Respiratory Emergencies

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Respiratory Emergencies
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Breathing Difficulty

• Dyspnea - (SOB)
• Respiratory arrest
• Hypoxia
• Bronchoconstriction
• Bronchospasm
• Bronchodilator

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Assessment

• Scene size-up
• Tunnel vision
• Medical
• Trauma
• Oxygen tanks already on scene
• Alcohol

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Assessment

• Initial Assessment
• Mental status
• Position - (Tripod)
• Facial expression
• Speech (1 or 2 word dyspnea)
• Skin color
• Mucus membranes
• Suction if necessary

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Assessment

• Initial Assessment cont..
• Chest
• Look, Auscultate, Feel
• Respiratory rate
• Adequate
• Inadequate
• Priority patient
• Consider ALS back up

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Assessment

• Focused History Physical Exam
• Sample history
• OPQRST
• Metered Dose Inhaler
• Medical control orders
• Assess vitals before and after
• Reassess mucus membranes/cyanosis
• Reinspect chest
• Auscultate lungs

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Signs and Symptoms

• Restlessness and anxiety
• Increased or irregular heart rate
• Tachypnea
• Bradyapnea
• Cyanosis
• Abnormal airway sounds
• Audible wheezing
• Diminished ability to speak

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Signs and Symptoms Cont..

• Retractions
• Diaphragmatic breathing
• Shallow breathing
• Coughing
• Tripod position
• Barrel chest (emphysema)
• Altered mental status
• Paradoxical motion
• Chest trauma
• Pursed-lip breathing

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Emergency Care/Inadequate Breathing

• Establish airway
• Begin positive pressure ventilation with
  supplemental oxygen
• Expeditiously transport

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Emergency Care/Adequate Breathing

• Big Os 15 lpm. NR.
• Assess baseline vitals
• Administer patients MDI with Med. Control order
• Complete focused history/physical exam
• Transport in Fowlers or semi-Fowlers position

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Metered Dose Inhaler (MDI)Page 278 Textbook

• Generic name - Albuterol
• Trade Name - Proventil, Ventolin
• Indications
• Contraindications
• Dosage
• Administration
• Actions
• Side Effects

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Infants and Children

• Respiratory arrest leads to cardiac arrest
• Do all assessments as usual
• Typically all signs and symptoms of breathing
  difficulty will precede respiratory arrest

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Early Signs and Symptoms

• Increased use of accessory muscles
• Retractions during inspiration
• Tachypnea
• Tachycardia
• Nasal flaring
• Grunting during exhalation
• Prolonged exhalation
• Frequent coughing
• Cyanosis in extremities
• Anxiety

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Late Signs and Symptoms

• Altered mental status
• Bradycardia
• Hypotension
• Extremely fast, slow or irregular breathing
  pattern
• Cyanosis to body core, mucous membranes
• Limp appearance
• Diminished or absent breath sounds
• Head bobbing with each breath
• See-saw breathing

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Emergency Care

• Position of comfort - (parent)
• Big Os 15 lpm. NR. Or Flow by
• If breathing becomes inadequate use positive
  pressure ventilation
• Administer patients MDI - Med control
• If airway is blocked begin AHA. FBAO maneuvers
• SAMPLE history
• Transport
• Ongoing assessment

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FBAO vs.. Disease

• FBAO begin maneuvers
• Disease
• Can cause intense swelling
• Inserting anything into the airway can cause
  dangerous spasms

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Epiglottitis

• Swelling of the epiglottis from localized
  infection
• Child sits straight up, juts out neck, and drools
• History
• Sore throat, stridor, fever
• Treatment
• Big Os 15 lpm. N.R. mask
• Position of comfort
• Transport
• Consider ALS
• Never insert or place anything in the mouth

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Croup

• Swelling of larynx, trachea, and bronchi
• Signs and symptoms
• Breathing difficulty
• Does not feel well
• Sore or hoarse throat
• fever
• Sounds like a seal barking
• Provide big Os humidified if possible
• Begin transport
• Cool air may reduce signs symptoms somewhat

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Assessing Breath Sounds
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Wheezing

• High-pitched whistling sound heard on exhalation
• Indication of bronchoconstriction
• Causes
• Asthma
• Emphysema
• Chronic bronchitis
• Pneumonia
• CHF

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Rhonchi

• Snoring or rattling noises heard upon
  auscultation
• Thick secretions of mucous obstruct the
  respiratory tract.
• Causes
• Chronic bronchitis
• Emphysema
• Aspiration
• Pneumonia

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Rales

• Crackles heard during inspiration
• Fluid fills the alveoli and small bronchioles
• Usually heard in the base of lungs first
• Indicates pulmonary edema or pneumonia

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Chronic Obstructive Pulmonary Disease (COPD)

• Obstruction to airflow in the lungs
• Common causes
• Chronic bronchitis
• Emphysema
• Most patients are aware of the problem and will
  report it during the SAMPLE history

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Emphysema

• Destruction of alveolar walls along with
  distension of air sacs
• Elasticity is lost
• Reduction of surface in contact with capillaries
• Air becomes trapped causing build up of CO2.
• Breathing becomes difficult
• Barrel chested appearance due to trapped air

