EMT Chapter 16*31 Respiratory Emergencies

Acidosis

the buildup of excess acid in the blood or body tissues that results from a primary illness

adventitous breath sounds

Abnormal breath sounds such as wheezing, stridor, rhonchi, and crackles.

Allergen

a substance that causes an allergic reaction

Alkalosis

The buildup of excess base (lack of acids) in the body fluids.

Analhylaxis

An extreme, life threatening, systemic allergic reaction that may include shock and respiratory failure

Asthma

An acute spasm of the smaller air passages, called bronchioles, associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages.

atelectasis

collapse of the alveolar air spaces of the lungs

Bronchiolitis

Inflammation of the bronchioles that usually occurs in children younger than 2 years and is often caused by the respiratory syncytial virus

Syncytial virus

a type of minute parasitic microorganism

Bronchitis

An acute or chronic inflammation of the lung that may damage lung tissue; usually associated with cough and production of sputum and, depending on its cause, sometimes fever.

Carbon dioxide retention

A condition characterized by a chronically high blood level of carbon dioxide in which the respiratory center no longer responds to high blood levels of carbon dioxide.

Carbon monoxide

An odorless, colorless, tasteless, and highly poisonous gas that results from incomplete oxidation of carbon in combustion.

chronic bronchitis

Irritation of the major lung passageways from infectious disease or irritants such as smoke.

chronic obstructive pulmonary disease (COPD)

a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible

Covid 19

A respiratory disease caused by the virus SARS-CoV-2. The virus is a coronavirus, similar to the one that causes the common cold.

Crackles

rattling breath sounds signaling fluid in the air spaces of the lungs; formerly called rales. Lower airway obstruction

Croup

A viral inflammatory disease of the upper respiratory system that may cause a partial airway obstruction and is characterized by a barking, seal like cough; usually seen in children

Diphtheria

An infectious disease in which a membrane forms, lining the pharynx; this lining can severely obstruct the passage of air into the larynx.

Dyspnea

shortness of breath

Embolus

A blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage of blood flow

Emphysema

A disease of the lungs in which there is extreme dilation and eventual destruction of the pulmonary alveoli with poor exchange of oxygen and carbon dioxide

Epiglottitis

A bacterial infection in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction.

Hay fever

An allergic response usually to outdoor airborne allergens such as pollen or sometimes indoor allergens such as dust mites or pet dander; also called allergic rhinitis.

Hyperventilation

Rapid, usually deep, breathing that lowers the blood carbon dioxide levels below normal

Hyperventilation syndrome

occurs in the absence of other physical problems. The respirations of a person who is experiencing this may be as high as 40 shallow breaths/min or as low as only 20 very deep breaths/min. Also known as a panic attack.

Hypoxia

A dangerous condition in which the body tissues and cells do not have enough oxygen.

Hypoxic drive

A condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive; seen in patients with chronic lung diseases; secondary drive to breathe that develops in presence of carbon dioxide retention

Influenza type a

Virus that has crossed the animal/human barrier and has infected humans, recently reaching a pandemic level with the H1N1 strain.

metered-dose inhaler (MDI)

A miniature spray canister used to direct medications through the mouth and into the lungs.

Orthopnea

Sever Dyspnea experienced when lying down and into relieved by sitting up

Oxygenation

The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs.

Pandemic

An outbreak of a disease that spreads worldwide.

paroxysmal nocturnal dyspnea

Severe shortness of breath, especially at night after several hours of reclining; the person is forced to sit up to breathe.

Pertussis (whooping cough)

An airborne bacterial infection that affects mostly children younger than 6 years. Patients will be feverish and exhibit a "whoop" sound on inspiration after a coughing attack; highly contagious through droplet infection.

Pleural effusion causes

A collection of fluid between the lung and chest wall that may compress the lung

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.

Pneumonia

An infectious disease of the lung that damages lung tissue.

Pneumothorax

an accumulation of air or gas in the pleural cavity

Pulmonary edema

A buildup of fluid in the lungs, usually as a result of congestive heart failure.

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.

Respiration

The process of exchanging oxygen and carbon dioxide

Respiratory Syncytial Virus (RSV)

A virus that causes an infection of the lungs and breathing passages; can lead to other serious illnesses that affect the lungs or heart, such as bronchiolitis and pneumonia - highly contagious and spread through droplets.

small-volume nebulizer

A respiratory device that holds liquid medicine that is turned into a fine mist. The patient inhales the medication into the airways and lungs as a treatment for conditions such as asthma.

Stridor

A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope.

Tuberculosis (TB)

a contagious disease that attacks the lungs and that can remain dormant in a persons lungs for decades, then reactivate; many strains are resistant to antibiotics - spread by cough

Ventilation

Exchange of air between the lungs and the environment, spontaneously by the patient or with assistance from another person, such as an EMT.

Vesicular breath sounds

Normal breath sounds made by air moving in and out of the alveoli.

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.

Dyspnea is most accurately defined as

shortness of breath or difficulty in breathing

Alkalosis is a condition that occurs when

blood acidity is reduced by excessive breathing

An alert patient presents with a regular pattern of inhalation and exhalation and breath sounds that are clear and equal on both sides of the chest. These findings are consistent with

adequate air exchange

In a healthy individual, the brainstem stimulates breathing on the basis of

increased carbon dioxide levels

The two processess that occur during respirations are

inspiration and expiration

A pleural effusion is most accurately defined as

fluid accumulation outside the lung

In order for efficient pulmonary gas exchange to occur

oxygen and carbon dioxide must be able to freely diffuse across the alveolar - capillary membrane

Acute pulmonary edema would most likely develop as the result of

toxic chemical inhalation

Which of the following statements regarding anaphylaxis is correct?

