EMT Respiratory

Upper airway

Warm and filter, Ventilation

Nasal air passage, Pharynx (Oropharynx, Oropharynx), Epiglottis,

Lower airway

Ventilation, Respiration, Gas exchange

Trachea, Carina, Bronchus, Bronchioles, Alveoli, Pulmonary capillaries, Diaphragm

Muscles of Breathing

Intercostals, Diaphragm: Contraction Inhalation, Relaxation Exhalation

Accessory: (labored) Neck, shoulders, chest, abs

Control of Breathing

high CO2 (acid) in bloodstream and cerebrospinal fluid stimulates brain stem

Opening the airway

Medical: Head tilt chin lift

Trauma: Jaw thrust (possible neck injury)

Suction Catheter

Yankauer: rigid, straw like

Soft Tip (nasal, <1yr, tracheostoma)

Airway Adjuncts

• Oropharyngeal Airway (OPA): Unconscious, BVM, No gag

  • corner of the mouth to corner of the jaw, 90 degree rotation (Peds tongue depressor)

• Nasopharyngeal Airway

  • Tip of nose to corner of mouth, bevel to septum, lubricate and rotate

Oxygen Delivery

Nasal Cannula (NC)- 1-6 L/min: low flow O₂, long transports

Non-rebreather mask (NRB)- 10-15, High

Bag Valve Mask (BVM)- 15, Ventilations

Respiratory distress

• Alert, awake (Possible Restlessness or anxiety)

• Tachypnea and/or Tachycardia

• Labored breathing or accessory muscle use

• SpO₂ normal or mildly reduced

Respiratory failure

• ***Altered, confused

• Breathing rate <10 or >30

• SpO₂ critically low (<88)

• gasping

• Cyanotic

• Severe hypoxia or hypercapnia developing

Respiratory arrest

No breathing at all or Agonal gasps

Tracheostomy Care

• Usually partial/full removal of larynx: laryngectomy

• Harder time clearing airway: can’t cough/swallow ⇒ more mucous

• If BVM Ventilations needed- can connect BVM directly to trache tube

  • , seal the mouth and nose If air moves escapes during BVM

Pulse Oximeter

% of hemoglobin saturated with oxygen (94 - 100%)

Low readings from: Shock, Hypothermia, Anemia, Excessive movement

Normal reading but low oxygenation- Carbon monoxide poisoning

iGel

• supraglottic Most secure/advance airway

• For patients who will maintain unconsciousness

• Can only use in some counties/companies

CPAP

• Positive End Expiratory Pressure to keep alveoli open

• NOT ventilation device ⇒ patient must be breathing and awake

• Useful in COPD, Asthma, CHF

Upper airway management

mechanical

• Open airway, oxygen, transport

• Jaw thrust, head-tilt chin-lift, positioning

• suction, abdominal thrusts (Heimlich), back blows

Croup

• Viral infection- inflammation of larynx and trachea

• s/s

  • **Seal-bark cough (short and sharp) 

  • Lung sound: stridor (from inflammation) 

  • low grade fever

  • Common in: kids 6 months – 3 years

• Treatment

  • ALS- Nebulized epinephrine 

Pertussis

AKA (Whooping cough), Tdap Vaccine

• Bacterial infection (LESS COMMON THAN CROUP)

• s/s

  • **Whoop following cough 

  • Lung sound: stridor (from inflammation) 

  • Higher grade Fever

  • Vomiting during or after coughing fits

  • Tiredness

  • Common cold symptoms prior

  • Common in: kids under 6

• Treatment- Oxygen, transport

Epiglottitis

• Bacterial Infection of the epiglottis

• Signs and symptoms:

  • **Copious drooling and difficult/painful swallowing

  • Lung sound: stridor (from inflammation) 

  • High grade fever

  • Severe sore throat/hoarseness

• Treatment: 

  • ALS- Intubation 

Anaphylaxis

• Immune response ⇒ Histamine release, Vasodilation

• s/s

  • **Hives (Urticartia)

  • Lung sound: stridor (from inflammation) 

  • Anguiedema (swelling)- common in tongue and airway

  • If ingested: GI problems like vomiting, etc.

