1. RESPIRATORY EMERGENCIES An Introduction

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

3. 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………

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

5. Minute Volume 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

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

7. RateRhythmQualityDepth 12-20regularbreath adequate sounds Skin is warm/pink/dry

8. INADEQUATE BREATHING Respiratory Distress Respiratory Distress Respiratory Failure Respiratory Failure Respiratory Arrest Respiratory Arrest

9. Inadequate Breathing Defined

10. Signs of Inadequate Breathing

11. Respiratory Distress

12. Respiratory Failure Respiratory Failure

13. Respiratory Arrest Respiratory Arrest

14. Patient Assessment RateRhythm Quality 12-20RegularDepth (minute volume) None Too Fast Too Slow

15. Oxygen Therapy Oxygen Therapy Nasal Canulae Non-Rebreather

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

17. Hypoxia Hypoxia Deprivation of adequate supply of oxygen

18. 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

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

20. Respiratory Conditions COPD COPDEmphysema Chronic Bronchitis Black Lung CHF CHF Hypoxic Drive NEVER WITHHOLD OXYGEN

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

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

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

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

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

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

27. 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

28. Contraindications Anatomic-physiologic 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

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

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

31. Hypotension Hypotension CPAP provides a constant pressure throughout the respiratory cycle hampering venous return 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 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 B/P should be monitored frequently and should be >90/systolic