Chapter 16 -Respiratory Emergencies

Dyspnea

shortness of breath/difficulty breathing

Signs of Normal Breathing

• Regular inhale/exhale pattern

• Clear & equal breath sounds on both sides of chest

• Regular chest rise and fall

• Adequate depth

• Normal rate of respirations

• Unlabored

Irregular Breathing Signs

• The patient reports difficulty breathing or shortness of breath.

• The patient has an altered mental status associated with shallow or slow breathing.

• The adult patient appears anxious or restless; the pediatric patient appears sleepy or listless.

• The respiratory rate is too fast or too slow

• The breathing rhythm is irregular.

• The skin is pale, cool, clammy, or cyanotic.

• Adventitious breath sounds are heard, including wheezing, gurgling, snoring, crowing, or stridor (harsh, high-pitched, barking sounds).

• Decreased or noisy breath sounds are heard on one or both sides of the chest.

• The patient cannot speak more than a few words between breaths.

• accessory muscle use, retractions, or labored breathing.

• The patient has unequal or inadequate chest expansion.

• The patient is coughing excessively.

• Tripod positioned

• pursed lips (pursed lip breathing) or nasal flaring.

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

Causes of High Blood CO2 Levels

• Exhaling is pated

• too much Co2 is being produced due to disease or abnormality

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

Hypoxia

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

Medical Conditions that have Hypoxia as a Symptom

• Pulmonary edema

• Hay fever

• Pleural effusion

• Obstruction of the airway

• Hyperventilation syndrome

• Environmental/industrial exposure

• Carbon monoxide poisoning

• Drug overdose

Conditions to be aware of if a Patient has a lung condition

• Atelectasis

• Damaged alveoli that cannot transport gases properly

• Blood clots that obstruct blood flow to lungs

• Pleural space filled with air or excess fluid

Croup

• inflammation and swelling of pharynx, larynx, and trachea

• secondary to viral infection of upper respiratory tract

• Usually seen in children from 6 months to 3 years

• mainly occurs in late fall and during the winter

Signs of Croup

• Fever

• Barking Cough

• Stridor

• Peds patients

Treating Croup

humidified oxygen

Epiglottitis

• Epiglottis swells to 2-3 times its normal size

• Caused by bacterial infection

• most commonly seen in infants and children

Signs of Epiglottitis

• Dyspnea

• High Fever

• Stridor

• Drooling

• Difficulty swallowing

• Severe sore thorax

• Tripod/sniffing position

• Mostly seen in peds pts

Treating Epiglottitis in Children

• Don’t make the cry

• Position of comfort

• High Flow O2

• DO NOT put anything in their mouths

Treating Epiglottitis in Adults

• maintain airway

• Transport ASAP

Respiratory Syncytial Virus (RSV)

• Lungs and breathing passages are infected

• Leads to illnesses like pneumonia, bronchitis etc

• Very Contagious

Signs of RSV

• Cough

• Wheezing

• Fever

• Dehydration

Treating RSV

• Focus on airway and breathing

• Humidified O2

Bronchiolitis

• Caused by RSV

• Severe inflammation of bronchioles that fill with mucus

• Common in newborns/toddlers

• Common in winter and spring

Treating Bronchiolitis

• Oxygen if needed

• position of comfort

• suction mucus if needed

• Reassess

• Airway management

Signs of Bronchiolitis

• Dyspnea

• wheezing

• coughing

• fever

• dehydration

• Tachypnea/cardia

Pneumonia

• infection of the lungs

• impairs lungs ability to exchange gases

• Secondary infection

• Commonly infects terminally/chronically ill people

Predispositions to Pneumonia

• Institutional residence (nursing home or long-term care facilities)

• Recent hospitalization

• Chronic disease processes (such as renal failure requiring dialysis)

• Immune system compromise (patient receiving chemotherapy or diseases such as HIV)

• History of COPD

Signs of Pneumonia

• Dyspnea

• Chills/fever

• cough

• Green, red, rust colored sputum

• Localized wheezing/crackles

• Cyanosis

• Dry skin

Pertussis (whooping cough)

• airborne bacterial infection

• highly contagious (passed though droplets)

• Mainly infects children younger than 6

Signs of Pertussis

• Coughing fits

• Whoop sound when coughing

• Fever

Treating Pertussis

• Hydrate

• Suction to clear airway

• give O2 in most appropriate way

• watch the airway

Influenza Type A

• Makes chronic medical conditions worse

• Transmitined by direct contact with nasal secretions and aerosolized droplets

Signs of Influenza Type A

• Fever

• Cough

• Sore throat

• Fatigue

Signs of COVID-19

• Cough

• Fever

• Dyspnea

• Chest pain

• Anosmia (inability to smell)

