Respiratory Emergencies CHAPTER 17. Anyone who has experienced respiratory difficulty knows that the...
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Respiratory Respiratory EmergenciesEmergencies
CH
AP
TER
17
CH
AP
TER
17
Anyone who has
experienced respiratory
difficulty knows that the
inability to breathe is
TERRIFYING!
Respiratory System Respiratory System ReviewReviewRespiratory System Respiratory System ReviewReview
AnatomyAnatomy
Respiratory System Anatomy
The Upper Airway
NasopharynxNasopharynx
OropharynxOropharynx
EpiglottisEpiglottis
Vocal cordsVocal cords
TracheaTrachea
The Lower Airway
UpperUpperlobelobe
MiddleMiddlelobelobe
LowerLowerlobelobe
TracheaTrachea
Due to their
anatomy,
Infants and
children are
more prone
to
respiratory
emergencies
.
Adult (20 mm)
Infant(4
mm)
PhysiologyPhysiologyPhysiologyPhysiology
BreathingBreathingInhalationInhalation ExhalationExhalation
Chest Chest contractscontracts
Chest Chest relaxesrelaxes
Alveolar/capillary Alveolar/capillary interfaceinterface
Cellular/capillary Cellular/capillary interfaceinterface
Alveolus
Body cells
Gas ExchangeGas Exchange
Blood
Blood
Capillary
Breathing AssessmentBreathing AssessmentBreathing AssessmentBreathing Assessment
Adequate BreathingAdequate Breathing
Normal Respiratory Rates Normal Respiratory Rates
Adult:Adult: 12 - 20/minute12 - 20/minute
Children:Children: 15 - 30/minute15 - 30/minute
Infants:Infants: 25 - 50/minute25 - 50/minute
Normal Breathing Normal Breathing Both lungs expand equallyBoth lungs expand equally
Breath sounds are present and equalBreath sounds are present and equal
Chest wall expands equally on both sidesChest wall expands equally on both sides
Breathing takes place with little effortBreathing takes place with little effort
Listen forListen for breath soundsbreath sounds at four at four points.points.
MidaxillaryMidaxillaryLineLine
MidclavicularMidclavicularLineLine
2345
Use a Use a stethoscopestethoscope to listen to to listen to
breath sounds.breath sounds.
Tidal volume:Tidal volume:
Amount of air exchanged in Amount of air exchanged in one breath.one breath.
Breathing Breathing DifficultyDifficulty
Breathing Breathing DifficultyDifficulty
Patients who are Patients who are breathingbreathing TOO FASTTOO FAST oror TOO SLOWLYTOO SLOWLY
may not be receiving may not be receiving adequate amounts of adequate amounts of oxygen.oxygen.
Difficulty Breathing Difficulty Breathing GeneralGeneral
Shortness of breathShortness of breath Restlessness or anxietyRestlessness or anxiety Patient position Patient position (preference for sitting up)(preference for sitting up) Altered mental statusAltered mental status Skin cool and/or clammySkin cool and/or clammy Increased or decreased breathing rateIncreased or decreased breathing rate Increased pulse rate Increased pulse rate (increased or decreased in infants and children)(increased or decreased in infants and children)
Difficulty Breathing continued Difficulty Breathing continued VisualVisual
Skin color Skin color (blue-gray, pale, flushed)(blue-gray, pale, flushed) Unusual anatomyUnusual anatomy Retractions/use of accessory musclesRetractions/use of accessory muscles Abdominal breathingAbdominal breathing Nasal flaringNasal flaring
AuditoryAuditory Noisy breathingNoisy breathing Inability to speak due to breathing effortsInability to speak due to breathing efforts CoughingCoughing Irregular breathing rhythmIrregular breathing rhythm Unequal breath soundsUnequal breath sounds
Difficulty Breathing continued Difficulty Breathing continued
Retractions may indicate labored breathing.
SternalSternal
SupraclavicularSupraclavicular
IntercostalIntercostal
SubsternalSubsternal
Nasal Flaring
Stridor:Stridor:
A harsh sound heard during A harsh sound heard during breathing (usually inhalation) that breathing (usually inhalation) that indicates an upper airway indicates an upper airway obstruction.obstruction.
Obstruction may be due to: Swelling Mucous Disease Foreign body
Barrel Chest
Agonal respirations:Agonal respirations:
Gasping respirations that are Gasping respirations that are sudden, short inspirations with sudden, short inspirations with long pauses in between.long pauses in between.
Often occurs just before death - a grave sign!
Focused History and Focused History and Physical Physical
ExaminationExamination
Focused History and Focused History and Physical Physical
ExaminationExamination
O O nsetnset
P P rovocationrovocation
Q Q ualityuality
R R adiationadiation
S S everityeverity
T T imeime
S S ignsigns & symptoms& symptoms
A A llergiesllergies
M M edicationsedications
P P ertinentertinent medical historymedical history
L L astast oral intakeoral intake
E E ventsvents leading to illnessleading to illness
Emergency Medical Emergency Medical CareCareEmergency Medical Emergency Medical CareCare
OxygenOxygen
Use a Use a NRB NRB
maskmask at 15 at 15
L/minute.L/minute.
Ventilate as necessary.
OxygenOxygen is theis the most most
importantimportant
medicationmedication you can you can
give a patient in give a patient in
respiratory respiratory
distress!distress!