• Treatment:  

  • Epinephrine (Epipen) 

    • Repeat every 5 minutes if symptoms persist

    • Side effects- Increases heart rate, blood pressure

Lower airway management

medication

• Open airway, medicate, oxygen, transport

• Jaw thrust, head-tilt chin-lift, positioning

• reduce bronchospasm or inflammation w/Bronchodilators (i.e. albuterol) 

• Position (tripod/upright)

• Airway is structurally patent, obstruction in gas exchange

Bronchiolitis

• Viral infection- Inflammation in bronchioles

• Signs and Symptoms

  • Lung sound: Wheezing

  • Low grade fever

  • Cough

  • Common cold symptoms prior

  • Common in: infants and children after RSV infection

    • RSV: Respiratory syncytial virus, specific type of Respiratory virus

Tuberculosis

• Bacterial infection

• S/S: 

  • **Productive bloody sputum (frothy red/pink)

  • Lung sound: Crackles

  • High grade Fever

  • long-term chronic cough

  • night sweats

  • unintentional weight loss

  • fatigue

• Can lay dormant for years, becomes active when immune system is weakened

• Wear N95 mask

Pneumonia

• bacteria, viruses, or fungal infection- inflammation of alveoli

• s/s 

  • **Gradual onset of fever/chills

  • **Preceded by upper respiratory infection  

  • Lung sound: Crackles

  • Fever

  • Malaise, weakness → FEEL sick

  • Productive cough that worsens over time

  • Green tinged sputum (phlegm)

  • Usually unilateral

Asthma

• Immune system response- Bronchioles contraction

• Signs and Symptoms:

  • Breath sounds: Wheezing or entirely Absent if severe

  • Longer exhale

  • History of asthma

• Treatment:

  • Prescribed inhaler (albuterol - beta 2/bronchodilator)

Chronic Obstructive Pulmonary Disease (COPD): Chronic Bronchitis

• Signs & Symptoms: Chronic Bronchitis (obstructed airways)

  • **Productive, chronic cough

  • Lung Sounds: Rhonchi 

  • long-term inflammation of the airways irritating trachea and bronchi

  • Cilia destroyed ⇒ increased irritants increasing Inflammation

• Treatment: 

  •  nasal cannula, CPAP if needed

    • Target SpO2 range: 88-92%

  • Fowler’s or Semi-fowler’s

Chronic Obstructive Pulmonary Disease (COPD): Emphysema

• Signs & Symptoms: Emphysema (damaged avioli)

  • Breath sounds: crackles

    • Rice Crispies- Snap, crackle, pop

  • Long expiratory phase

  • **Common in: long time smokers

  • Extra info

    • Loss of elastic material in the alveoli due to chronically inflamed airways

    • Alveoli start to fall apart, leaving holes and large air pockets

• Treatment: 

  •  Oxygen: Use nasal cannula > NRB for distress, CPAP if needed

    • Target SpO2 range: 88-92%

  • Fowler’s or Semi-fowler’s

Pulmonary Embolism

• pulmonary artery in the lungs blocked by a blood clot

• Risk Factors: Afib, sedentary, plane, birth control, smoking, childbirth

• Signs and Symptoms

  • Pinpoint chest pain- very specific, singular location (actually pinpoint size) 

  • Lung sounds: clear, normal

  • Sudden onset shortness of breath

  • Respiratory distress/failure

  • Hemoptysis: coughing up blood

Spontaneous Pneumothorax

• Accumulation of air in the pleural space, collapsing a lung

• High risk: emphysema and asthma patients

• s/s

  • Lung sounds: absent/diminished on affected side, uneven

  • Pleuritic chest pain- sharp, unilateral pain during inhalation & exhalation

  • Shortness of breath

• Can compress heart structures

• Can progress to Tension Pneumothorax

Tension Pneumothorax

• Accumulation of air in the pleural space, collapsing a lung

• High risk: emphysema and asthma patients

• s/s

  • Lung sounds: absent/diminished on affected side, uneven

  • Pleuritic chest pain- sharp, unilateral pain during inhalation & exhalation

  • Shortness of breath

  • Decreased BVM compliance

  • Subcutaneous emphysema- air gets trapped under your skin (like a pizza pocket)

