RESPIRATORY EMERGENCIES

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RESPIRATORY EMERGENCIES

• An Introduction

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• Nose/mouth pharynx/oropharynx Larynx
  Trachea Bronchi Bronchioles Lungs-
  Alveoli

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• The intercostal muscles and the diaphragm
  contract, increasing the size of the thoracic
  cavity. The diaphragm moves slightly downward,
  the ribs move upward/outward and air flows into
  the lungs
• Inhalation
• Exhalation is the reverse
• ALL IS NORMAL BASED ON

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• Tidal Volume
• The amount of air moved into or out of the lungs
  in a single breath
• Normal is 500 ml

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• Minute Volume
• The amount of air moved in or out of the lungs in
  one minute minus dead space
• mV RR x vT dead space (150) ml

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• Normal Minute Volume
• 12bpm x 500 mL 150 mL/bpm dead space
• 5850mL/minute

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• Rate Rhythm Quality Depth
• 12-20 regular breath adequate
• sounds
• Skin is warm/pink/dry

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• INADEQUATE BREATHING
• Respiratory Distress
• Respiratory Failure
• Respiratory Arrest

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• Inadequate Breathing Defined

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• Signs of Inadequate Breathing

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• Respiratory Distress

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• Respiratory Failure

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• Respiratory Arrest

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• Patient Assessment
• Rate Rhythm Quality
• 12-20 Regular Depth (minute volume)
• None
• Too Fast
• Too Slow

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• Oxygen Therapy
• Nasal Canulae
• Non-Rebreather

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• Oxygen Therapy (administration)
• Examples requiring O2 administration
• Respiratory or cardiac arrest
• Heart attack
• Stroke
• Shock
• Blood loss
• Lung disease
• Broken bones
• Head injuries

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• Hypoxia
• Deprivation of adequate supply of oxygen

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• Breathing Difficulties
• Signs and Symptoms
• Shortness of breath
• Tightness in the chest
• Restlessness
• Increased pulse rate
• Decreased pulse rate (especially in infants and
  children)
• Changes in breathing rate/rhythm

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• Pale, cyanotic or flushed skin
• Noisy breathing
• Inability to speak in full sentences
• Use of accessory muscles
• Retractions
• AMS
• Coughing
• Flared nostrils pursed lips
• Positioning
• Barrel chest

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• Respiratory Conditions
• COPD
• Emphysema
• Chronic Bronchitis
• Black Lung
• CHF
• Hypoxic Drive
• NEVER WITHHOLD OXYGEN

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• Pulmonary Edema
• Abnormal collection of fluid in the alveoli
• Left-sided heart failure
• orthopnia

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• Asthma
• Seen in young and old alike
• Episodic disease
• May be triggered by an allergic reaction

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• When an attack occurs
• Small bronchioles become narrow
• Overproduction of thick mucus
• Small passages practically shut down
• Flow restricted in one direction
• Expiratory wheezes
• Air is trapped in the lungs

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• Assisting with the Inhaler
• The drug is in the form of a fine powder that
  become active when comes in contact with lung
  tissue
• Calm your patient
• Administration check list
• Right patient
• Right medication
• Right dose
• Right route
• Check expiration date

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• Shake inhaler vigorously several times
• Make sure patient is alert enough to properly
  use
• Make sure patient exhales deeply
• Inhale deeply as Inhaler is administered
• Hold breath as long as possible

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• CPAP
• Continuous Positive Airway Pressure
• Forcing air or oxygen into the lungs when a
  patient has inadequate breathing
• Relatively low pressures are used

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• Indications
• CHF
• Pulmonary Edema
• Effects
• Prevents the alveoli from collapsing at the end
  of exhalation
• Push fluid out of the alveoli back into the
  capillaries

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• Contraindications
• Anatomic-physiologic
• Depressed mental status patient cannot protect
• the airway or cannot follow instructions
• Lack of normal, spontaneous respiratory rate
  CPAP does not increase respiratory rate
• Inability to sit up
• Inability to get and maintain a good mask seal

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• Pathologic contraindications
• Nausea and vomiting
• Penetrating chest trauma
• Shock
• Upper GI bleed
• Recent gastric surgery
• Inadequate mask seal malformation, burns,trauma

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• Other contraindications to consider
• Claustrophobia
• Cannot tolerate
• History of inability to use CPAP
• Secretions requiring frequent suctioning
• History of pulmonary fibrosis

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• Hypotension
• CPAP provides a constant pressure throughout the
  respiratory cycle hampering venous return
• During normal inspiration pressure is decreased
  enough to allow blood to return to the heart
• B/P should be monitored frequently and should be
  gt90/systolic