Position and Position and TransportTransport
Position and Position and TransportTransport
Patients should be Patients should be
transported in a transported in a
position position THEY THEY
find most find most
comfortable.comfortable.
Artificial Artificial VentilationVentilationArtificial Artificial
VentilationVentilation
Mouth-to-maskMouth-to-mask VentilationVentilation
Two-personTwo-person BVM BVM TechniqueTechnique
One-personOne-person BVM BVM TechniqueTechnique
InhalersInhalersInhalersInhalers
Typical Inhaler Devices
Most inhalers (metered-
dose inhalers) administer a
medication belonging to a
class of drugs known as
beta-agonist
bronchodilators.
Inhaler Medications Inhaler Medications Trade NameTrade Name Generic NameGeneric Name
ProventilProventil albuterolalbuterol
VentolinVentolin albuterol albuterol
BronkosolBronkosol isoetharineisoetharine
AlupentAlupent metaproterenolmetaproterenol
BrethineBrethine terbutalineterbutaline
MetaprelMetaprel metaproterenolmetaproterenol
AtroventAtrovent ipatropium bromideipatropium bromide
Indications for an Inhaler Indications for an Inhaler Signs and symptoms of respiratory distressSigns and symptoms of respiratory distress
Patient has own physician-prescribed inhalerPatient has own physician-prescribed inhaler
Authorization to aid patients in inhaled medications Authorization to aid patients in inhaled medications On-line or off-line medical directionOn-line or off-line medical direction
Contraindications for an Inhaler Contraindications for an Inhaler
Disoriented patientsDisoriented patients
Medications prescribed for Medications prescribed for someone elsesomeone else
Situations with lack of approval Situations with lack of approval (medical direction)(medical direction)
Patient has already taken maximum recommended dosePatient has already taken maximum recommended dose
Have patient Have patient inhale deeplyinhale deeply and and hold breath.hold breath.
Inhaler with a SpacerInhaler with a Spacer
Assisting with an Inhaler Assisting with an Inhaler
Check inhaler’s expiration dateCheck inhaler’s expiration date
Ask if any doses have already been takenAsk if any doses have already been taken Compare with prescribed dosageCompare with prescribed dosage
Make sure inhaler is at room temperatureMake sure inhaler is at room temperature
Shake inhaler vigorously several timesShake inhaler vigorously several times
Remove oxygen mask Remove oxygen mask Nasal cannulas can be left in placeNasal cannulas can be left in place
Assisting with an Inhaler continued Assisting with an Inhaler continued
Have patient place inhaler in mouthHave patient place inhaler in mouth
Have patient inhale slowly and deeply while depressing the inhalerHave patient inhale slowly and deeply while depressing the inhaler
Have patient hold breath for as long Have patient hold breath for as long as comfortableas comfortable
Allow patient to breath a few times, then repeat second dose, if orderedAllow patient to breath a few times, then repeat second dose, if ordered
Record time, dose, medication, vital signs and any changesRecord time, dose, medication, vital signs and any changes
Inhaler Side Effects Inhaler Side Effects Increased heart rateIncreased heart rate
TremorsTremors
NervousnessNervousness
Nausea or vomitingNausea or vomiting
Respiratory DiseasesRespiratory DiseasesRespiratory DiseasesRespiratory Diseases
Obstructive Airway Disease
Obstructive Airway Disease
Emphysema:Emphysema:
An abnormal condition of the lungs An abnormal condition of the lungs characterized by overinflation and characterized by overinflation and destructive changes of the alveoli, destructive changes of the alveoli, resulting in decreased lung resulting in decreased lung elasticity and impaired gas elasticity and impaired gas exchange.exchange.
These patients are sometimes referred to as “pink puffers.”
Chronic bronchitis:Chronic bronchitis:
A chronic condition characterized A chronic condition characterized by excessive mucous secretions by excessive mucous secretions and inflammatory changes in the and inflammatory changes in the bronchial tree.bronchial tree.
These patients are sometimes referred to as “blue bloaters.”
CChronichronic
OObstructivebstructive
PPulmonaryulmonary
DDiseaseisease
Emphysema
Chronic Bronchitis
Asthma:Asthma:
A lung disorder characterized A lung disorder characterized by recurring episodes of by recurring episodes of breathing difficulty, wheezing breathing difficulty, wheezing on exhalation due to on exhalation due to constriction of the bronchi, constriction of the bronchi, coughing, and lung secretions.coughing, and lung secretions.
Pneumonia:Pneumonia:
An infection of the lungs that An infection of the lungs that may be caused by bacteria, may be caused by bacteria, viruses or fungi.viruses or fungi.
Characterized by fever, shortness of breath and a cough.
Hyperventilation:Hyperventilation:
An abnormally high respiratory An abnormally high respiratory rate and depth of breathing.rate and depth of breathing.
CAUTION! Can be caused by anxiety or actual respiratory problems.
Hyperventilation Syndrome Hyperventilation Syndrome
Increased respiratory rateIncreased respiratory rate
Numbness and tingling in hands and feet Numbness and tingling in hands and feet (paresthesias)(paresthesias)
Muscle spasms in fingers and toesMuscle spasms in fingers and toes
Chest pain associated with respirationsChest pain associated with respirations
Anxiety and agitationAnxiety and agitation
SU
MM
AR
YS
UM
MA
RY Respiratory System ReviewRespiratory System Review
Breathing AssessmentBreathing Assessment
Emergency Medical CareEmergency Medical Care
Respiratory DiseasesRespiratory Diseases