Respiratory

Chapter 11

Pulmonary edema: Fluid in the lungs, sounds like crackles.

Ronchi: Mucus on lungs, rattly.

Stridor: Whistle sound.

Wheezing: Lower airway constriction.

Paradoxical Motion: Chest falls during inhale, rises during exhale. Breathing is still occurring, but it looks backwards.

Flail Chest: Three or more adjacent ribs break in at least two places, creating a free-floating chest wall segment. Usually causes paradoxical motion.

Ventilation: Physical aspect of breathing. Regulation of ventilation is based on pH changes in the blood and cerebrospinal fluid (if it’s too high, it makes you breath more to remove CO2).

Respiration: Actual exchange of oxygen and carbon dioxide in the alveoli as well as the tissues in the body.

Oxygenation: Loading up oxygen on hemoglobin.

Aerosol-Generating Procedures (AGP): CPR, nebulizer treatments, endotracheal intubation, continuous positive airway pressure.

Adequate breathing: Between 12 to 20 breaths/min; regular pattern of inhalation and exhalation; bilatieral clear and equal lung sounds; good depth.

Abnormal Breathing: Fewer than 12/min, higher than 20/min; irregular rhythm; diminished, absent, or noisy auscultated breath sounds; reduced flow of expired air at nose and mouth; increased effort breathing; cyanotic, pale, cool, moist; skin pulling in around ribs or above clavicles during inspiration.

    Suggest BVM if cyanotic is too widespread, depends on the field.

Agonal gasps: Breathing after heart has stopped, like a fish out of water. Not good, probably not alive, ventilate them, don’t count them as breathing.

Cheyne-Strokes: Rapid breathing that are deep, then followed by period of apnea before restarting. Often seen in patients with stroke or head injury. Increased BP, low bpm.

Ataxic: Irregular breathing or unidentifiable pattern, may follow serious head injury.

Kussmaul: Deep, rapid respirations that happen during metabolic acidosis. Sugar accumulates in blood but not being absorbed, it takes up more space in blood vessels, decreasing circulation.

ALL patients with inadequate breathing need to be treated immediately.

End Tidal CO2: Measurement of the maximal CO2 at the end of an exhaled breath. High CO2 means ventilatory inadequacy, apnea; Low CO2 means hyperventilation, decreased CO2 return to the lungs, reduced CO2 production at the cellular level.

  • Measured using capnometry and capnography devices. Normal range is 35-45 mm Hg. Can be used in spontaneously breathing patients with a special nasal cannula.

Oxygen Toxicity: Can be bad for patients with certain illnesses such as COPD. Don’t want to shut down patients hypoxic drive by giving them too much oxygen, so maybe use partial nonrebreather or lower oxygen.

Nonrebreather:

Nasal Cannula: Can provide 24% to 44% inspired oxygen when set at 1-6 L/min

Venturi Mask: Delivers 24% to 40%, allows you to control the percentage of oxygen flow. Not really used on the field.

Tracheostomy Masks: For patients with tracheostomies since they don’t breathe through their mouth or nose. Usually not available in emergency settings, so improvise.

DOPE: Mnemonic for an intubated patient who’s condition is deteriorating. Dislodged, Obstruction, Pneumothorax, Equipment Fail.

Assisted/Artificial Ventilation: BVM or bag mask. 1500mL of air delivered by BVM. Being too forceful or fast causes gastric distension, treated by opening airway and gently pressing on stomach.

CPAP: Noninvasive ventilatory support for respiratory distress. Typically given to people with obstructive sleep apnea at night. Have to be A&O4, obvious signs of moderate to severe respiratory distress (even after submersion incident), patient is breathing rapidly, below 90% SpO2; Overall good for pulmonary edema/fluid in lungs. Contraindications: Respiratory arrest, hypoventilating, cannot speak, unresponsive, cannot protect his or her airway, hypotension (Anything below 100 systolic); Signs/symptoms of pneumothorax or chest trauma, tracheostomy, active gastrointestinal bleeding or vomiting, facial trauma, cardiogenic shock, can’t sit upright, can’t tolerate mask.

Assisting with ALS Airway Procedures: Placement of advanced airways; preoxygenation; equipment setup; performing the procedure “BE MAGIC”

  • B - Perform bag mask


Chapter 16

Upper and Lower Airway Infections: Infectious diseases may affect all parts of the airway. Mucus and secretions obstructing airflow, swelling of soft tissues in upper airways, and impaired exchange of gases in the alveoli.

Croup: Inflammation and swelling of pharynx, larynx, and trachea. Stridor and seal-bark cough. Responds well to humidified oxygen.

