Respiratory Emergencies CHAPTER 17. Anyone who has experienced respiratory difficulty knows that the inability to breathe is TERRIFYING!

Respiratory Respiratory EmergenciesEmergencies

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Anyone who has

experienced respiratory

difficulty knows that the

inability to breathe is

TERRIFYING!

Respiratory System Respiratory System ReviewReviewRespiratory System Respiratory System ReviewReview

AnatomyAnatomy

Respiratory System Anatomy

The Upper Airway

NasopharynxNasopharynx

OropharynxOropharynx

EpiglottisEpiglottis

Vocal cordsVocal cords

TracheaTrachea

The Lower Airway

UpperUpperlobelobe

MiddleMiddlelobelobe

LowerLowerlobelobe

TracheaTrachea

Due to their

anatomy,

Infants and

children are

more prone

to

respiratory

emergencies

.

Adult (20 mm)

Infant(4

mm)

PhysiologyPhysiologyPhysiologyPhysiology

BreathingBreathingInhalationInhalation ExhalationExhalation

Chest Chest contractscontracts

Chest Chest relaxesrelaxes

Alveolar/capillary Alveolar/capillary interfaceinterface

Cellular/capillary Cellular/capillary interfaceinterface

Alveolus

Body cells

Gas ExchangeGas Exchange

Blood

Blood

Capillary

Breathing AssessmentBreathing AssessmentBreathing AssessmentBreathing Assessment

Adequate BreathingAdequate Breathing

Normal Respiratory Rates Normal Respiratory Rates

Adult:Adult: 12 - 20/minute12 - 20/minute

Children:Children: 15 - 30/minute15 - 30/minute

Infants:Infants: 25 - 50/minute25 - 50/minute

Normal Breathing Normal Breathing Both lungs expand equallyBoth lungs expand equally

Breath sounds are present and equalBreath sounds are present and equal

Chest wall expands equally on both sidesChest wall expands equally on both sides

Breathing takes place with little effortBreathing takes place with little effort

Listen forListen for breath soundsbreath sounds at four at four points.points.

MidaxillaryMidaxillaryLineLine

MidclavicularMidclavicularLineLine

2345

Use a Use a stethoscopestethoscope to listen to to listen to

breath sounds.breath sounds.

Tidal volume:Tidal volume:

Amount of air exchanged in Amount of air exchanged in one breath.one breath.

Breathing Breathing DifficultyDifficulty

Breathing Breathing DifficultyDifficulty

Patients who are Patients who are breathingbreathing TOO FASTTOO FAST oror TOO SLOWLYTOO SLOWLY

may not be receiving may not be receiving adequate amounts of adequate amounts of oxygen.oxygen.

Difficulty Breathing Difficulty Breathing GeneralGeneral

Shortness of breathShortness of breath Restlessness or anxietyRestlessness or anxiety Patient position Patient position (preference for sitting up)(preference for sitting up) Altered mental statusAltered mental status Skin cool and/or clammySkin cool and/or clammy Increased or decreased breathing rateIncreased or decreased breathing rate Increased pulse rate Increased pulse rate (increased or decreased in infants and children)(increased or decreased in infants and children)

Difficulty Breathing continued Difficulty Breathing continued VisualVisual

Skin color Skin color (blue-gray, pale, flushed)(blue-gray, pale, flushed) Unusual anatomyUnusual anatomy Retractions/use of accessory musclesRetractions/use of accessory muscles Abdominal breathingAbdominal breathing Nasal flaringNasal flaring

AuditoryAuditory Noisy breathingNoisy breathing Inability to speak due to breathing effortsInability to speak due to breathing efforts CoughingCoughing Irregular breathing rhythmIrregular breathing rhythm Unequal breath soundsUnequal breath sounds

Difficulty Breathing continued Difficulty Breathing continued

Retractions may indicate labored breathing.

SternalSternal

SupraclavicularSupraclavicular

IntercostalIntercostal

SubsternalSubsternal

Nasal Flaring

Stridor:Stridor:

A harsh sound heard during A harsh sound heard during breathing (usually inhalation) that breathing (usually inhalation) that indicates an upper airway indicates an upper airway obstruction.obstruction.

Obstruction may be due to: Swelling Mucous Disease Foreign body

Barrel Chest

Agonal respirations:Agonal respirations:

Gasping respirations that are Gasping respirations that are sudden, short inspirations with sudden, short inspirations with long pauses in between.long pauses in between.

Often occurs just before death - a grave sign!

Focused History and Focused History and Physical Physical

ExaminationExamination

Focused History and Focused History and Physical Physical

ExaminationExamination

O O nsetnset

P P rovocationrovocation

Q Q ualityuality

R R adiationadiation

S S everityeverity

T T imeime

S S ignsigns & symptoms& symptoms

A A llergiesllergies

M M edicationsedications

P P ertinentertinent medical historymedical history

L L astast oral intakeoral intake

E E ventsvents leading to illnessleading to illness

Emergency Medical Emergency Medical CareCareEmergency Medical Emergency Medical CareCare

OxygenOxygen

Use a Use a NRB NRB

maskmask at 15 at 15

L/minute.L/minute.

Ventilate as necessary.

OxygenOxygen is theis the most most

importantimportant

medicationmedication you can you can

give a patient in give a patient in

respiratory respiratory

distress!distress!

