Breathing Difficulties

Asthma

Moderate Acute Life Threatening Asthma Wheeze Shortness of breath Able to complete sentences in one breath Respiratory rate <25breaths/min Heart rate <110beats/min Acute respiratory rate >25breaths/min Pulse >110beats/min Inability to complete sentences in one breath Life Threatening Silent chest Poor respiratory effort Exhaustion Cyanosis Arrhythmia Hypotension

Asthma Types of inhalers Reliever inhaler (short-acting) - usually blue and is “on-the-spot” treatment to give relief from asthma symptoms and asthma attacks. Preventer inhalers- used everyday as prescribed. Airways will be less sensitive, which means the patient will be less likely to react to their usual asthma trigger. There are 3 forms of inhalers they are: metered dose inhalers- which give the medicine in a spray form. These can be used with a spacer. ( shown by picture blue inhaler above) Breath activated inhalers - which automatically releases a spay of medicine when they begin to inhale ( shown by picture brown inhaler above) Dry power inhaler- it releases dry power in stead of a spay ( shown by both pictures in next PowerPoint) they can also come in granules and spoon feed and absorbed into their system. When taking the reliever they must hold their breath for a few seconds ideally 10, other wise they will just be blowing the medicine straight out.

Asthma Combination inhalers- combines two kinds of asthma medicine, a long-acting reliever to reliever ongoing symptoms and a preventer to protect there airway from inflammation. Long-acting reliever inhaler-used as an add-on therapy alongside their preventer and reliever inhalers to make it more easier to breath. Also mention that there is a non-steroidal inhaler which is a alternatives to a considered to be less effective preventer therapies but may be of value in treating allergic asthma.

Asthma There are a lot of different colours, as these will have a different active ingredient and strength. But they will all treat the same thing. They may even look the same but they could be a different strength. This is why we do NOT use anyone else's medication even if it is an emergency.

Asthma Spacers- usually used by babies and children although some adults will also use them and the spacer will help them all to get the right dose of medication. This is because they may not be able to use the inhalers properly or ever like the taste/feel of the spay or powder in their mouth so will breath it out straight away. If they breath the medicine out straight away it will not have any affect on their symptom’s making things worse. the way the spacers are used is to push the medicine in to the spacers and the person/ child will breath in and out a few times at the other end and each time they breath in they will be breathing in the medicine. There are two types one with a mouth piece that they place inside the mouth and breath in and out through as shown above. The other has a face mask which is placed over the face.

Asthma

Asthma Treatment : Plenty of reassurance Upright position Don’t crowd Inhaler (if available) High-flow Oxygen Request backup Monitor (pulse, breathing) SAMPLE

Chronic Obstructive Pulmonary Disease

COPD Acute Chronic Is a condition that happen suddenly and is not persistent. The onset may occur immediately or over several hours Is a long-term condition and develops gradually and worsens over an extended period of time Acute= could be describe as anything from a broken bone to an asthma attack Chronic = could be describe as an condition such as osteoporosis or asthma and COPD.

Chronic bronchitis (Blue bloater) Emphysema (pink puffer) COPD Chronic bronchitis (Blue bloater) Emphysema (pink puffer) Cigarette smoking, occupational exposure and/or recurrent bronchial infections lead to inflammation that narrows the airways and an increase in mucus secretion coupled with inhibition of the cilia, which leads to an accumulation of secretion and bronchoconstriction due to irritant receptor activation, which also causes the chronic productive cough. In emphysema, the walls of the alveoli are destroyed by enzymes called proteases. These are usually kept under control by another group of enzymes imaginatively called anti-proteases. Once the balance is upset destruction of the alveoli occurs, leading to collapse of the airways, resulting in obstruction.

COPD Chronic bronchitis Emphysema Also know as Blue bloater Pink puffer Hyperinflated chest Yes Body size Obese Thin Cyanosis Yes, centrally No Blood level of CO2 High Low

Symptoms COPD Increased dyspnoea Increased cough Increased wheeze Reduced exercise tolerance Fluid retention Increased fatigue Acute confusion

COPD Treatment : Oxygen using the venturi mask(28%) @ 4L/min Inhalers if they have any Plenty of reassurance Sit them in an upright position Request back up Sample Make the class aware that the nasal cannula will not help during exacerbation so if the patient is already wearing one it will have to be removed and replaced by the venturi mask (28%) and that means then filling out a PCR form.

Hypoxic Drive – Signs: Lethargy Drowsiness Slowing of breathing rate COPD Hypoxic Drive – Signs: Lethargy Drowsiness Slowing of breathing rate Unconscious Arrest

Hypoxic Drive management: COPD Hypoxic Drive management: Call 999 Make the patient safe Remove the oxygen ( if was placed on it by you) Change the flow rate back to their normal flow (if you changed it including the mask they where precisely wearing) Monitor Be prepared for unconsciousness Be prepared for arrest

Croup

Croup Croup also know as lardngotracheobronhitis, is a type of respiratory infection that can be caused by several viruses which affect the airways to the lungs (the bronchi), windpipe (trachea) and the voice box (larynx). Causing them to swell and become narrower. Which interferes with normal breathing. It usually affects babies and young children. Some children can have croup two or more times in the childhood. It is most common in autumn and winter. As children become older their breathing tubes become firmer and wider, so croup is uncommon after the age of six. Croup will usually gets better on its own within 48hrs.

croup

croup

Symptoms: Cold-like symptoms A barking cough which sounds like a seal. Croup Cold-like symptoms A barking cough which sounds like a seal. A hoarse voice Difficulty breathing A rasping sound when breathing in. Symptoms: Cold-like symptoms would be temperature, runny nose and a cough. The child will have cold-like symptoms first. Croup symptoms usually come on after a few days and are often worse at night.

Treatment: Stay calm Sit the child upright Comfort them if distressed Croup Treatment: Stay calm Sit the child upright Comfort them if distressed Give them plenty of fluid Go into a steamed room (if possible or practical) DO NOT give them cough or cold medicines Keeping the child calm will help as the crying will make the symptoms worse. The reason they should not be given cough medicine is because these will dry the mucus making the airways even smaller.

Symptoms: Sever croup which will need emergency treatment breathing becomes more difficult for the child They are very pale or blue Child becomes agitated, delirious or restless Their breast bone is drawn back on breathing They have a very high temperature and is drooling The child is severely agitated alongside respiratory distress. Sever croup which will need emergency treatment

Treatment: Call 999 Keep the child as calm as possible Croup Call 999 Keep the child as calm as possible if they have a high temperature try and cool them down Give oxygen if they are really struggling. Not under 1yrs keep monitoring them. Treatment: The reason we need to keep the child calm is the crying will make the symptoms worse. Also trying to cool them down is a good thing as if you don’t this could lead to febrile convulsion’s.

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