Epiglottitis: Bacterial infection causing inflammation of epiglottis. Children are often found in tripod position and drooling. Position comfortably and provide oxygen.

Respiratory Syncytial Virus (RSV): Contagious respiratory infection and is a common cause of illness in young children. Causes infection in the lungs and passages, look for signs of dehydration. Treat airway and breathing problems, humidified oxygen is helpful.

Use humidified oxygen for dry conditions or viruses, not things like edema though.

Bronchiolitis: Viral illness caused by RSV, usually affects newborns and toddlers. Bronchioles becomes inflamed, swell, and fill with mucus. Provide oxygen therapy and frequently reassess. Different from bronchitis, since bronchiolitis is usually in lower parts of lungs, and bronchitis causes rhonchi.

Pneumonia: Bacterial pneumonia will come quickly and result in high fever. Viral pneumonia presents more gradually and is less severe. Especially affects people who are chronically ill. Assess temperature and provide airway support and supplemental oxygen.

Pertussis: “Whooping cough.” Airborne bacterial infection affects children younger than 6 mostly. Patients will be feverish and exhibit a “whoop” sound on inspiration after a coughing attack. Watch for dehydration and suction as needed. Full PPE

Influenza Type A: Became pandemic in 2009, symptoms include fever, cough, sore throat, muscle aches, headache, and fatigue. May lead to pneumonia or dehydration.

Covid-19: Similar to the virus that causes the common cold. Usually affects elderly, immunocompromised, and people living in close quarters. Transmitted by aerosol droplets and airborne particles. Respiratory deterioration may occur rapidly.

Tuberculosis (TB): Bacterial infection most often affects lungs. Can remain inactive for years. Fever, coughing, fatigue, night sweats, and weight loss. Full PPE: Wear gloves, eye protection, and an N-95 respirator.

Acute Pulmonary Edema: Heart muscle cannot circulate blood properly, fluid builds up within alveoli and in lung tissue. Usually result of congestive heart failure, most patients have a long standing history of chronic CHF. In severe cases, a frothy pink sputum forms at the nose and mouth. 7-10 PEEP setting 10-15 L/min O2 for CPAP.

Chronic Obstructive Pulmonary Disease (COPD): Slow process of dilation and disruption of airways and alveoli. Caused by chronic bronchial obstruction. Tobacco smoke can create chronic bronchitis. Emphysema occurs in some COPD where alveoli are damaged or destroyed, so they’re functionally useless.

    COPD will have “dry” lung sounds, but people with pulmonary edema will have “wet” lung sounds. Treat patient, not sounds.

Albuterol: 2 puffs = 2.5mg

  • Indication:

    • Asthma

    • Exertion

    • Allergy

    • “Wheezing”

    • Prescribed

  • Contraindication:

    • Not prescribed

    • Altered

Asthma, Hay Fever, and Anaphylaxis: Result of allergic reaction to inhaled, ingested, or injected substance. In some cases, allergen cannot be identified.

    Asthma affects all ages, mostly between 5-17; Produces characteristic wheezing; may be caused by an allergic reactions to foods or allergens or severe emotional distress, exercise and respiratory infections.

    Hay Fever causes cold-like symptoms; allergens include pollen, dust mites, pet dander.

Spontaneous Pneumothorax: Accumulation of air in pleural space. Most often caused by trauma, may be caused by medical conditions. Occurs with lung infections or in weak lungs; patient becomes dyspneic, breath sounds may be absent on affected side, JVD, deviated trachea, etc.

Pleural Effusion: Collection of fluid outside the lung, compressing lungs and causing dyspnea. Can stem from irritation, infection, congestive heart failure, or cancer. Upright position eases pain. Sounds like muffled rhonchi. Just give oxygen.

Pulmonary Embolism: A blood clot that circulates through the venous system. Circulation cut off partially or completely, significantly decreases blood flow. If large enough can cause sudden death. Signs and symptoms are dyspnea, tachycardia, tachypnea, varying degrees of hypoxia, cyanosis, acute chest pain, hemoptysis. Surgeries can cause it, after child birth there’s greater risk, sedentary lifestyle (DVT; Deep Vein Thrombosis), other things that cause the body to clot.

Environmental/Industrial Exposure: Carbon monoxide: Odorless, highly poisonous, produced by fuel-burning appliances and smoke. Pesticides, cleaning solutions, chemicals, chlorine, and other gases can be released and bad.

Treatment of Specific Conditions (Finish these notes with PPT):

    Upper or lower airway infection Administer humidified oxygen,

    Acute pulmonary edema: CPAP 7-10 water pressure, 10-15L

    Asthma: Be prepared to suction, assist prescribed inhaler,