Ch 16 Respiratory Emergencies - EMT Exam 1

Mediastinum

contains…

• heart

• great vessels

• esophagus

• trachea

• major bronchi

• many nerves

Ventilation

physical act of moving air into and out of the lungs

Oxygenation

the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream

Respiration

actual exchange of oxygen and carbon dioxide in the alveoli as well as the tissues of the body

Deoxygenated blood → Oxygenated Blood

deoxygenated → heart → lungs→ by pulmonary arteries and arterioles

gas exchange at alveolar capillaries

• via simple diffusion, oxygen passes into capillaries, co2 passes into the alveoli

Oxygenated blood → Deoxygenated Blood

Oxygenated blood → lungs → pulmonary veins/venules → heart

Factors Affecting Respiration (3)

External factors, Internal factors, Circulatory compromise

External Factors affecting respiration

• atmospheric pressure

• partial pressure o2

Internal Factors affecting respiration

• pneumonia

• pulmonary edema

• COPD/Emphysema - reduces surface area for gas exchange

Circulatory compromise affecting respiration

• trauma that obstructs blood flow

• blood loss

RR range

12-20 bpm

Adequate breathing

• 12-20 bpm RR

• reg patterns of inhalation/exhalation

• bilateral clear and equal lung sounds

• reg equal chest rise/fall

• adequate depth (tidal volume)

Abnormal Breathing

• RR: outside normal range

• HR: irregular rhythm

• Lung sounds: diminished, absent, or noisy

• reduced flow of expired air of nose and mouth

• unequal/inadequate chest expansion

• increased effort

• Skin: pale, cyanotic, cool, or moist

• skin pulling in around ribs or above clavicles during inspiration

Sign

seen, objective

• tripod position, accessory muscle use, cyanosis, labored breathing

Symptom

patient description, unseen complaint, subjective condition that the pt has to tell you about

• hurts to breath, feeling SOB, can’t get enough air

Respiratory Distress

high effort into breathing (not adequately breathing but still trying)

• agitation, anxiety, restlessness

• lung sounds: stridor, wheezing

• accessory muscle use, intercostal retractions

• tachypnea

• mild tachycardia

• nasal flaring

• seesaw breathing

• head bobbing

Respiratory Failure

low effort into breathing

• Lethargy

• Difficulty to rouse

• Tachypnea with periods of bradypnea or agonal

• Inadequate chest rise, poor chest expansion

• Inadequate rate and effort

• Bradycardia

• Diminished muscle tone

Causes of Dyspnea

6 Ps

pulmonary bronchial constriction

possible foreign body

pulmonary embolus

pneumothorax

pneumonia

pump failure

other possible causes - infectious diseases, pulmonary edema, OD, obstructions, pulmonary edema, environmental, etc

NRB

non rebreathermask

Non Rebreather Mask

1st choice for O2 admin

10-15 liters per minute (IRL 15)

90% saturation

can’t tolerate? nasal cannula

Nasal Cannula

administer O2 at 2-6 LPM

24-44% saturation

Humidified Oxygen

form of oxygen for prolonged use/extended transports

use for conditions like croup

SpO2

oxygen saturation

maintain above 94%

Croup

inflammation and swelling of the pharynx, larynx, and trachea; upper airway infection

• Age: 6mo-3yrs, children are at risk

• onset: often secondary to an acute viral infection; starts with cold symptoms and low fever

• peak season is late fall/winter

Croup Symptoms

stridor and seal bark coughing

• cause by narrowing of passageways

cold like symptoms

low grade fever

Croup Treatment

• humidified oxygen

• position of comfort

• be careful of agitating young children, may cause symptoms to worsen; stay with parents

• NO bronchodilators

Epiglottitis

inflammation and infection of the epiglottis

• age: children

• extreme difficulty swallowing

Epiglottitis Symptoms

• high fever

• severe sore throat

• tripod position

• drooling

• dyspnea

• difficulty swallowing

• visibly sick

• late sign - stridor

Epiglottitis Treatment

• Rapid Transport, ALS

• position of comfort

• high flow O2

• nothing by mouth

• be careful of agitating young children, may cause symptoms to worsen; stay with parents