It is characterized by airway swelling and hypotension

In what area of the lungs does respiration occur?

Alveoli

Asthma is caused by a response of the

immune system

Albuterol is the generic name for

Ventolin

When administering supplemental oxygen to a hypoxemic patient with a chronic lung disease, you should

adjust the flow rate accordingly until you see symptom improvement, but be prepared to assist his or her ventilations

When assessing for fluid collection in the lungs during auscultation of lung sounds, you should

start at the lower lung fields and determine at which level you start hearing clear breath sounds

Harsh, high pitched inspiratory sounds are characteristic of

stridor

A concious and alert 29 year old female with a history of asthma complains of difficulty breathing that began after her morning jog. The temperature outside is 40 degrees. On exam, you hear bilateral expiratory wheezing. After providing supplemental oxygen, you should

determine if she has been prescribed a beta-agonist inhaler

A 30 year old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past medical history and takes no meds. During you assessment, you hear wheezing over all lung fields. His BP is 90/50 mm Hg, and his HR is 110 beats/min. In addition to giving him high flow oxygen, the most important treatment for this patient would be

epinephrine

When the level of arterial carbon dioxide rises above normal

respirations increase in rate and depth

Hyperventilation could be associated with all of the following except

a narcotic overdose

When auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds, this means that the patient has

abnormal breath sounds

The process in which oxygen and carbon dioxide are exchanged in the lungs is called

respiration

Which of the following respiratory diseases causes obstruction of the lower airway?

Asthma

Which of the following diseases is potentially drug resistant and is thought to be transmitted by coughing?

Tuberculosis

All of the following are causes of acute dyspnea, EXCEPT

emphysema (COPD form)

Bronchospasm is MOST often associated with

asthma

A sudden onset of difficulty breathing, sharp chest pain, and cyanosis that persists despite supplemental oxygen is MOST consistent with

a pulmonary embolism

Albuterol, a beta-2 agonist, is the generic name for

Ventolin

An acute bacterial infection that results in swelling of the flap that covers the larynx during swallowing is called

epiglottitis

A 70-year-old man recently had a heart attack and now complains of severe difficulty breathing, especially when lying flat. He is coughing up pink, frothy secretions. This patient is MOST likely experiencing

severe left heart failure

Which of the following patients is breathing adequately?

29-year old woman with respirations of 20 breaths/min, who is conscious and alert

Respiratory system includes all the structures that contribute to breathing

Diaphragm, Chest wall muscles, Accessory muscles of breathing, Nerves to the muscles

Upper airway consists of structures above the vocal cords

Nose and mouth, Jaw, Oral cavity, Pharynx (Larynx)

Lower Airway consists

Larynx, Trachea, Main bronchi, Bronchioles, Alveoli

Principal function of lungs is

respiration

Air travels through trachea into lungs to

Bronchi (larger airways), Bronchioles (smaller airways), and Alveoli (where actual exchange takes place)

Alveoli are

microscopic air sacs

In the alveoli

Oxygen passes into capillaries; Carbon dioxide returns to lungs

Brainstem senses

blood’s carbon dioxide levels

Oxygen exchange can be hindered by

Conditions in the anatomy of the airway, Disease processes, Traumatic conditions, Abnormalities in pulmonary vessels

Normal Respiratory Rates

Adult 12-20 breaths per minute, Peds 15-30 breaths per minute, Infant 25-50 breaths per minute

Carbon dioxide drops too low

breathing slows to retain carbon dioxide

Carbon dioxide level rises

breathing becomes more rapid and deep to blow off extra

Chronic rise in carbon dioxide levels from respiratory disease (COPD) causes

carbon dioxide retention (patients with respiratory disease get used to these levels)

Patients often have dyspnea or hypoxia with

Pulmonary edema, Hay fever, Pleural effusion, Obstruction of the airway, Hyperventilation syndrome, Environmental/industrial exposure, Drug overdose

Dyspneic patients may have

Gas exchange obstructed, Damaged alveoli, Obstructed air passages, Obstructed blood flow to the lungs, Excess fluid in pleural space

Dyspnea Treatment

Give supplemental oxygen at 10-15 L/min via non-rebreathing mask, Patients with longstanding COPD may be started on low-flow oxygen (2 L/min) unless they need high-flow oxygen, Assist with inhaler if available, Consult medical control

Epiglottitis may cause

complete airway obstruction

Respiratory Syncytial Virus (RSV)

HIGHLY CONTAGIOUS; Common cause of illness in young children

Bacterial pneumonia

will come on quickly and result in high fever

Viral pneumonia

presents more gradually and is less severe

Treatment of Upper/Lower Airway Infections

Administer humidified oxygen, Keep patient calm, Do not attempt to suction the airway or place an oropharyngeal airway in a patient with suspected epiglottitis, Comfort, Transport promptly

Acute Pulmonary Edema

Fluid build-up in the lungs and alveoli due to heart muscle unable to circulate blood properly (sudden attacks)