Position and Position and TransportTransport

Position and Position and TransportTransport

Patients should be Patients should be

transported in a transported in a

position position THEY THEY

find most find most

comfortable.comfortable.

Artificial Artificial VentilationVentilationArtificial Artificial

VentilationVentilation

Mouth-to-maskMouth-to-mask VentilationVentilation

Two-personTwo-person BVM BVM TechniqueTechnique

One-personOne-person BVM BVM TechniqueTechnique

InhalersInhalersInhalersInhalers

Typical Inhaler Devices

Most inhalers (metered-

dose inhalers) administer a

medication belonging to a

class of drugs known as

beta-agonist

bronchodilators.

Inhaler Medications Inhaler Medications Trade NameTrade Name Generic NameGeneric Name

ProventilProventil albuterolalbuterol

VentolinVentolin albuterol albuterol

BronkosolBronkosol isoetharineisoetharine

AlupentAlupent metaproterenolmetaproterenol

BrethineBrethine terbutalineterbutaline

MetaprelMetaprel metaproterenolmetaproterenol

AtroventAtrovent ipatropium bromideipatropium bromide

Indications for an Inhaler Indications for an Inhaler Signs and symptoms of respiratory distressSigns and symptoms of respiratory distress

Patient has own physician-prescribed inhalerPatient has own physician-prescribed inhaler

Authorization to aid patients in inhaled medications Authorization to aid patients in inhaled medications On-line or off-line medical directionOn-line or off-line medical direction

Contraindications for an Inhaler Contraindications for an Inhaler

Disoriented patientsDisoriented patients

Medications prescribed for Medications prescribed for someone elsesomeone else

Situations with lack of approval Situations with lack of approval (medical direction)(medical direction)

Patient has already taken maximum recommended dosePatient has already taken maximum recommended dose

Have patient Have patient inhale deeplyinhale deeply and and hold breath.hold breath.

Inhaler with a SpacerInhaler with a Spacer

Assisting with an Inhaler Assisting with an Inhaler

Check inhaler’s expiration dateCheck inhaler’s expiration date

Ask if any doses have already been takenAsk if any doses have already been taken Compare with prescribed dosageCompare with prescribed dosage

Make sure inhaler is at room temperatureMake sure inhaler is at room temperature

Shake inhaler vigorously several timesShake inhaler vigorously several times

Remove oxygen mask Remove oxygen mask Nasal cannulas can be left in placeNasal cannulas can be left in place

Assisting with an Inhaler continued Assisting with an Inhaler continued

Have patient place inhaler in mouthHave patient place inhaler in mouth

Have patient inhale slowly and deeply while depressing the inhalerHave patient inhale slowly and deeply while depressing the inhaler

Have patient hold breath for as long Have patient hold breath for as long as comfortableas comfortable

Allow patient to breath a few times, then repeat second dose, if orderedAllow patient to breath a few times, then repeat second dose, if ordered

Record time, dose, medication, vital signs and any changesRecord time, dose, medication, vital signs and any changes

Inhaler Side Effects Inhaler Side Effects Increased heart rateIncreased heart rate

TremorsTremors

NervousnessNervousness

Nausea or vomitingNausea or vomiting

Respiratory DiseasesRespiratory DiseasesRespiratory DiseasesRespiratory Diseases

Obstructive Airway Disease

Obstructive Airway Disease

Emphysema:Emphysema:

An abnormal condition of the lungs An abnormal condition of the lungs characterized by overinflation and characterized by overinflation and destructive changes of the alveoli, destructive changes of the alveoli, resulting in decreased lung resulting in decreased lung elasticity and impaired gas elasticity and impaired gas exchange.exchange.

These patients are sometimes referred to as “pink puffers.”

Chronic bronchitis:Chronic bronchitis:

A chronic condition characterized A chronic condition characterized by excessive mucous secretions by excessive mucous secretions and inflammatory changes in the and inflammatory changes in the bronchial tree.bronchial tree.

These patients are sometimes referred to as “blue bloaters.”

CChronichronic

OObstructivebstructive

PPulmonaryulmonary

DDiseaseisease

Emphysema

Chronic Bronchitis

Asthma:Asthma:

A lung disorder characterized A lung disorder characterized by recurring episodes of by recurring episodes of breathing difficulty, wheezing breathing difficulty, wheezing on exhalation due to on exhalation due to constriction of the bronchi, constriction of the bronchi, coughing, and lung secretions.coughing, and lung secretions.

Pneumonia:Pneumonia:

An infection of the lungs that An infection of the lungs that may be caused by bacteria, may be caused by bacteria, viruses or fungi.viruses or fungi.

Characterized by fever, shortness of breath and a cough.

Hyperventilation:Hyperventilation:

An abnormally high respiratory An abnormally high respiratory rate and depth of breathing.rate and depth of breathing.

CAUTION! Can be caused by anxiety or actual respiratory problems.

Hyperventilation Syndrome Hyperventilation Syndrome

Increased respiratory rateIncreased respiratory rate

Numbness and tingling in hands and feet Numbness and tingling in hands and feet (paresthesias)(paresthesias)

Muscle spasms in fingers and toesMuscle spasms in fingers and toes

Chest pain associated with respirationsChest pain associated with respirations

Anxiety and agitationAnxiety and agitation

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RY Respiratory System ReviewRespiratory System Review

Breathing AssessmentBreathing Assessment

Emergency Medical CareEmergency Medical Care

Respiratory DiseasesRespiratory Diseases