RESPIRATORY EMERGENCIES An Introduction

Nose/mouth – pharynx/oropharynx – Larynx – Trachea – Bronchi – Bronchioles – Lungs- Alveoli

The intercostal muscles and the diaphragm contract, increasing the size of the thoracic cavity. The diaphragm moves slightly downward, the ribs move upward/outward and air flows into the lungs Inhalation Exhalation is the reverse ALL IS NORMAL BASED ON………

Tidal Volume The amount of air moved into or out of the lungs in a single breath Normal is 500 ml

Minute Volume The amount of air moved in or out of the lungs in one minute minus dead space mV= RR x vT – dead space (150) ml

Normal Minute Volume 12bpm x 500 mL – 150 mL/bpm dead space= 5850mL/minute

Rate Rhythm Quality Depth 12-20 regular breath adequate sounds Skin is warm/pink/dry

INADEQUATE BREATHING Respiratory Distress Respiratory Failure Respiratory Arrest

Inadequate Breathing Defined DELETE NOTE

Signs of Inadequate Breathing DELETE NOTES

Respiratory Distress DELETE NOTE

Respiratory Failure DELETE NOTE

Respiratory Arrest

12-20 Regular Depth (minute volume) Patient Assessment Rate Rhythm Quality 12-20 Regular Depth (minute volume) None Too Fast Too Slow

Oxygen Therapy Nasal Canulae Non-Rebreather

Oxygen Therapy (administration) Examples requiring O2 administration: Respiratory or cardiac arrest Heart attack Stroke Shock Blood loss Lung disease Broken bones Head injuries

Hypoxia Deprivation of adequate supply of oxygen

Breathing Difficulties Signs and Symptoms Shortness of breath Tightness in the chest Restlessness Increased pulse rate Decreased pulse rate (especially in infants and children) Changes in breathing rate/rhythm

Pale, cyanotic or flushed skin Noisy breathing Inability to speak in full sentences Use of accessory muscles Retractions AMS Coughing Flared nostrils; pursed lips Positioning Barrel chest

Respiratory Conditions COPD Emphysema Chronic Bronchitis Black Lung CHF Hypoxic Drive NEVER WITHHOLD OXYGEN

Pulmonary Edema Abnormal collection of fluid in the alveoli Left-sided heart failure orthopnia

Asthma Seen in young and old alike Episodic disease May be triggered by an allergic reaction

When an attack occurs Small bronchioles become narrow Overproduction of thick mucus Small passages practically shut down Flow restricted in one direction Expiratory wheezes Air is trapped in the lungs

Assisting with the Inhaler The drug is in the form of a fine powder that become active when comes in contact with lung tissue Calm your patient Administration check list Right patient Right medication Right dose Right route Check expiration date

Shake inhaler vigorously several times Make sure patient is alert enough to properly use Make sure patient exhales deeply Inhale deeply as Inhaler is administered Hold breath as long as possible

CPAP Continuous Positive Airway Pressure Forcing air or oxygen into the lungs when a patient has inadequate breathing Relatively low pressures are used

Indications CHF Pulmonary Edema Effects Prevents the alveoli from collapsing at the end of exhalation Push fluid out of the alveoli back into the capillaries

Contraindications Anatomic-physiologic Depressed mental status; patient cannot protect the airway or cannot follow instructions Lack of normal, spontaneous respiratory rate; CPAP does not increase respiratory rate Inability to sit up Inability to get and maintain a good mask seal

Pathologic contraindications Nausea and vomiting Penetrating chest trauma Shock Upper GI bleed Recent gastric surgery Inadequate mask seal; malformation, burns,trauma

Other contraindications to consider Claustrophobia Cannot tolerate History of inability to use CPAP Secretions requiring frequent suctioning History of pulmonary fibrosis

Hypotension CPAP provides a constant pressure throughout the respiratory cycle hampering venous return During normal inspiration pressure is decreased enough to allow blood to return to the heart B/P should be monitored frequently and should be >90/systolic