Breathing Patterns, Lung Sounds, Devices/Adjuncts, and Suction

wheezing

high pitch

whistling sound

most heard of expiration

cause: narrowing of airways (upper)

rales

wet crackles on end of inspiration

fluid in small airways and/or alveoli

rhonchi

low pitch, rumbling sound

caused by secretions in larger airways

stridor

brassy, crowning sound

upper airway obstruction

snoring

upper airway blocked by tongue

kussmaul respirations

deep, rapid

DKA

agonal

gasping

respiratory arrest

bradypnea

under 12 bpm

too slow

tachypnea

over 20 bpm

too fast

ataxia

irregular with pauses

Cheyne-Stokes

fast, shallow then heavy and deep on repeat

Respiratory Distress

Increased work in breathing and inadequate gas exchange (Oxygenation problem).

Treat the emergency and give O2

still alert

agitated/anxious

open airway

increased resp. rate (over 20)

tachycardia

pale skin

Look for: retractions, accessory muscle use, nasal flaring, tripod position

Respiratory Failure

Respiration begins to slow, patient gets tired,

O2/ventilation cannot support the body’s needs

Most likely need ventilation support

confussion

alt. mental status

airway not patent,

decreased resp. rate (under 12)

bradycardia

cyanosis

Look for: slow, sluggish respiration and tiredness

Respiratory Arrest

patient stops breathing

Respiratory Depression

Some event has caused the respiratory drive to become depressed

slow respirations

ex: head trauma, Benzo O.D, Opioid O.D

Normal Respiration Rate ADULT

12-20 breaths per minute

Nasal Canula

1-6 Liters per minute

For low SP02 with mild symptoms

24-44%

non rebreather

10-15 Liters per minute

for respiratory distress with low SP02

80-95%

Bag Valve Mask (BVM)

15 Liters per minute

for unable to maintain own airway with low respiratory rate

nearly 100%, 90-95% or higher

Continus Positive Airway Pressure (CPAP)

8-15 Liters per minute for 5-10 PEEP (Positive End-Expiratory Pressure)

allows alveoli to remain open for gas exchange and push fluid off

Indicators: COPD, CHF, Asthma, pneumonia, drownings

Contras: unresponsive, hypotensive, pneumothorax, N/V, resp. arrest

NPA measurement

the tip of the patient’s nose to the earlobe (or angle of the jaw)

OPA Measurement

center of the mouth (or corner of the mouth) to the angle of the jaw (or earlobe)

Suction measurement

corner of mouth to earlobe

maximum suctioning time

adult-15 sec

Peds- 10 sec

infants- 5 sec

suctioning technique

Apply suction only while withdrawing the tip, using a gentle, rotating or circular motion.

Patient on lateral recumbent (side lying)

If spinal trauma, keep manual in line stabilization, log roll if needed