Chapter 16 - Respiratory Emergencies

acidosis

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

adventitious breath sounds

abnormal breath sounds such as wheezing, stridor, rhonchi, and crackles

alkalosis

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

allergen

a substance that causes an allergic reaction

anaphylaxis

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

bronchial breath sounds

normal breath sounds made by air moving through the bronchi

bronchiolitis

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

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 long-term exposure to 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

continuous positive airway pressure (CPAP)

a method of ventilation used primarily in the treatment of critically ill patients with respiratory distress;

can prevent the need for endotracheal intubation

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

crackling, rattling breath sounds that signal fluid in the air spaces of the lungs

croup

a viral inflammatory disease of the upper respiratory system that may cause a partial airway obstruction and is characterized by a barking cough;

usually seen in children

diphtheria

an infectious disease in which a pseudomembrane 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;

it is one form of chronic obstructive pulmonary disease

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;

aka allergic rhinitis

hyperventilation

rapid, usually deep, breathing that lowers the blood carbon dioxide level below normal

hyperventilation syndrome

occurs in the absence of physical problems;

respirations of a person who is experiencing hyperventilation syndrome may be as high as 40 shallow breaths/min or as low as only 20 very deep breaths/min;

often associated with panic attacks

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

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

severe dyspnea experienced when lying down and 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 that occurs on a global scale

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 bacteria 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

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, often 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;

RSV is highly contagious and spread through droplets

rhonchi

coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways

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 person’s 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

The upper airway consists of all anatomic structures above the level of the…

vocal cords

What part of the brain senses the level of carbon dioxide in the arterial blood?

brainstem

What are the signs of normal, adequate breathing?

• normal rate, 12 to 20 breaths/min

• regular pattern of inhalation and exhalation

• clear and equal breath sounds on both sides of the chest

• regular and equal chest rise and fall

• adequate depth

• unlabored; without adventitious breath sounds

Chest tightness is commonly reported by patients with…

asthma

What disease is often secondary to an acute viral infection of the upper respiratory tract and is typically seen in children between ages 6 months and 3 years?

croup

How does croup start off as?

a cold, cough, and a low-grade fever that develops over a few days

What are the hallmark signs of croup?

stridor and a seal-bark cough

What does the seal-bark cough in croup signal?

a narrowing of the air passage of the trachea that may progress to significant obstruction

Why is croup rarely seen in adults?

adults have larger breathing passages that can accommodate the inflammation and mucus production without producing symptoms

What treatment does croup oftenr respond well to?

administration of humidified oxygen

What is the most common cause of epiglottitis?

bacterial infection

How will children with epiglottitis often be found?

in the tripod position and drooling

How should you treat children with epiglottitis?

• gently; don’t do anything that will cause them to cry

• keep them in a position of comfort

• give high-flow oxygen

• do not put anything in their mouths

What should you look for signs of when assessing a child with suspected RSV?

signs of dehydration

How should you treat a child with RSV?

• treat airway and breathing problems

• humidified oxygen if available

What demographic does bronchiolitis occur in most frequently?

newborns and toddlers, especially boys

How should you treat a child with brochiolitis?

• provide appropriate oxygen therapy

• allow the patient to remain in a position of comfort

• suction thick mucus from nostrils

Pneumonia is often a secondary infection, meaning…

it begins after an upper respiratory tract infection such as a cold or sore throat;

can also be caused by a virus or bacterium or chemical injury

What factors predispose patients to pneumonia?

• institutional residence

• recent hospitalization

• chronic disease processes

• immune system compromise

• history of COPD

How do children with pneumonia often present as?

unusually rapid or labored breathing or breathing characterized by grunting or wheezing sounds

What is the difference between bacterial pneumonia and viral pneumonia in terms of symptoms?

bacterial = severe and quicker, including high fevers

viral = more gradual and less severe

What is the treatment for pneumonia?

airway support and supplemental oxygen

What is the treatment for whooping cough?

• supplemental oxygen

• suction thick secretions to clear the airway

What signs and symptoms does influenza A cause?

• fever

• cough

• sore throat

• muscle aches

• headache

• fatigue

What are the signs and symptoms of COVID-19?

• high fever

• cough

• chest pain during inspiration

• vomiting

• diarrhea

• anosmia

What will patients with active TB involving the lungs report?

• fever

• coughing

• fatigue

• night sweats

• weight loss

What are the symptoms of acute pulmonar edema?

• dyspnea

• rapid, shallow respirations

• frothy pink sputum at the nose and mouth in severe cases

COPD is an umbrella term used to describe several lung diseases, including…

• emphysema

• chronic bronchitis

What is COPD most often the result of?

cigarette smoking

What is the most common form of COPD?

emphysema

What are some common signs and symptoms of COPD?

• chronically produce sputum

• chronic cough

• have difficulty expelling air from their lungs

• long expiration phases

• wheezing

What is the difference in lung sounds with COPD and CHF?

COPD = dry lung sounds (wheezes)
CHF = wet lungs sounds (crackles)