Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson

Copyright ©2012 by Pearson Education, Inc.All rights reserved.

Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson

Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley

CHAPTERCHAPTER

Caring for Respiratory EmergenciesCaring for Respiratory Emergencies

1414




1. Review respiratory anatomy and physiology in Chapter 4.

2. Define the following terms:a. Accessory muscles b. Asthmac. Bronchitis d. Chronic Obstructive Pulmonary Disease

(COPD)e. Cyanosis f. Dyspneag. Emphysemah. Hypercarbia

(continued)




2. Define the following terms:i. Hyperventilationj. Hypoxiak. Respiratory compromisel. Respiratory distressm. Respiratory failure n. Tripod position o. Wheezing

(continued)




3. Explain common causes of respiratory compromise.

4. Describe the signs and symptoms of a patient experiencing respiratory compromise.

5. Explain the pathophysiology of respiratory compromise.

6. Describe the appropriate assessment and care for a patient experiencing respiratory compromise.

(continued)




7. Demonstrate the ability to appropriately assess and care for a patient experiencing respiratory compromise.

8. Recognize the fear that a respiratory emergency can cause.

9. Value the importance of reassurance when caring for a patient with a respiratory emergency.




MediaMedia

Slide 19Asthma VideoSlide 20Angina VideoSlide 21Chronic Obstructive Pulmonary Disease Video




TopicsTopics

• Overview of Respiratory Anatomy• Respiratory Compromise




OVERVIEW OF RESPIRATORY OVERVIEW OF RESPIRATORY ANATOMYANATOMY




Overview of Respiratory AnatomyOverview of Respiratory Anatomy

• Pathways where air enters body (nose and mouth); areas at back of throat (nasopharynx and oropharynx).

• Oropharynx leads down throat into top of trachea (larynx), where vocal chords are positioned.

(continued)




Overview of the respiratory system.





• Upper airway– All spaces and structures above vocal

chords.

• Lower airway– All structures and spaces below vocal

chords.

• Carina– Where trachea splits into right and left

main stem bronchi.

(continued)





• Bronchioles– Smaller airways.

• Alveoli– Where exchange of oxygen and carbon

dioxide takes place.

• Control center for respiratory is within the brain.

(continued)




Think About ItThink About It

• What two functions does respiration accomplish?

• What mechanical problems might impede the movement of air?




RESPIRATORY COMPROMISERESPIRATORY COMPROMISE




Respiratory CompromiseRespiratory Compromise

• Inability of person to breath adequately.• Hypoxia: when the body's cells do not

receive adequate supply of oxygen. – Signs: altered mental status, pale skin,

cyanosis of nail beds/mucous membranes.

• Hypercarbia: condition of having too much carbon dioxide in blood.





• Respiratory Distress (Dyspnea) – Result of not getting adequate supply of

oxygen; increased in levels of carbon dioxide in blood

– Increased work of breathing– Increased respiratory rate– Use of accessory muscles





• Respiratory Failure – When body's normal compensatory

mechanisms fail.– Breathing rate begins to slow.– Tidal volume begins to get shallower.





• Common causes:– Hyperventilation– Asthma– Chronic bronchitis– Emphysema– Exposure to poison – Allergic reaction




Click here to view a video on the topic of asthma.BACK TO DIRECTORY




Click here to view a video on the topic of angina.BACK TO DIRECTORY




Click here to view a video on the topic of chronic obstructive pulmonary disease.

BACK TO DIRECTORY





• Normal Breathing– Sufficient to support life. – Easy and effortless (adequate).– Do not work hard to breathe. – Able to speak full sentences without having

to catch breath.– Normal respiratory rate, depth, and very

little effort or work of breathing.





• Characteristics of Normal Breathing– Normal rate (number breaths per minute):

12 to 24 for adult; 16 to 32 for child; 24 to 48 for infant.

– Normal depth (size of each breath): tidal volume; normal breaths not too shallow and not too deep.

(continued)





• Characteristics of Normal Breathing– Work of breathing: effort it takes for patient

to move each breath in and out.– Respiratory rhythm regular.





• Abnormal Breathing– Inadequate; not sufficient to support life. – Left untreated, will result in death.– Common signs:

Increased work of breathing Increased respiratory rate

(continued)





• Abnormal Breathing– Common signs:

Decreased respiratory rate Respirations that are too deep or too shallow Irregular breathing rhythm Audible breath sounds (gurgling, snoring or

wheezing)

(continued)





• Abnormal Breathing– Tripod position: seated or standing with

hands on knees, shoulders arched upward, head forward.

– Accessory muscles: muscles of neck, chest, abdomen that assist during respiratory difficulty.




Signs and symptoms of respiratory distress.





• Signs and Symptoms of Respiratory Compromise– Labored or difficulty breathing; a feeling of

suffocation.– Audible breathing sounds.– Rapid or slow rate of breathing.– Abnormal pulse rate (too fast or too slow).

(continued)





• Signs and Symptoms of Respiratory Compromise– Changes in skin color, particularly of lips

and nail beds.– Tripod position.– Altered mental status.





• Chronic Obstructive Pulmonary Disease– Conditions: asthma, chronic bronchitis,

emphysema– Signs and symptoms:

History of heavy cigarette smoking Persistent cough Chronic shortness of breath Pursed-lip breathing

(continued)





• Chronic Obstructive Pulmonary Disease– Signs and symptoms:

Maintaining tripod position Fatigue Tightness in chest Wheezing





• Asthma– Condition affecting lungs, characterized by

narrowing of air passages and wheezing.– Caused by sensitivity to irritants (pollen,

pollutants, exercise).– Narrowing air passages cause wheezing.

