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Transcript of EMR ch15
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
CHAPTERCHAPTER
Caring for Respiratory EmergenciesCaring for Respiratory Emergencies
1515
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
OVERVIEW OF RESPIRATORY OVERVIEW OF RESPIRATORY ANATOMYANATOMY
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Overview of the respiratory system.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Overview of Respiratory AnatomyOverview of Respiratory Anatomy
• Upper airway– All spaces and structures above vocal
chords.• Lower airway
– All structures and spaces below vocal chords.
• Carina– Where trachea splits into right and left
main stem bronchi.(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Overview of Respiratory AnatomyOverview of Respiratory Anatomy
• Bronchioles– Smaller airways.
• Alveoli– Where exchange of oxygen and carbon
dioxide takes place.• Control center for respiratory is within
the brain.
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
RESPIRATORY COMPROMISERESPIRATORY COMPROMISE
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Inability of person to breath adequately.• Hypoxia: when the body's cells do not
receive adequate supply of oxygen. – Signs: altered mental status, pale skin,
cyanosis of nail beds/mucous membranes. • Hypercarbia: condition of having too
much carbon dioxide in blood.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Respiratory Distress (Dyspnea) – Result of not getting adequate supply of
oxygen; increased in levels of carbon dioxide in blood
– Increased work of breathing– Increased respiratory rate– Use of accessory muscles
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Respiratory Failure – When body's normal compensatory
mechanisms fail.– Breathing rate begins to slow.– Tidal volume begins to get shallower.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Common causes:– Hyperventilation– Asthma– Chronic bronchitis– Emphysema– Exposure to poison – Allergic reaction
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Normal Breathing– Sufficient to support life. – Easy and effortless (adequate).– Do not work hard to breathe. – Able to speak full sentences without having
to catch breath.– Normal respiratory rate, depth, and very
little effort or work of breathing.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Characteristics of Normal Breathing– Normal rate (number breaths per minute):
12 to 24 for adult; 16 to 32 for child; 24 to 48 for infant.
– Normal depth (size of each breath): tidal volume; normal breaths not too shallow and not too deep.
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Characteristics of Normal Breathing– Work of breathing: effort it takes for patient
to move each breath in and out.– Respiratory rhythm regular.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Abnormal Breathing– Inadequate; not sufficient to support life. – Left untreated, will result in death.– Common signs:
Increased work of breathing Increased respiratory rate
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Abnormal Breathing– Common signs:
Decreased respiratory rate Respirations that are too deep or too shallow Irregular breathing rhythm Audible breath sounds (gurgling, snoring or
wheezing)
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Abnormal Breathing– Tripod position: seated or standing with
hands on knees, shoulders arched upward, head forward.
– Accessory muscles: muscles of neck, chest, abdomen that assist during respiratory difficulty.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Signs and symptoms of respiratory distress.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Signs and Symptoms of Respiratory Compromise– Labored or difficulty breathing; a feeling of
suffocation.– Audible breathing sounds.– Rapid or slow rate of breathing.– Abnormal pulse rate (too fast or too slow).
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Signs and Symptoms of Respiratory Compromise– Changes in skin color, particularly of lips
and nail beds.– Tripod position.– Altered mental status.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Chronic Obstructive Pulmonary Disease– Conditions: asthma, chronic bronchitis,
emphysema– Signs and symptoms:
History of heavy cigarette smoking Persistent cough Chronic shortness of breath Pursed-lip breathing
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Chronic Obstructive Pulmonary Disease– Signs and symptoms:
Maintaining tripod position Fatigue Tightness in chest Wheezing
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Asthma– Condition affecting lungs, characterized by
narrowing of air passages and wheezing.– Caused by sensitivity to irritants (pollen,
pollutants, exercise).– Narrowing air passages cause wheezing.
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Asthma– Signs and symptoms:
Moderate to severe shortness of breath Wheezing Anxiety Nonproductive cough
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Asthma causes the bronchioles to become narrow and filled with mucus.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Asthma– Little/no symptoms between attacks.– Medication in metered-dose inhaler.
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Metered-Dose Inhaler
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Metered-Dose Inhaler with Spacer
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Asthma– If left untreated, asthma attack can be
severe enough to cause respiratory arrest and even death.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Bronchitis– Causes swelling and thickening of walls of
bronchi and bronchioles.– Causes overproduction of mucus in air
passages.– Chronic bronchitis: productive cough for
three consecutive months and occurs at least two consecutive years.
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Emphysema affects the alveoli, and bronchitis affects the bronchioles.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Emphysema affects the alveoli, and bronchitis affects the bronchioles.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Emphysema affects the alveoli, and bronchitis affects the bronchioles.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Bronchitis– Signs and symptoms:
Overweight Mild to moderate shortness of breath Pale complexion Productive cough Wheezes
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Emphysema– Associated with cigarette smoking; disease
of lungs that causes permanent damage to alveoli.
– Causes destruction of alveoli, making them useless for exchange of oxygen and carbon dioxide.
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Emphysema– Loss of lung elasticity and accumulation of
air cause chest wall to become extended over time; “barrel chest.”
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Emphysema– Signs and symptoms:
Moderate to severe shortness of breath Very thin in appearance Large chest (barrel chest) Nonproductive cough Extended exhalations
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Hyperventilation Syndrome– Occurs when person breathes out and
eliminates excess amount of carbon dioxide.
– Most cases caused by anxiety and do not represent medical emergency.
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Hyperventilation Syndrome– Can be a sign of something serious.– Be alert for cyanosis.– Monitor for changes in vital signs.– Reduce anxiety by reassuring and
comforting patient.
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Hyperventilation Syndrome – Signs and symptoms:
Moderate to severe shortness of breath Anxiety Numbness or tingling of fingers, lips, and/or
toes Dizziness Spasm of fingers and/or toes Chest discomfort
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Emergency Care for Respiratory Compromise– Observe body language.– Determine characteristics of breathing.– Pay attention to level of distress and facial
expression.– Reassure patient.
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Emergency Care for Respiratory Compromise– Gather a history.– Ability to speak clearly and in full
sentences.– Listen for sounds as patient breathes.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Take appropriate BSI precautions.• Perform primary assessment; support
ABCs.• Ensure patent airway; administer
oxygen per local protocols.• Allow patient to maintain position of
comfort.• Arrange for ALS response if available.
(continued)
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Assist with prescribed medication per local protocols and medical direction.
• Obtain vital signs.• Continue to monitor patient and provide
reassurance.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Positive Pressure Ventilations– Use bag-mask device to provide rescue
breaths when breathing determined to be inadequate.
– Place mask firmly over patient's face; provide rescue breaths at rate appropriate for patient's age.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
When breathing is inadequate, provide positive pressure ventilations with a bag-mask device.
Copyright ©2012 by Pearson Education, Inc.All rights reserved.
Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley
Respiratory CompromiseRespiratory Compromise
• Metered-Dose Inhalers (MDI)– Small device that stores and delivers
medication that patient inhales into lungs.– Encourage patient to take medication
exactly as prescribed.– Check expiration date.