First Aid: Respiratory Emeregencies

Respiratory Emergencies

Anas Bahnassi PhD

8

Anas Bahnassi PhD CDM CDE 2

Respiratory System:

3 Anas Bahnassi PhD CDM CDE

• Each bronchus then divides again forming the bronchial tubes. These divide into many smaller tubes which connect to tiny sacs called alveoli.

• The inhaled oxygen passes into the alveoli and then diffuses through the capillaries into the arterial blood.

• The waste-rich blood from the veins releases its carbon dioxide into the alveoli.

• The primary function of the respiratory system is to supply the blood with oxygen in order for the blood to deliver oxygen to all parts of the body.

• Respiration is achieved through the mouth, nose, trachea, lungs, and diaphragm.

• Oxygen enters through the mouth and the nose. • The oxygen then passes through the larynx and the

trachea which is a tube that enters the chest cavity. • The trachea splits into two smaller tubes called the

bronchi.

Respiratory System:


Adequate Breathing Rates:

o Adults o Children o Infant

12-20/min. 15-30/min. 25-50/min.

Adequate breathing:

o Usually regular rhythm

o Rhythm may be slightly irregular influenced by talking

o Breath sounds are present and equal.

o Chest expansion is adequate and equal.

o Minimal effort.

o Adequate tidal volume.

Inadequate breathing:

o Breathing rate outside normal

range.

o Rhythm may be irregular at rest.

o Inadequate depth.

o Shallow volume.

o Diminished or absent breathing sounds.

o Unequal or inadequate chest expansion.

o Increased effort and use of accessory muscles to breathe.

Inadequate breathing:

o Pale or blue skin.

o Cool clammy skin.

o Occasional gasp.

Respiratory Emergencies:


Primary Assessment:

Scene Size-up:

Scene safety: 1. Ensure safe access to patient. 2. Consider that the patient may

be in distress because of exposure to toxic materials.

3. Use a HEPA respirator if there is evidence of communicable diseases.

4. Assess the need for additional resources.



Primary Assessment:

Scene Size-up: Mechanism of Injury: 1. Observe the scene and look for

possible MoI. 2. Ensure that the RE is not a

result of traumatic injury. 3. Question the patient, family

members, or bystanders for possible MoI.

4. Observe for signs of urticaria, chest pain, and fever.



Primary Assessment:

1. Perform a rapid scan to the patient.

2. Is the patient in a tripod position?

3. Does the patient have a barrel chest?

4. AVPU? 5. Set priorities depending on

MoI. 6. Call emergency…

Form a general impression:



Primary Assessment:

1. Ensure airways are open. 2. If closed open using jaw thrust. 3. A person with altered level of

consciousness, may need emergency help.

4. Consider nasopharyngeal or oropharyngeal airway.

5. Assess for gurgling or stridor. 6. Suction as needed.

Airway and Breathing:



Primary Assessment:

1. Evaluate the patient’s ventilatory status for rate, depth, effort, and tidal volume.

2. Inspect the chest for DCAP-BTLS 1. Deformities 2. Contustions 3. Abrasions 4. Punctures/Penetrations 5. Burns 6. Tenderness 7. Lacerations 8. Swelling

Airway and Breathing:

Determine if the breathing is adequate

or not…


Primary Assessment:

Circulation:


1. Evaluate distal pulse rate, strength, and rhythm. 2. Tachycardia respiratory distress.

shock. 3. Bradycardia possible cardiac emergency.

medication reaction or poisoning. 4. Observe skin color, temperature, and condition. 5. Look for life-threatening bleeding and treat accordingly. 6. Transport of O2 may be reduced due to lack or RBC. 7. If distal pulse is not palpable, assess central pulse.


Primary Assessment:

Transport Decision:


Airway or Breathing Problem?

Internal Bleeding?

Life-threat?


History Taking:

Investigate the chief complaint:


1. Monitor patient for mental changes. 2. Ask OPQRST, and SAMPLE

questions. 3. Identify pertinent negatives. 4. Has the patient done anything for

their breathing problem? 5. If inhaler was used, how many

does? 6. Is the patient coughing? 7. Can he sleep lying down?


