1. Chapter 11 Respiratory Emergencies

2. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 2 List the structure and functions of the respiratory system. State the signs and symptoms of a patient with difficulty breathing. Recognize the need for medical direction to assist in the care of breathing difficulty. Objectives (1 of 3)

3. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 3 Describe the care of a patient with breathing distress. Establish the relationship between airway management and breathing difficulty. List signs of adequate air exchange. Objectives (2 of 3)

4. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 4 State the generic name, forms, dose, administration, actions, indications, and contraindications for inhalers. Differentiate between upper airway obstruction and lower airway disease in infants. Objectives (3 of 3)

5. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 5 Respiratory System

6. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 6 Anatomy and Function of the Lung

7. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 7 Characteristics of Poor Breathing Pulmonary vessels become obstructed. Alveoli are damaged. Air passages are obstructed. Blood flow to the lungs is obstructed. Pleural space is filled.

8. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 8 Characteristics of Normal Breathing Normal rate and depth Regular breathing pattern Good breath sounds on both sides of the chest Equal rise and fall of chest Movement of the abdomen

9. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 9 Signs of Abnormal Breathing Slower than 8 breaths/min or faster than 24 breaths/min Muscle retractions Pale or cyanotic skin Cool, damp (clammy) skin Shallow or irregular respirations Pursed lips Nasal flaring

10. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 10 Dyspnea Shortness of breath or difficulty breathing Patient may not be alert enough to complain of shortness of breath.

11. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 11 Upper or Lower Airway Infection Infectious diseases may affect all parts of the airway. The problem is some form of obstruction to the air flow or the exchange of gases.

12. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 12 Acute Pulmonary Edema Fluid build-up in the lungs Signs and symptoms Dyspnea Frothy pink sputum History of chronic congestive heart failure Recurrence high

13. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 13 Chronic Obstructive Pulmonary Disease (COPD) COPD is the result of direct lung and airway damage from repeated infections or inhalation of toxic agents. Bronchitis and emphysema are two common types of COPD. Abnormal breath sounds may be present. Rhonchi and wheezes

14. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 14 Spontaneous Pneumothorax Accumulation of air in the pleural space Caused by trauma or some medical conditions Dyspnea and sharp chest pain on one side Absent or decreased breath sounds on one side

15. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 15 Asthma or Allergic Reactions Asthma is an acute spasm of the bronchioles. Wheezing may be audible without a stethoscope. An allergen can trigger an asthma attack. Asthma and anaphylactic reactions can be similar.

16. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 16 Pleural Effusion Collection of fluid outside lung Causes dyspnea Caused by irritation, infection, or cancer Decreased breath sounds over region of the chest where fluid has moved the lung away from the chest wall Eased if patient is sitting up

17. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 17 Mechanical Obstruction of the Airway Be prepared to treat quickly. Obstruction may result from the position of head, the tongue, aspiration of vomitus, or a foreign body. Opening the airway with the head tilt- chin lift maneuver may solve the problem.

18. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 18 Pulmonary Embolism A blood clot that breaks off and circulates through the venous system Signs and symptoms Dyspnea Acute pleuritic pain Hemoptysis Cyanosis Tachypnea Varying degrees of hypoxia

19. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 19 Hyperventilation Overbreathing resulting in a decrease in the level of carbon dioxide Signs and symptoms Anxiety Numbness A sense of dyspnea despite rapid breathing Dizziness Tingling in hands and feet

20. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 20 Treatment of Dyspnea Perform initial assessment. Place the patient on oxygen. If patient is in respiratory distress, ventilate. Check pulse.

21. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 21 Signs and Symptoms (1 of 2) Difficulty breathing Anxiety or restlessness Decreased respirations Cyanosis Abnormal breath sounds Difficulty speaking Accessory muscles

22. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 22 Signs and Symptoms (2 of 2) Altered mental status Coughing Irregular breathing rhythm Tripod position Barrel chest Pale conjunctivae Increased pulse and respirations

23. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 23 Emergency Medical Care Give supplemental oxygen at 10 to 15 L/min via nonrebreathing mask. Patients with longstanding COPD may be started on low-flow oxygen (2 L/min). Assist with inhaler if available. Consult medical control.

24. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 24 Medications in MOI Trade names Proventil Ventolin Alupent Metaprel Brethine Generic names Albuterol Metaproterenol Terbutaline

25. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 25 Prescribed Inhalers Actions Relax the muscles surrounding the bronchioles Enlarge the airways leading to easier passage of air Side effects Increased pulse rate Nervousness Muscle tremors

26. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 26 Prior to Administration Read label carefully. Verify it has been prescribed by a physician for this patient. Consult medical control. Make sure the medication is indicated. Check for contraindications.

27. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 27 Contraindications for MDI Patient unable to help coordinate inhalation Inhaler not prescribed for patient No permission from medical control Maximum dose prescribed has been taken.

28. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 28 Administration of MDI (1 of 3) Obtain order from medical control or local protocol. Check for right medication, right patient, right route. Make sure the patient is alert. Check the expiration date. Check how many doses have been taken.

29. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 29 Administration of MDI (2 of 3) Make sure inhaler is at room temperature or warmer. Shake inhaler. Stop administration of oxygen. Ask the patient to exhale deeply and put lips around opening. If the inhaler has a spacer, use it.

30. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 30 Administration of MDI (3 of 3) Have the patient depress the inhaler and inhale deeply. Instruct the patient to hold his or her breath. Continue administration of oxygen. Allow the patient to breathe a few times then repeat dose according to protocol.

31. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 31 Reassessment Carefully watch for shortness of breath. 5 minutes after administration: Obtain vital signs again. Perform focused reassessment. Transport and continue to assess breathing.

32. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 32 Upper or Lower Airway Infection Administer warm, humidified oxygen. Do not attempt to suction the airway or insert an oropharyngeal airway in a patient with suspected epiglottitis. Transport patient in position of comfort.

33. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 33 Acute Pulmonary Edema Administer 100% oxygen. Suction secretions. Transport in position of comfort.

34. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 34 Chronic Obstructive Pulmonary Disease (COPD) Assist with prescribed inhaler if patient has one. Transport promptly in position of comfort.

35. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 35 Spontaneous Pneumothorax Administer oxygen. Transport in position of comfort. Monitor closely.

36. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 36 Asthma or Allergic Reactions Obtain history. Assess vitals signs. Assist with inhaler if patient has one. Administer oxygen. Transport promptly.

37. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 37 Pleural Effusion Definitive treatment is performed in a hospital. Administer oxygen and support measures. Transport promptly.

38. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 38 Mechanical Obstruction of the Airway Clear airway. Administer oxygen. Transport promptly.

39. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 39 Pulmonary Embolism Administer oxygen. Place patient in comfortable position, usually sitting. Assist breathing as necessary. Keep airway clear. Transport promptly.

40. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 40 Hyperventilation Complete initial assessment and history of the event. Assume underlying problems. Do not have patient breathe into a paper bag. Give oxygen. Reassure patient and transport.

41. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 41 Geriatric Needs Aging alters respiratory system. Older patients are at risk for lung diseases. They may need ventilatory support.

42. 11: Respiratory Emergencies Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS 42 Pediatric Needs Asthma is common in childhood. Cyanosis is a late finding. Treatment is the same as for an adult.