RSV

Respiratory Syncytial Virus

infection in the lungs and breathing passages

• age: children

• highly contagious via droplets, PPE

RSV symtoms

• contagious

• cold like symptoms

• refusing liquids

• be alert for dehydration

RSV treatment

• position of comfort

• humidified oxygen

Bronchiolitis

Severe inflammation of bronchioles

• age: NB and toddlers

• viral

• often caused by RSV

Bronchiolitis symptoms

• Viral illness often caused by RSV

• Bronchioles become inflamed, swell, and fill with mucus

• Common in late fall and winter

Bronchiolitis treatment

• Provide oxygen therapy

• Suction thick mucus if necessary

• frequently reassess for signs of respiratory distress

Pneumonia

infection of the lungs; significant of death worldwide

• bacterial → quick onset, more severe

• viral → gradual onset, less severe

Pneumonia Predisposed populations

• chronic illness/disease

• nursing home

• recent hospitalizations

• Hx COPD

• sedentary

Pneumonia symptoms

• Productive yellow/green cough

• Vomiting instead of cough

• Wheezing, crackles, or rhonchi (goes away with coughing)

• Overall malaise (bleh)

Pneumonia treatment

• Assess the presence of a fever

• Provide airway and breathing support

• Supplemental oxygen

Pertussis

aka whooping cough; airborne bacterial infection

• age: children under 6yr

• PPE

Pertussis Symptoms

• Coughing spells lasting more than a minute and end with “whooping” noise

• Severe coughing spells, child turns red/purple

• FEVER

• Cold like symptoms

• Dehydration in children

Adults → disrupts eating, breathing sleeping

Geriatric → coughs can fracture ribs

Pertussis Treatment

• Supplemental oxygen by the most appropriate means

• Position of comfort

• PROTECT YOURSELF

Influenza Type A

• animal respiratory disease that has mutated to infect humans

• transmission: direct contact (basal secretions and droplets from coughing)

• symptoms: fever, cough, sore throat, muscle aches, headaches, fatigue

• may lead to pneumonia or dehydration

SARS-COV-2/COVID-19

• A coronavirus similar to the one that causes the common cold

• risk pop: affects the elderly, patients living in close quarters with one another, and those with weakened immune systems.

• transmission: aerosol dropletsthrough airborne particles by sneezing, coughing,direct contact

• Symptoms: high fever, cough, inspirational chest pain, vomiting and diarrhea, and anosmia (inability to smell)

Respiratory deterioration may occur rapidly.

Tuberculosis

bacterial infection spread by cough; contagious

TB symptoms

• coughing

• night sweats

• productive blood sputum

• fever

• fatigue

• weight loss

• SOB

• chest pain

TB treatment

PPE → N95, gloves, eye protection

supportive airway management

supp oxygen by the appropriate means

Asthma

spasm of bronchioles, mucus productions, and swelling of passages

Asthma Symptoms

• dyspnea

• inadequate breathing

• wheezing

• absent or diminished lung sounds

Asthma Treatment

• high flow O2

• Albuterol MDI

• rapid transport ALS

• Reassess often

MDI

metered dose inhaler

Pulmonary Edema

fluid in the lungs

• left side of the heart cannot remove blood from the lung as fast as the right side delivers it

• fluid builds within the alveoli and in lung tissue

• usually results from congestive heart failure

• interferes with gas exchange in the lungs

Pulmonary Edema Symptoms

• dyspnea with rapid, shallow respirations

• anxiety, restlessness

• severe cases → frothy pink sputum forms at the nose and mouth

• Hx of chronic congestive heart failure with meds (not all tho)

CHF abbr

congestive heart failure

Congestive Heart Failure Risk factors

hypertension (HTN), Coronary Artery Disease (CAD), Atrial Fibrillation

CHF acute onset causes

• stopped meds

• salty foods

• stresfull illness

• new heart attack

• abnormal heart rhythm

CHF symptoms

• respiratory distress that wakes them because of laying down (orthopnea/paroxysmal nocturnal dyspnea)

• exertional dyspnea

• feelings of suffocation

• lung sounds: crackles, wheezing

• hypertension

• coughing

• cool/clammy/diaphoretic

• tachycardia

• hypotension (late)

CPAP abbr

continuous positive airway pressure

CPAP indications

• moderate to severe distress

• pulmonary edema

• alert and able to follow commands

• breathing more than 26 times a minute

• SpO2 less than 90%

CPAP contra

• respiratory arrest

• signs and symptoms of pneumothorax or chest trauma

• active GI bleed or vomiting

• unable to follow commands

• hypotension

COPD

chronic obstructive pulmonary disease

Dilation and disruption of the airways and alveoli (caused by chronic bronchitis)

