Copyright 2008 Seattle/King County EMS CBT/OTEP 425 Respiratory Emergencies.

Copyright 2008 Seattle/King County EMS

CBT/OTEP 425Respiratory Emergencies


Introduction

This course reviews common This course reviews common disorders that can cause respiratory disorders that can cause respiratory

emergencies and prehospital emergencies and prehospital management of these conditions.management of these conditions.

This course reviews common This course reviews common disorders that can cause respiratory disorders that can cause respiratory

emergencies and prehospital emergencies and prehospital management of these conditions.management of these conditions.

Patients with lung and heart diseases frequently call 9-1-1 because of breathing difficulty


New Terms

hypoxic drive – A condition in which the body's stimulus for taking a breath is low oxygen. Occurs in people with COPD.

metabolism – The process by which food molecules are broken down to provide material and energy for cellular function.

pH (potential of hydrogen) – A measure of the acidity or alkalinity of a solution, numerically equal to 7 for neutral solutions.


New Terms, continued

perfusion – The movement of blood through an organ or tissue in order to supply nutrients and oxygen.

tidal volume – The volume of gas that is moved with each breath which is normally 500 ml in an adult.

ventilation – The rate at which gas enters or leaves the lungs.


Respiratory Structures

Image credit: Copyright 2007 Seattle/King County EMS


Metabolism Produces Carbon Dioxide • Metabolism is process by which body

breaks down or "burns" stored fuel to create energy

• Cells use oxygen to transform stored glucose into energy

• A byproduct of metabolism is carbon dioxide


pH

• Acidity measured by potential of hydrogen

• Body must maintain narrow pH range

• Respiratory system helps maintain a balanced acid level (pH) in blood



pH• If blood pH is too low (acidic), respiratory

system will attempt to fix by making lungs breathe more deeply and rapidly

• Because respiratory system helps regulate carbon dioxide excretion or retention, it is an important mechanism for regulating pH


Hypercarbia A state of excessive carbon dioxide in the body

Hypercarbia can occur through:• Metabolic processes that form acids • Muscle exertion • Shivering


Hypercarbia, continued

• Also can occur through decreased elimination of carbon dioxide:

• Airway obstruction • Inability to exhale fully• Depressed respiratory drive

• Affects chemistry of body causing pH imbalance

• Can be treated by BLS provider by improving ventilation


Metabolic Problems Affect Resp.• Metabolic imbalances affect chemistry of body,

affecting pH • While not a respiratory problem, respiratory

system often tries to compensate by changing depth/rate

• Ketoacidosis • Aspirin overdose • Fever and sepsis


Airway Obstruction

• Severe • Mild


Asthma • Chronic, inflammatory disease of the

airways • Allergens, infection, exercise, smoke • Muscles around bronchioles tighten• Lining of bronchioles swells• Inside of bronchioles fills with thick mucous



Asthma - Treatment

• Calm patient • Airway management • Oxygen therapy • Assist with a prescribed inhaler


COPD• Category of diseases – asthma, emphysema,

and chronic bronchitis • Slow process of dilation and disruption of

airways and alveoli that limit ability to exhale

• Present with history of COPD, shortness of breath, fever, and increased sputum production


COPD - Treatment

• BLS treatment for a COPD patient with respiratory distress should include oxygen therapy (high flow if needed)


Congestive Heart Failure (CHF)• Fluid in lungs makes it difficult to get

air in • Present sitting up, short of breath,

diaphoretic, and pale or cyanotic • Meds/Hx can help differentiate from

COPD


CHF - Treatment

• Seat upright• Administer high flow oxygen (NRM)• Consider positive pressure

ventilation with BVM if needed


Inhalation Injuries

• Chemicals, smoke, or other substances

• Shortness of breath, coughing, hoarseness, chest pain due to bronchial irritation, and nausea

• Treat with high flow oxygen


Pneumonia

• Fever, chills, cough, yellowish sputum, shortness of breath, general discomfort, fatigue, loss of appetite, and headache

