.

What is dyspnea?

Dyspnea is the medical term for shortness of breath (SOB) or difficulty breathing.

What can be a sign that the brain is hypoxic in a patient experiencing dyspnea?

Altered mental status may be a sign that the brain is hypoxic.

List common conditions that can cause dyspnea or hypoxia.

Common conditions that can cause dyspnea or hypoxia include:
1. Pulmonary edema
2. Hay fever
3. Pleural effusion
4. Obstruction of the airway
5. Hyperventilation syndrome
6. Environmental/industrial exposure
7. Carbon monoxide poisoning
8. Drug overdose
9. Cardiopulmonary diseases, like congestive heart failure
10. Upper or lower airway infection

What five general situations may be present in a dyspneic patient?

One or more of the following situations may exist in the dyspneic patient:
1. Gas exchange is obstructed by fluid in the lung, infection, or collapsed alveoli.
2. The alveoli are damaged and cannot transport gases properly across their own walls.
3. The air passages are obstructed by muscle spasm, mucus, or weakened, floppy airway walls.
4. Blood flow to the lungs is obstructed by blood clots.
5. The pleural space is filled with air or excess fluid, so the lungs cannot properly expand.

How can severe pain affect a patient's breathing?

Severe pain can cause a patient to experience rapid, shallow breathing without the presence of a primary pulmonary dysfunction.

In infectious diseases causing dyspnea, what is the core problem?

The problem causing dyspnea in infectious diseases is always some form of obstruction.

What are examples of infectious obstructions in the respiratory system?

Infectious obstructions include:
1. Mucus and secretion obstructing airflow in major passages (cold, diphtheria)
2. Swelling of soft tissues in upper airways (epiglottitis, croup)
3. Impaired exchange of gases in the alveoli (pneumonia)

What is Croup?

Croup is an infectious disease of the upper airway that causes inflammation and swelling of the pharynx, larynx, and trachea. It is typically seen in children between 6 months and 3 years of age.

What are the hallmark signs and prehospital management of Croup?

Hallmark signs of croup are stridor and a seal

What is Epiglottitis and what causes it?

Epiglottitis is the inflammation of the epiglottis, usually as the result of a bacterial infection. It is more predominant in children but can also occur in adults.

What are the assessment findings and prehospital management for a child with suspected Epiglottitis?

Children are often found in the tripod position and drooling. Prehospital care is:
1. Treat them gently and try not to make them cry.
2. Position comfortably.
3. Provide high

What is Respiratory Syncytial Virus (RSV)?

RSV is a highly contagious common cause of illness in young children that causes an infection in the lungs and breathing passages and leads to bronchiolitis and pneumonia.

How is Respiratory Syncytial Virus (RSV) generally managed in the prehospital setting?

Assess for signs of dehydration and treat airway and breathing problems as appropriate, which may include oxygen therapy.

What is Bronchiolitis?

Bronchiolitis is a viral illness that occurs due to RSV and usually affects newborns and toddlers. The bronchioles become inflamed, swell, and fill with mucus.

What is Pneumonia?

Pneumonia is a general term that refers to an infection of the lungs. It is often a secondary infection that begins after an upper respiratory tract infection.

How does bacterial pneumonia differ from viral pneumonia in presentation?

Bacterial pneumonia will come on quickly and result in high fevers, while viral pneumonia presents more gradually and is less severe.

What patient populations are especially affected by pneumonia?

Pneumonia especially affects people who are chronically and terminally ill.

What is the prehospital care for Pneumonia?

Assess temperature to determine the presence of fever, and provide airway support and supplemental oxygen.

What is Pertussis?

Pertussis, or whooping cough, is an airborne bacterial infection that mostly affects children under age 6. It is highly contagious and passed through droplet infection.

What are the symptoms and prehospital management for Pertussis?

Patients will be feverish and exhibit a "whoop" sound on inspiration after a coughing attack. Management includes watching for signs of dehydration and performing suction if necessary.

How is Influenza Type A transmitted and what are its symptoms?

Influenza Type A is an animal respiratory disease that has mutated to infect humans. It is transmitted via direct contact with basal secretions and aerosolized droplets from coughing. Symptoms include fever, cough, sore throat, muscle aches, headache, and fatigue.