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Sign Symptoms

• Thin barrel chest appearance
• Coughing, but with little sputum
• Prolonged exhalation
• Diminished breath sounds
• Wheezing and rhonchi
• Pursed-lip breathing
• extreme SOB on exertion
• Pink complexion
• Tachypnea
• Diaphoresis
• Home oxygen

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Chronic Bronchitis

• Inflammation, swelling, excessive mucous in the
  bronchi bronchioles
• Productive cough for last 3 months out of the
  year for at least 2 years
• Does not affect alveoli, however they cant
  expand fully because air cant get past the
  diseased bronchi or bronchioles
• Recurrent infections cause scar tissue

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Signs Symptoms

• Typically overweight
• Chronic cyanotic complexion
• Difficulty in breathing less prominent than
  emphysema
• Productive cough (sputum)
• Course rhonchi

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Emergency Care

• Ensure airway
• Position of comfort
• Administer supplemental Oxygen
• Hypoxic drive
• High CO2 levels in blood cause receptors to
  respond
• If receptors pick up high levels of O2 patient
  may stop breathing
• MDI if patient has one (Med control)
• Never withhold oxygen from any patient who needs
  it!

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Asthma

• Increased sensitivity of lower airway to
  irritants.
• Causes
• Bronchospasms
• Edema
• Increased production of mucous
• Attacks are usually acute or periodic
• Usually no or very few signs symptoms between
  attacks

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Status Asthmaticus

• True emergency
• Prolonged attacks that doesnt respond to oxygen
  or medication
• Consider ALS back-up

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Extrinsic Asthma

• Allergic asthma
• Dust, pollen, smoke
• Often in children
• Seasonal
• May subside after adolescence

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Intrinsic Asthma

• Infection, emotional stress, or strenuous
  exercise
• Exhalation becomes difficult
• Air becomes trapped in alveoli
• Exhalation becomes active process
• Respiratory arrest may soon follow

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Signs Symptoms

• Dyspnea
• Productive cough
• Wheezing
• Tachypnea
• Tachycardia
• Anxiety and apprehension
• Possible fever
• Runny nose, blood shot eyes, or stuffy nose

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Severe Signs Symptoms

• Extreme fatigue or exhaustion
• Inability to speak
• Cyanosis to core of body
• Tachycardia greater than 130 bpm.
• Quiet or absent lung sounds

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Emergency Care

• Ensure airway
• Big Os with supplemental oxygen NR mask or
  positive pressure ventilation
• Assess circulation
• Try to calm the patient to reduce breathing
  workload
• Patients MDI (Med control order)
• Transport

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Note

• All that wheezes is not asthma.
• Patient may be suffering from an obstructed
  airway
• Never assume anything

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Pneumonia

• Acute infectious disease
• Bacteria or virus
• Irritants or aspiration
• Affects lower respiratory tract
• Lung inflammation and fluid or pus-filled alveoli
• Poor gas exchange or hypoxia

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Signs Symptoms

• Malaise and decreased appetite
• Fever
• Cough productive or non-productive
• Dyspnea
• Tachypnea tachycardia
• Chest pain made worse when breathing
• Shallow respirations
• Splinting of thorax with arms
• Rales and rhonchi

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Emergency Care

• Ensure airway
• Ensure adequate oxygenation
• Position of comfort
• Consult med-control or follow protocol concerning
  MDI

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Pulmonary Embolism

• Blockage of pulmonary artery or branches
• Blood clot, fat particle, air bubble, foreign
  body
• Decreased blood flow
• Interrupts breathing and heart rhythm

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Factors

• Surgery
• Prolonged immobilization
• Thrombophlebitis
• Birth control pills
• Chronic atrial fibrillation
• Multiple fractures

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Signs Symptoms

• Sudden onset of unexplained dyspnea
• Respiratory distress, rapid breathing
• Sudden onset of sharp, stabbing chest pain
• Cough (may cough up blood)
• Tachypnea tachycardia
• Syncope
• Cool moist skin
• Restlessness and anxiety
• Decreased BP (Late sign)
• Cyanosis (Late sign)
• Distended neck veins (Late sign)

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Emergency Care

• Ensure airway
• Ensure proper oxygenation
• Monitor the patient
• Rapid transport

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Acute Pulmonary Edema

• Fluid collects in space between alveoli and
  capillaries
• Two Kinds
• Cardiogenic
• Non-cardiogenic

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Cardiogenic

• Inadequate pumping action of the heart
• Increased pressure in the pulmonary capillaries
• Fluid is forced to leak into the space between
  alveoli and capillaries
• Eventually fluid will enter the alveoli

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Non-Cardiogenic

• Destruction of the capillary bed allows fluid to
  leak out
• Pneumonia, aspiration, near-drowning, narcotic
  overdose, inhalation of smoke or other toxic
  gases, high altitudes, trauma

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Signs Symptoms

• Dyspnea (especially on exertion)
• Difficulty breathing while laying flat
• Frothy pink or white sputum (late sign)
• Tachycardia
• Anxiety, Confusion, combativeness
• Tripod position
• Fatigue
• Rales, possible wheezing
• Cyanosis
• Pale moist skin
• Distended neck veins
• Swollen lower extremities

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Emergency Care

• Ensure airway
• Ensure proper oxygenation, big Os.
• Position patient in Fowlers position
• Transport without delay