  • Later signs: Hypotension, Jugular vein distension (protruding neck veins), Tracheal deviation (very late sign)

Pleural Effusion

• Fluid build up in the pleural space (space around lung)

• s/s

  • ***Starts over days or weeks ⇒ gradual onset

  • Breath sounds: friction rub

  • shortness of breath

• Treatment 

  • remove the fluid (ALS)

Cystic Fibrosis

• Genetic disorder of salt balance in mucus

• s/s

  • Lung sounds: wheezing

  • Productive cough 

  • Mucus secretions are thicker/heavier

  • Chronic lung infections (from sedentary mucous)

    • Sinus infection and stuffy nose

  • Malabsorption of food in the GI tract (from mucous in GI tract)

Carbon Monoxide

• Colorless, odorless gas

• s/s 

  • **Similar symptoms in people all in the same space

  • Flu like symptoms

    • Headache, dizziness, fatigue, nausea, vomiting, shortness of breath

  • SpO₂ will be good despite dyspnea (inability to breathe)

    • Hemoglobin favors carbon monoxide over oxygen

Hyperventilation Syndrome

• Breathing too fast, reducing arterial CO2 levels

• Can be physiological cause (Too much acid the body, DKA- Aspirin overdose)

• Can be psychogenic cause (Dizziness, hand and feet tingling, carpopedal spasms)

• Treatment: Oxygen, Coaching (Inhale 4s, hold 4s, exhale 4s)

• Not diagnosed in the field

Congestive Heart Failure

• Long term condition: Reduced cardiac function ⇒ Fluid pooling in lungs and legs

• Ask the patient about their medical history

• Signs & Symptoms: CHF

  • Leads to Pulmonary edema: fluid in the lungs

    • Breath sounds: Crackles

  • Dependent edema - swelling of feet and ankles

  • Pink, frothy sputum

  • Orthopnea - Suddenly waking from sleep with shortness of breath 

    • Also called paroxysmal nocturnal dyspnea (PND)

• Left Sided Heart Failure 

• Treatment: CHF

  • BLS: beta blockers (albuterol) ALS: Medications - ACE inhibitors, diuretics

  • Consider CPAP

  • Upright/Fowlers

Stridor

• Upper Airway Sound

• Mucous-y high pitched whale sounds/wheezing but gaspier

  • Can hear it without stethoscope

• Stridor Think- Seals whoop drool, allergic burns block

  • Croup (kids <3): Seal Bark Cough

  • Pertussis (kids<6): Whoop following cough

  • Epiglottitis: Drooling, difficult/painful swallowing

  • Anaphylaxis: Hives (Urticartia)

  • Inhalation Burn

  • Foreign body obstruction

Crackles

AKA Rales- (snap crackle pop, rice krispies)

• Pushing a rolling pin through bubble wrap (but mucousy/wet), crumpling paper, sucking last of liquid through straw

• Types:

  • Course (thicker/louder)

  • fine (wetter/more consistent)

• Affects alveoli ⇒ Rales affects tails

  • Pulmonary edema: fluid in the lungs

    • CHF: Bilateral, pink frothy sputum

    • Early onset Pneumonia: (Usually) unilateral, Gradual onset, recent upper respiratory infection

  • TB: Productive bloody cough (sputum streaked w/red/rust)

  • COPD: long time smokers

Wheeze

Whistle or Whale sounds, more prolonged/continuous 

• Bronchoconstriction: lower airway bronchial constriction

  • AAC

    • When severe, absent/diminished lung sounds

    • Asthma: History of asthma

    • anaphylaxis: **Hives (Urticartia)

    • COPD

• Bronchiolitis: Common in infants and children after RSV infection

• Cystic Fibrosis: genetic disorder, Thick Mucus secretions, Chronic lung infections
  

Rhonchi-

low pitch, wet rumble, bubbling pudding

• Rhonchi affects bronchi

• Secretion of mucous or infection

• Pneumonia 

absent/diminished

• severe,

  • Asthma: History of asthma

  • anaphylaxis: **Hives (Urticaria)

  • COPD

• unilateral absent lung sounds: pneumothorax