What are the potential complications of Influenza Type A?

Influenza Type A may lead to pneumonia or dehydration.

How is COVID

19 (SARS

What are the symptoms of COVID

19?

What is Tuberculosis (TB)?

TB is a bacterial infection that most commonly affects the lungs, but it can also be found in almost any other organ. It can remain inactive for years before producing any symptoms.

What are the symptoms of active Tuberculosis (TB)?

Patients often complain of fever, coughing, fatigue, night sweats, and weight loss.

What are the PPE requirements if you suspect your patient has active Tuberculosis (TB)?

If you suspect your patient may have active TB, you need to wear (at a minimum) your gloves, eye protection, and an N

What causes Acute Pulmonary Edema?

Acute pulmonary edema usually results from congestive heart failure, where the left side of the heart cannot remove blood from the lung as fast as the right side delivers it. This causes fluid to build up within the alveoli and in lung tissue.

What are the signs and symptoms of Acute Pulmonary Edema?

The patient usually experiences dyspnea with rapid, shallow respirations. In severe cases, a frothy pink sputum forms at the nose and mouth.

What is the prehospital management for Acute Pulmonary Edema?

Prehospital management includes:
1. Provide 100% oxygen.
2. Suction, if necessary.
3. Position comfortably.
4. Provide CPAP if indicated and allowed by protocol.
5. Transport promptly.

What is COPD?

COPD (Chronic Obstructive Pulmonary Disease) is an umbrella term used to describe several lung diseases (including emphysema and chronic bronchitis), characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.

What is Chronic Bronchitis and what causes it?

Chronic bronchitis is an ongoing irritation of the trachea and bronchi, often caused by tobacco smoke. It results in the constant production of excessive mucus, which obstructs small airways and alveoli, and the destruction of protective lung cells.

What is Emphysema?

Emphysema is the most common type of COPD and is characterized by the loss of elastic material around the air spaces as a result of chronic stretching of the alveoli, often caused directly by smoking.

How do the lung sounds of Pulmonary Edema (CHF) and COPD often differ?

Patients with pulmonary edema (often caused by congestive heart failure) often have "wet" lung sounds (rhonchi, crackles), while patients with COPD will often have "dry" lung sounds (wheezes).

What is the primary management principle when assessing lung sounds for COPD vs. CHF?

Do not assume that all COPD patients have wheezing and all congestive heart failure patients have crackles; treat the patient, not the lung sounds.

What are the key prehospital management steps for a patient with COPD?

The key prehospital management for COPD is to assist with a prescribed inhaler (watching for side effects due to overuse), position comfortably, and transport promptly.

What is Asthma?

Asthma is an acute spasm of the bronchioles associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages. It is an allergic reaction to an inhaled, ingested, or injected substance.

What is the characteristic finding during an asthma attack?

Asthma produces a characteristic wheezing as the patient attempts to exhale through partially obstructed airways.

What can cause an acute asthma attack?

An acute asthma attack may be caused by allergic reaction to specific foods or some other allergen, severe emotional distress, exercise, and respiratory infections.

What is Hay Fever?

Hay Fever (allergic rhinitis) is an allergic reaction, usually to outdoor, airborne allergens, that causes cold

What is Anaphylaxis?

Anaphylaxis is a severe allergic reaction characterized by severe airway swelling and dilation of the blood vessels all over the body, which can lead to total airway obstruction and signs of shock.

What are the signs and symptoms of Anaphylaxis?

Signs and symptoms of anaphylaxis may include widespread hives (urticaria), itching, signs of shock, and signs and symptoms similar to asthma.

What is the treatment of choice for Anaphylaxis?

Epinephrine is the treatment of choice, and oxygen and antihistamines are helpful.

What is Spontaneous Pneumothorax?

A pneumothorax is the partial or total accumulation of air in the pleural space, which causes the negative vacuum pressure that keeps the lungs inflated to be lost. A spontaneous pneumothorax is not caused by trauma but may occur in patients with certain chronic lung infections or in young people born with weak areas of the lung.

What are the assessment findings for Spontaneous Pneumothorax?