• Treat with oxygen


Pneumothorax

• Presence of air in pleural space• Wound allows air to enter space

between pleural tissues, leads to collapse lung




Pulmonary Embolism• Blood clot, fat embolus, amniotic fluid embolus,

or air bubble gets loose in blood stream and travels to lungs

• Wound allows air to enter space between pleural tissues

• Lodges in major branch of pulmonary artery and lung circulation is interrupted



Pulmonary Embolism, continued

• Caused by immobility of lower extremities, prolonged bed rest, or recent surgery

• Signs include sudden-onset of SOB, tachypnea, chest pain worsened by breathing and coughing up blood

• Treat with high flow oxygen and rapid transport• Be gentle in moving patient


Assessment

• Rate and depth of respirations• Together rate and depth will tell you

whether tidal volume is adequate


Auscultation of Breath Sounds• Listen at six locations on back (medical pt.)• Listen at four locations on front • Instruct patient to take deep breath through

mouth then exhale • Listen to one or two inspiration/expiration

cycles per location • Avoid listening through clothing


Airway Management• Head tilt/chin lift• Jaw thrust• Patient positioning• Airway adjuncts• Suction• Oxygen therapy• Assisted ventilation• Relief of foreign body airway obstruction


Suction• Measure tip from corner of mouth to earlobe • Oxygenate patient well (if situation permits)• Insert tip into oral cavity without applying

suction• Move suction tip side–to-side• Oxygenate well after suctioning


Assisted VentilationUnconscious breathing patient:• Consider need for oropharyngeal airway• Do not over-ventilate• Keep the airway open• Maintain a good seal• Apply Sellick maneuver to help reduce

airflow into stomach


Assisted VentilationNon-breathing patient:• Deliver a ventilation of 1-second duration • Deliver enough volume to make chest

rise • 12 ventilations/min• 8-10 ventilations/min if an advanced

airway is in place


Summary

Main structures of the respiratory system:

• Pharynx • Bronchi• Trachea • Bronchioles• Epiglottis • Larynx• Alveoli • Pleura• Diaphragm


Summary, continued

• Respiratory system is an important mechanism for regulating pH in the body

• If respiration is impaired, carbon dioxide builds up in the blood (hypercarbia) and producing an acid

• BLS providers can help treat this condition by improving ventilation


Summary, continued

• Signs of severe airway obstruction include poor air exchange and increased breathing difficulty

• COPD-related emergency may present with shortness of breath, fever, and increased sputum production

• CHF signs include acute onset of breathing difficulty, diaphoresis, and cyanosis


Summary, continued

• Pneumothorax can cause sharp chest pain and SOB

• Signs of pulmonary embolism include sudden onset of SOB, tachypnea, chest pain worsened by breathing, coughing up blood

• Treatment for respiratory emergency can include high flow oxygen and/or assisted ventilations

• CHF patients may require positive-pressure ventilations


Summary, continued

Auscultating the chest: • Listen at six locations on back (medical

pt.)• Listen at four locations on front • Move from bottom to top in medical pt • Instruct pt to take a deep breath

through mouth then exhale • Listen to one or two

inspiration/expiration cycles • Avoid listening through clothing


Summary, continued

Guidelines for use of suction:• Measure tip from corner of mouth to

earlobe • Oxygenate patient well, if situation permits• Insert tip into oral cavity without applying

suction• Suction of the way out• Move suction tip side to side• Oxygenate well after suctioning


Summary, continued

Ventilating unconscious breathing patient:

• Consider oropharyngeal airway• Do not over ventilate• Keep airway open• Maintain good seal• Apply Sellick maneuver to reduce

airflow into stomach

Copyright 2008 Seattle/King County EMS CBT/OTEP 425 Respiratory Emergencies.

Documents

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seattleking county ems

ph slide

carbon dioxide slide

ventilation slide

sepsis slide

respiratory system

blood ph