1. Breathing Difficulties

2. Asthma

3. 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

4. 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.

5. 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.

6. 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.

7. 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.

8. Asthma

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

10. Chronic Obstructive Pulmonary Disease

11. 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.

12. 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.

13. 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

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

15. 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.

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

17. 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

18. Croup

19. 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.

20. croup

21. croup

22. 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.

23. 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.

24. 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

25. 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.

26. Any Questions?