Signs of Asthma

• Wheezing on inspiration/expiration

• Bronchospasm

Signs of Anaphylaxis

• Flushed skin

• hives

• Generalized Edema

• Decreased BP

• Wheezing/stridor

• laryngeal edema with dyspnea

Signs of Bronchitis

• Chronic Cough

• Wheezing

• Cyanosis

• Tachypnea

Signs of Congestive Heart Failure

• Dependent edema

• Crackles

• Orthopnea

• Paroxysmal nocturnal dyspnea

Orthopnea

Severe dyspnea experienced when lying down and relieved by sitting up

Paroxysmal nocturnal dyspnea

• Severe shortness of breath, especially at night after several hours of reclining

• Patient has to sit to breathe

Signs of the Common Cold

• Cough

• Runny/stuffy nose

• Sore throat

Signs of Diphtheria

• Difficulty breathing/swallowing

• Sore throat

• Thick grey build up in nose/throat

• Fever

Signs of Emphysema

• Barrel Chest

• Pursed lip breathing

• Dyspnea on exertion

• Cyanosis

• Wheezing/decreased breath sounds

Signs of Tension Pneumothorax

• Severe shortness of breath

• Diminished/absent breath sounds on one side

• Decreased/altered LOC

• Neck vein distension

• Tracheal deviation

• Hypotension

Signs of Pulmonary Embolus

• Dyspnea

• sharp chest pain

• sudden onset

• tachycardia

• Clear breath sounds initially

• Coughing up blood

• Cyanosis

Tuberculosis (TB)

• bacterial infection caused by Mycobacterium Tuberculosis

• Spreads by cough

• Resistant to antibiotics

• Can be found in most body organs

• Dormant in most infected people

• High prevalency in people with weakened immune systems

Signs of Tuberculosis (TB)

• Cough

• Fever

• Fatigue

• Productive/blood sputum

• night sweats

• weight loss

Treating TB

• Wear all the protection possible

• place surgical/o2 mask on the patient

Pulmonary Edema

• Build up of fluid in the lung tissue due to the heart functioning improperly

• Prevents oxygenation

Causes of Pulmonary Edema

• high bp and low cardiac output

• Congestive heart failure

• Traumatic chest injuries

• high altitude exposure

• Inhalation of smoke/toxic fumes

Chronic Obstructive Pulmonary Disease (COPD)

• Not fully reversible

• lung airflow is chronically obstructed

• Umbrella term for many lung diseases like emphysema/chronic bronchitis

Causes of COPD

• Repeated lung infections/inflation of toxic gases and particles

• Smoking

Chronic Bronchitis

Irritation of the major lung passageways from long-term exposure to infectious disease or irritants such as smoke

Emphysema

• Most common form of COPD

• Loss of elastic material in the lungs caused by alveolar airways being chronically stretched

Difference between COPD & Congestive Heart Failure

• Lung sounds

  • COPD = wheezes

  • Congestive Heart Failure = crackles

• History of smoking

• Medication they take

• How fast the symptoms set in

  • COPD = slow

Asthma

• acute spasm of the bronchioles associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages

• most common in children 5-17 years

• caused by allergens

• Treated with inhaler or nebulizer

Hay Fever (Allergic Rhinitis)

• Caused by outdoor airborne allergens

• presents as coldlike symptoms

• Worse in the spring/summer

Anaphylaxis

• severe allergic reaction characterized by airway swelling and dilation of blood vessels

• Two body systems affected

• usually occurs within 30 min of allergen exposure

• Epi is usually treatment of choice

Spontaneous Pneumothorax (Collapsed lung)

• partial/complete accumulation of air in the plural space

• Occurs in pts with chronic lung infections or people with weak areas of the lung

Signs of Spontaneous Pneumothorax

• dyspnea

• pleuritic chest pain

• hypertension

• anxiety

• decreased breath sounds on one side

Pleuritic Chest Pain

Sharp, stabbing pain in the chest that is worsened by a deep breath or other chest wall movement

Pleural Effusion

• collection of fluid outside the lung on one/both sides of the chest

• lung compression causes dyspnea

Causes of Pleural Effusion

• infection

• congestive heart failure

• cancer

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

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

• No gas exchange

Causes of Pulmonary Embolism

• long-term bed rest

• pregnancy

• cancer

Hyperventilation

• rapid breathing to the point arterial CO2 falls below normal range

• indicator of life threatening illness

Acidosis

• buildup of excess acid in the blood/body tissue

Alkalosis

build up of excess base in the body tissue

Hyperventilation Syndrome

• occurs in the absence of physical problems

• Associated with panic attacks

• 20 bpm - 40 bpm

Signs of Hyperventilation Syndrome

• anxiety

• dizziness

• numbness

• tingling of hands/feet

• spasms of hands/feet

Carbon Monoxide Poisoning

• potential for permanent brain damage

• more frequent in cold weather due to CO’s presence in heating devices

Signs of Carbon Monoxide Poisoning

• Headache

• Dizziness

• fatigue

• nausea

• vomiting

• Altered LOC

• Dyspnea

Treating Carbon Monoxide Poisoning

• Remove from toxic environment

• High flow O2 from non breathing mask

• Ventilation if unconscious