Secondary Assessment:

Physical Exam:


1. Perform Head-to-Toe exam. 2. Check for DCAP-BTLS. 3. Focus on respiratory efforts, and respiratory adequacy. 4. The sounds you hear when you auscultate will help you

determine lung function. 5. Accessory muscle use, nasal flaring, pursed lips,

confusion, and tachypnea are signs of respiratory distress. 6. Look for hives. 7. Examine skin color, cyanosis is a sign of hypoxia. 8. Monitor mental status.


Secondary Assessment:

Vital signs:


1. Obtain baseline vital signs. 2. Repeat every 5-15 mins. 3. Vital signs should include BP by

ausculation, pulse rate and quality, respiration rate and quality, and skin assessment for perfusion.

4. Level of concousness. 5. Pulse oximeter to determine

perfusion status.


Reassessment:

Interventions:


1. Reassess the primary examination, vital signs, and chief complaint.

2. Assist breathing as required. 3. Administer high flow O2. 4. Assist patient with prescribed meds. 5. Check interventions rendered. 6. Be prepared to modify treatment. 7. Support the cardio-vascular system. 8. Do not delay transport.


General Management of RE:


1. Managing life-threatening ABCs and ensuring high flow O2 delivery are the major concerns.

2. Patients breathing with less than 8 breaths/min or more than 30 breaths/min should have ventilations assisted with a bag-mask device.

3. Continually assess mental health. 4. Transport in the position of comfort. 5. Use precautions (HEPA mask).


Upper or lower airway infections:


1. Dyspnea may be from croup or epiglottitis. 2. Patient should receive humidified O2 if

available, 3. Patient sitting forward, seem lethargic, or

are drooling may have epiglottitis. 4. Don’t force patient to lie down or to insert

an oropharyngeal tube. It may cause spasm and complete obstriction. Transport rapidly.

5. In lower infections, provide O2, monitor signs, and transport to hospital


Acute pulmonary edema:


1. Congestive heart failure or toxic inhalation may cause pulmonary edema.

2. Place the patient in position of comfort (sitting-up).

3. Administer high flow O2. 4. Provide ventilatory support and suction. 5. Continuous positive air can be provided. 6. Transport quickly to hospital.


COPD:


1. Patient maybe semiconscious or unconscious due to hypoxia.

2. They may appear to have respiratory distress or cyanotic.

3. They may have pursed lips and may be using accessory muscles to breathe (shoulders and neck).

4. Assist with patient’s prescribed inhaler. Document time and effect of each use.

5. Many may overuse their inhalers. 6. Keep patient in sit-upright position. 7. Treat with full-flow oxygen using a non-rebreathing

mask.


Asthma, hay fever, and anaphylaxis:


1. Not all wheezing is related to asthma…. 2. If patient is asthmatic help with

inhaler/nebulizer. 3. Hay fever requires support. If

accompanied with cold symptoms, oxygen might be needed.

4. Anaphylaxis is a true emergency that requires transporting the patient to the hospital.

5. Use epinephrine shot if the patient was prescribed it. 6. Inject the epinephrine in the thigh at 90° angle.



Pneumothoax:

Spontaneous Result of trauma

Place patient in comfortable position

Support the ABCs

Prompt transport

CPR if necessary



Pleural effusion:

Removal of fluid collected outside the Lungs.

Provide Oxygen

Support the ABCs

Prompt transport



Airway obstruction:

Use age-appropriate foreign body to maneuver and clear the airway.

Provide Oxygen

Prompt transport



Pulmonary embolism:

Ventilation perfusion mismatch

No gas exchange takes place

Patient is hypoxic

Cardiac arrest may occur

Sitting position is preferred

Provide Oxygen

Clear airway from hymoptysis



Hyperventilation:

Investigate history to determine cause

Don’t have the patient breathe into paper bag

Reassure patient

Provide Oxygen

Prompt transport

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Anas Bahnassi PhD CDM CDE

Clinical Pharmacy VI: First Aid

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Health & Medicine

First Aid: Respiratory Emeregencies