• umbrella term → emphysema, chronic bronchitis

  • most pt has element of both

COPD risk factors

• repeated infections

• repeated inhalation of toxic fumes (cigarettes)

• repeated episodes of pneumonia, injury, irritation, and inflammation in alveoli

  • results in obstruction and scarring and permanent dilation of alveoli

Chronic Bronchitis

Ongoing irritation of the trachea and bronchi

Constant excess mucus production

Obstructs small airways and alveoli

Chronic Bronchitis symptoms

• Obesity

• Difficulty with exhalation

• Skin- often cyanotic

• Exertional SOB

• Frequent/chronic cough

• Excessive mucus production

• Increased carbon dioxide retention

Emphysema Symtpoms

• Barrel chest

• Pursed lips, puffing breathing

• Tripod

• Skin- pink

• Exertional shortness of breath

• Muscle wasting/ weight loss

• Decreased ability to oxygenate the blood

• Low cardiac output

• hyperventilation

Pneumothorax

accumulation of air in pleural space

• spontaneous or nonspontaneous

• medical cond, w lung infections or in weak lungs

• dyspnea

• breath sounds absent on affected side (unilateral)

Pleural Effusion

A collection of fluid outside the lung.

• compresses the lung and causes dyspnea.

• can be caused by an irritation, infection, congestive heart failure, or cancer.

• Breath sounds will be decreased over the area where the effusion is Patients feel better if they are sitting upright.

• Upright position eases pain

Pulmonary Embolus

a sudden blockage in an artery in your lung, most commonly caused by a blood clot traveling from a deep vein in your legs or pelvis

Pulmonary Embolus Symptoms

• Anxiety, restless, impending doom

• Low spo2

• Dyspnea (acute)

• Tachycardia and tachypnea

• Acute chest pain

• Hemoptysis (coughing up blood)

• cyanosis

Cystic Fibrosis (CF)

generic disorder that affects smooth muscles in the lungs and digestive system

• Mucus becomes thick, sticky and hard to move, holds germs, causing lungs to be infected Predisposes patient to chronic lung infections

CF Symptoms

• Sinus congestion

• Wheezing

• Asthma like complaints

• Chronic cough with heavy thick discolored mucus

• Dyspnea

• Chronic pneumonia

CF Treatment

• suctioning

• supplemental oxygen via appropriate means

• transport

Hyperventilation

Over breathing to the point that arterial carbon dioxide falls below normal

• buildup of excess acid in blood/tissue (can lead to excess base in fluids)

• causes symptoms of panic attack → anxiety, dizziness, numbness, spams of hands/feet

Foreign Body Airway Obstruction - Found Unresponsive

• check responsiveness

• breathing? pulse?

• yes pulse, no breathing → ventilate

• no chest rise after after 2 vents → 30 chest compressions

• open airway, remove visible, NO BLIND

Foreign Body Airway Obstruction - Becomes Unresponsive

• floor

• help

• 30 chest compression

• no pulse check before CPR

• open airway, remove visible objects

• attempt to ventilate

• continue until ALS arrives

Environmental exposures

• pesticides

• cleaning solutions, chemicals, chlorines, gases

• CO

  • odorless

  • highly poisonous

  • fuel burning appliances and smoke

do NOT put yourself at risk

Assessing Airway/Breathing

Airway and breathing

Make sure airway is patent and adequate.

Assess rate, rhythm, and quality.

Ask the following questions:

Is the air going in?

Does the chest rise and fall with each breath?

Is the rate adequate for the victim’s age?

Breath?Lung Sounds

back, underneath clothes

down from shoulder blade

abnormal → wheezing, rales, rhonchi, stridor

Wheezing diseases

• asthma

• COPD

• CHF

• pulmonary edema

• pneumonia

• bronchitis

• anaphylaxis

Wheezing Symptoms

Dyspnea

Productive or non productive cough

Dependent edema, pink frothy sputum

Fever

Chest pain

Clear or white sputum

Hives, facial swelling, stridor

Rhonchi

• COPD

• Pneumonia

• Bronchitis

signs: productive cough, fever, pleuritis chest pain, clear or white sputum

Crackles

CHF, Pulmonary Edema, Pneumonia

signs: dependent edema, pink frothy sputum, fever, pleuritic chest pain

Stridor

croup, epiglottitis

signs: fever, barking seal cough, sore throat, drooling

Dec/Absent Breath Sounds

Asthma, COPD, Pneum, hemothorax, pneumothorax, alectasis

signs: cough, dyspnea, fever, shock, distress, dec SpO2