Respiratory Emergencies

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Respiratory Emergencies
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Anatomy Review

• Nose and mouth
• Pharynx
• Oropharynx
• Nasopharynx
• Epiglottis a leaf-shaped structure that
  prevents food and liquid from entering the
  trachea during swallowing
• Trachea (windpipe)
• Cricoid cartilage firm cartilage ring forming
  the lower portion of the larynx
• Larynx (voice box)
• Bronchi two major branches of the trachea to
  the lungs. Bronchus subdivides into smaller air
  passages ending at the alveoli
• Alveoli site of oxygen and carbon dioxide
  exchange

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Adequate Breathing

• Normal Rate
• gt Adult 12 20 bpm
• gt Child 15 30 bpm
• gt Infant 25 50 bpm
• Rhythm regular
• Quality Breath sounds diminished or absent
• Chest expansion adequate/equal
• Depth (tidal volume) normal/adequate (500cc/air)

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Inadequate Breathing

• Rate
• gt outside normal ranges lt10 or gt29
• Rhythm irregular
• gt Agonal respirations (dying respirations) are
  sporadic, irregular, or gasping
• Quality
• diminished or absent breath sounds
• unequal chest expansion, use of accessory
  muscles.
• Children seesaw breathing, nasal flaring,
  grunting, retractions.
• Have smaller airways so easier to obstruct
• Skin
• pale or cyanotic, cool and clammy

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Retractions
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Flared Nostrils in an Infant
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Artificial Ventilation (BVM/Pocket Mask)

• Chest should rise and fall with each ventilation.
• Exhalation (passive)
• Diaphragm, ribs muscles relax
• Decrease in chest size
• Diaphragm moves up
• Inhalation (active)
• Diaphragm moves downward
• Ribs move up and out
• Air flows in

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Breathing Difficulty

• This is subjective need to do a thorough
  assessment.

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Breathing Difficulty

• Signs and Symptoms
• Shortness of breath
• Restlessness
• Noisy breathing crowing, wheezing, gurgling,
  snoring, stridor (harsh sound/upper airway
  obstruction)
• Silent chest found in asthma patients
• Inability to speak due to breathing efforts
• Increased or decreased pulse rate
• Skin color changes
• Tripod position
• Change in breathing rate
• Unusual anatomy (barrel chest)

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Barrel Chest
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Emergency Care

• OPQRSTI
• Apply oxygen how would you provide this?????
• Baseline vital signs
• Prescribed inhaler if available with medical
  direction

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Diseases of the Respiratory System
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Chronic Obstructive Pulmonary Disease (COPD)

• Examples
• gt emphysema
• gt chronic bronchitis
• gt black lung
• Found in middle age or older
• Develops as tissues of the respiratory tract
  react to irritants cigarettes most common

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Emphysema

• Walls of the alveoli break down, the lungs lose
  elasticity. Patient will develop a hypoxic drive.
  This patient will breathe based on the levels of
  oxygen in their system instead of the levels of
  carbon dioxide.
• Amount of surface area has been reduced for
  respiratory exchange.

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Lung Cancer Cells
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Chronic Bronchitis

• Bronchiole lining is inflamed and excess mucus is
  formed
• Cilia have been damaged or destroyed

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Black Lung

• Coal worker's pneumoconiosis due to the
  inhalation of coal dust.
• Enlarged heart suffer from right side heart
  failure.

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Black Lung
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• pneumonoultramicroscopicsilicovolcanoconiosis

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Asthma

• Can be triggered by an allergic reaction,
  pollutants, infection, exercise, etc.
• Young and old can have this
• Can be episodic
• There is an over production of thick mucus that
  close down the small passages restricting air
  flow.

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Asthma
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Pulmonary Edema

• Fluid in/around alveoli, small airways
• Causes
• Left heart failure
• Toxic inhalants
• Aspiration
• Drowning
• Trauma

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Pulmonary Edema

• Signs/Symptoms
• Labored breathing
• Coughing
• Rales, rhonchi, crackles
• Wheezes
• Pink, frothy sputum
• Increased swelling in the extremities

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Pulmonary Edema

• Management
• Place the patient in a full fowlers position
• High concentration O2
• Assist ventilation
• Be prepared to suction

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Pulmonary Embolism

• Clot from venous circulation
• Passes through right side of the heart
• Lodges in pulmonary circulation
• Shuts off blood flow past part of alveoli

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Pulmonary Embolism

• Associated with
• Prolonged bed rest or immobilization
• Casts or orthopedic traction
• Pelvic or lower extremity surgery
• Phlebitis inflammation of a vein

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Pulmonary Embolism

• Signs/Symptoms
• Dyspnea
• Chest pain
• Tachycardia
• Hemoptysis coughing up blood

Sudden Dyspnea No Readily Identifiable Cause

Pulmonary Embolism
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Pulmonary Embolism

• Management
• Oxygen
• Assisted ventilation
• Transport

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Respiratory Emergencies in Infants Children

• Epiglottitis
• Bacterial infection
• Causes edema of the epiglottis
• Children age 4-7 years
• Rapid onset, high fever, stridor, sore throat,
  excessive drooling
• Can progress to complete obstruction
• Do not look in throat
• Do not use obstructed airway maneuver

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Respiratory Emergencies in Infants Children

• Croup
• Viral infection
• Causes edema of larynx/trachea
• Children ages 6 months to 4 years
• Slow onset, mild fever, hoarseness, brassy cough,
  nightime stridor (seal-like bark), dyspnea
• Looks less ill than epiglottis patient
• When in doubt, manage as epiglottitis

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Respiratory Emergencies in Infants Children

• Croup/Epiglottitis
• Management
• Blow-by oxygen
• Assist ventilations as needed
• Do not excite patient
• DO NOT look or stick anything in the throat
• Cool night air or steam from a shower may help a
  child with croup
• Consider ALS intercept