(continued)





• Asthma– Signs and symptoms:

Moderate to severe shortness of breath Wheezing Anxiety Nonproductive cough

(continued)




Asthma causes the bronchioles to become narrow and filled with mucus.





• Asthma– Little/no symptoms between attacks.– Medication in metered-dose inhaler.

(continued)




Metered-Dose Inhaler




Metered-Dose Inhaler with Spacer





• Asthma– If left untreated, asthma attack can be

severe enough to cause respiratory arrest and even death.





• Bronchitis– Causes swelling and thickening of walls of

bronchi and bronchioles.– Causes overproduction of mucus in air

passages.– Chronic bronchitis: productive cough for

three consecutive months and occurs at least two consecutive years.

(continued)




Emphysema affects the alveoli, and bronchitis affects the bronchioles.













• Bronchitis– Signs and symptoms:

Overweight Mild to moderate shortness of breath Pale complexion Productive cough Wheezes





• Emphysema– Associated with cigarette smoking; disease

of lungs that causes permanent damage to alveoli.

– Causes destruction of alveoli, making them useless for exchange of oxygen and carbon dioxide.

(continued)





• Emphysema– Loss of lung elasticity and accumulation of

air cause chest wall to become extended over time; “barrel chest.”

(continued)





• Emphysema– Signs and symptoms:

Moderate to severe shortness of breath Very thin in appearance Large chest (barrel chest) Nonproductive cough Extended exhalations





• Hyperventilation Syndrome– Occurs when person breathes out and

eliminates excess amount of carbon dioxide.

– Most cases caused by anxiety and do not represent medical emergency.

(continued)





• Hyperventilation Syndrome– Can be a sign of something serious.– Be alert for cyanosis.– Monitor for changes in vital signs.– Reduce anxiety by reassuring and

comforting patient.

(continued)





• Hyperventilation Syndrome – Signs and symptoms:

Moderate to severe shortness of breath Anxiety Numbness or tingling of fingers, lips, and/or

toes Dizziness Spasm of fingers and/or toes Chest discomfort





• Emergency Care for Respiratory Compromise– Observe body language.– Determine characteristics of breathing.– Pay attention to level of distress and facial

expression.– Reassure patient.

(continued)





• Emergency Care for Respiratory Compromise– Gather a history.– Ability to speak clearly and in full

sentences.– Listen for sounds as patient breathes.





• Take appropriate BSI precautions.• Perform primary assessment; support

ABCs.• Ensure patent airway; administer

oxygen per local protocols.• Allow patient to maintain position of

comfort.• Arrange for ALS response if available.

(continued)





• Assist with prescribed medication per local protocols and medical direction.

• Obtain vital signs.• Continue to monitor patient and provide

reassurance.




Algorithm for emergency care of patients with respiratory distress.





• Positive Pressure Ventilations– Use bag-mask device to provide rescue

breaths when breathing determined to be inadequate.

– Place mask firmly over patient's face; provide rescue breaths at rate appropriate for patient's age.




When breathing is inadequate, provide positive pressure ventilations with a bag-mask device.





• Metered-Dose Inhalers (MDI)– Small device that stores and delivers

medication that patient inhales into lungs.– Encourage patient to take medication

exactly as prescribed.– Check expiration date.




Think About ItThink About It

• You are treating a patient with severe respiratory distress. You notice that his/her respiratory rate is slowing down. Is this a good sign or bad sign?

• How would you tell the difference?• Would your observation warrant

updating the responding ambulance?




SUMMARYSUMMARY




SummarySummary

• Respiratory compromise is one of the most common calls encountered.

• Causes include asthma, bronchitis, emphysema, hyperventilation.

• Characterized by increased work of breathing, increased breathing rate, use of accessory muscles.




SummarySummary

• Left untreated, can lead to respiratory failure; respiratory arrest; death.

• Asthma: disease of the lower airways characterized by spasm and swelling of bronchioles, resulting in narrowing of airways. – Triggered by allergies, dust, stress, and/or

exercise.




SummarySummary

• Bronchitis: inflammation of bronchi and bronchioles.– Results in overproduction of mucus over

inside lining of airways; may last for months at a time.

– Characterized by productive cough.




SummarySummary

• Emphysema: loss of elasticity of lung tissue and destruction of alveoli. – Results in poor gas exchange and trapping

of excess carbon dioxide within lungs. – Slow, progressive disease that results in

severe respiratory distress.




SummarySummary

• Hyperventilation syndrome: associated with situations of high stress or anxiety.– Begins when stress of situation causes

patient to breath fast. – If not controlled, will result in loss of too

much carbon dioxide. – Usually treated by helping patient calm

down and control breathing.




SummarySummary

• Care includes support of ABCs, providing supplemental oxygen, calming and reassuring patient.

• Allow patient to maintain position of comfort and do not force patient to lie down unless unresponsive.




SummarySummary

• Often a true emergency, and rapid transport by ALS ambulance is often most appropriate care.

• If available, encourage patient to self-administer prescribed meter-dose inhaler as prescribed.




REVIEW QUESTIONSREVIEW QUESTIONS




1. What are the common causes of respiratory compromise?

2. What are the signs and symptoms of a patient experiencing respiratory compromise?

3. Why is it important to recognize the fear that a respiratory emergency can cause?

4. What is the appropriate assessment and care for a patient experiencing respiratory compromise?




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Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer OKeefe Grant Murray Bergeron Dickinson