A patient with spontaneous pneumothorax becomes dyspneic and might complain of pleuritic chest pain. Breath sounds are sometimes absent or decreased on the affected side.

What is Pleural Effusion?

Pleural effusion is a collection of fluid outside the lung that compresses the lung and causes dyspnea. It can be caused by an irritation, infection, congestive heart failure, or cancer.

What are the assessment findings and prehospital management for Pleural Effusion?

Breath sounds will be decreased over the area where the effusion is present. Patients feel better if they are sitting upright. Prehospital management includes providing oxygen and transporting promptly (fluid removal must be done in a hospital).

When should an EMT suspect a foreign body airway obstruction?

Always consider the possibility of foreign body obstruction if the patient was eating just before onset of the dyspnea.

What is an Embolus?

An embolus is anything in the circulatory system that moves from its point of origin to a distant site and lodges there, obstructing blood flow. It can be fragments of blood clots that break off and travel through the bloodstream, or foreign bodies such as a bubble of air.

What is a Pulmonary Embolism (PE)?

A pulmonary embolism is a blood clot that circulates through the venous system and the right side of the heart and lodges in the pulmonary artery.

What are the signs and symptoms of Pulmonary Embolism?

Signs and symptoms of pulmonary emboli include:
1. Dyspnea
2. Tachycardia
3. Tachypnea
4. Varying degrees of hypoxia
5. Cyanosis
6. Acute chest pain
7. Hemoptysis

What is Hyperventilation?

Hyperventilation is defined as overbreathing to the point that the level of arterial carbon dioxide falls below normal, which may be the body's attempt to compensate for acidosis.

What can occur if too much carbon dioxide is blown off during hyperventilation?

If too much carbon dioxide is blown off, alkalosis can occur.

What are the symptoms of Hyperventilation Syndrome?

Symptoms of hyperventilation syndrome caused by alkalosis include:
1. Anxiety
2. Dizziness
3. Numbness
4. Tingling of the hands and feet
5. Painful spasms of the hands and/or feet (carpopedal spasms)

What is an important caution regarding the diagnosis of Hyperventilation Syndrome?

The decision whether hyperventilation is being caused by a life

What is an important "do not" for treating hyperventilation?

Do not have the patient breathe into a paper bag.

What are the key characteristics of Carbon Monoxide Poisoning?

Carbon monoxide is odorless, tasteless, and highly poisonous. It is produced by fuel

What symptoms do people with carbon monoxide poisoning typically complain of?

People who have carbon monoxide poisoning complain of flulike symptoms and even dyspnea.

What is the best prehospital treatment for conscious patients with carbon monoxide poisoning?

High

What are important considerations during the scene size

up for a patient with dyspnea?

What alternative assessment tool is used for a complaint of shortness of breath (SOB) or difficulty breathing?

The PASTE assessment is a specific alternative assessment for a complaint of shortness of breath or difficulty breathing.

What does the acronym PASTE stand for?

Progression
Associated chest pain
Sputum
Talking tiredness
Exercise tolerance

What are the typical characteristics of a patient with COPD found during a secondary assessment?

Patients with COPD often:
1. Are usually older than 50 years of age
2. Often have a history of lung problems
3. Are almost always long

What are common interventions for respiratory problems?

Interventions for respiratory problems may include:
1. Providing oxygen via nonrebreathing mask at (15~L/min)
2. Providing positive pressure ventilations using a bag

When should ventilatory support be administered to a patient in respiratory distress?

Administer ventilatory support if the patient's mental status is declining, if they are in moderate to severe respiratory distress, or if the depth of respiration is inadequate.

What is the action of most respiratory inhalation medications delivered via metered

dose inhalers (MDIs) or small

What are common side effects of respiratory inhalers?

Common side effects of inhalers include:
1. Increased pulse rate
2. Nervousness
3. Muscle tremors

How are MDIs used for children?

MDIs are used as you would with older patients, but for children, you may also provide blow

What is Cystic Fibrosis (CF)?

Cystic fibrosis (CF) is a genetic disorder that affects the lungs and digestive system and predisposes children to repeated lung infections.

What are the respiratory symptoms of Cystic Fibrosis?

Symptoms range from sinus congestion to wheezing and asthma

```