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Temple College EMS Program1 The Respiratory System Emergency Medical Technician - Basic.

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Presentation on theme: "Temple College EMS Program1 The Respiratory System Emergency Medical Technician - Basic."— Presentation transcript:

1 Temple College EMS Program1 The Respiratory System Emergency Medical Technician - Basic

2 Temple College EMS Program2 Respiratory System Purpose Takes in oxygen Disposes of wastes –Carbon dioxide –Excess water O 2 + Glucose CO 2 + H 2 O The Cell

3 Temple College EMS Program3 Respiratory System Anatomy Nasopharynx Oropharynx Epiglottis Larynx Trachea Bronchi Bronchioles Carina

4 Temple College EMS Program4 Respiratory System Anatomy Lung –Right lung 3 lobes –Left lung 2 lobes

5 Temple College EMS Program5 Respiratory System Anatomy Bronchioles –Smallest airways –Walls consist entirely of smooth muscle (no cartilage present) –Constriction increases resistance to airflow –Dilation reduces resistance to airflow

6 Temple College EMS Program6 Respiratory System Anatomy Alveoli –Air sacs –Site of oxygen and carbon dioxide exchange with blood

7 Temple College EMS Program7 Respiratory System Anatomy

8 Temple College EMS Program8 Respiratory System Anatomy Diaphragm

9 Temple College EMS Program9 Respiratory System Anatomy Pleura –Double-walled membrane –Visceral layer covers lung –Parietal layer lines inside of chest wall, diaphragm

10 Temple College EMS Program10 Respiratory System Physiology Inspiration Active process Chest cavity expands Intrathoracic pressure falls Air flows in until pressure equalizes Expiration Passive process Chest cavity size decreases Intrathoracic pressure rises Air flows out until pressure equalizes

11 Temple College EMS Program11 Respiratory System Physiology –Automatic Function Primary drive: increase in arterial CO 2 Secondary (hypoxic) drive: decrease in arterial O 2 Normally we breathe to remove CO 2 from the body, NOT to get oxygen in

12 Temple College EMS Program12 Respiratory Pathophysiology Airway (Obstruction) –Tongue –Foreign body airway obstruction –Anaphylaxis/angioedema –Upper airway burn –Maxillofacial/laryngeal/ tracheobronchial trauma –Epiglottitis –Croup –Aspiration –Asthma –Chronic Obstructive Airway Disease Emphysema Chronic bronchitis

13 Temple College EMS Program13 Respiratory Pathophysiology Gas Exchange Surface (Blood Flow or Gas Diffusion) –Pulmonary Edema Left-sided heart failure Toxic inhalations Near drowning –Pneumonia –Pulmonary Embolism Blood clots Amniotic fluid Fat embolism

14 Temple College EMS Program14 Respiratory Pathophysiology Thoracic Bellows (Ventilation) –Chest Trauma Simple rib fractures Flail chest Pneumothorax Hemothorax Sucking chest wound Diaphragmatic hernia –Pleural effusion –Spinal cord trauma (High C-spine lesion) –Morbid obesity –Neurological/neuro- muscular disease Poliomyelitis Myasthenia gravis Muscular dystrophy Guillian-Barre syndrome

15 Temple College EMS Program15 Respiratory Pathophysiology Control System (Decreased Respiratory Drive) –Head trauma –CVA –Depressant drug toxicity Narcotics Sedative-hypnotics Ethyl alcohol

16 Temple College EMS Program16 Respiratory Assessment Initial Assessment (A, B, C, D) Manage life threats Complete focused history and physical

17 Temple College EMS Program17 Initial Assessment Airway –Listen to patient breathe, talk Noisy breathing is obstructed breathing But all obstructed breathing is not noisy Snoring = Tongue blocking airway Stridor = “Tight” upper airway from partial obstruction

18 Temple College EMS Program18 Initial Assessment Airway –Anticipate airway problems with Decreased LOC Head trauma Maxillofacial trauma Neck trauma Chest trauma OPEN—CLEAR—MAINTAIN

19 Temple College EMS Program19 Initial Assessment Breathing –Is patient moving air? –Is air moving adequately? –Is the patient’s blood being oxygenated?

20 Temple College EMS Program20 Initial Assessment Breathing –LOOK Symmetry of chest expansion Increased respiratory effort Changes in skin color –LISTEN Air movement at mouth, nose Air Movement in peripheral lung fields –FEEL Air movement at mouth, nose Symmetry of chest expansion –RATE Tachypnea Bradypnea –POSITIONING Orthopnea Tripod position

21 Temple College EMS Program21 Initial Assessment Breathing –Signs of respiratory distress Nasal flaring Tracheal tugging Retractions Neck, pectoral muscle use on inhalation Abdominal muscle use on exhalation –Skin Color Pale, cool moist skin (Early sign of hypoxia) Cyanosis (Late, unreliable sign of hypoxia)

22 Temple College EMS Program22 Initial Assessment Breathing –If trauma patient has compromised breathing, bare chest, assess for: Open pneumothorax Flail chest Tension pneumothorax

23 Temple College EMS Program23 Respiratory Assessment Circulation –Is heart beating? –Is there major external hemorrhage? –Is patient perfusing? –Effects of hypoxia: Adults (early): tachycardia Adults (late): bradycardia Children: bradycardia

24 Temple College EMS Program24 Initial Assessment Circulation –Don’t let respiratory failure distract you from assessing for circulatory failure –Low oxygen or high carbon dioxide levels can depress cardiovascular function

25 Temple College EMS Program25 Respiratory Assessment Disability –Restlessness, anxiety, combativeness = hypoxia Until proven otherwise –Drowsiness, lethargy = hypercarbia Until proven otherwise Just because the patient stops fighting, he’s not necessarily getting better!!!

26 Temple College EMS Program26 Initial Management Patient Responsive/Breathing Adequate –Oxygen may be indicated –Oxygenate immediately if patient has: Decreased level of consciousness Possible shock Possible severe hemorrhage Chest pain Chest trauma Respiratory distress or dyspnea History of any kind of hypoxia

27 Temple College EMS Program27 Initial Management Patient responsive, breathing inadequate –Open/maintain airway –Place nasopharyngeal airway –Assist ventilations Mouth to Mask 2-person Bag-valve Mask Manually Triggered Ventilator 1-person Bag-valve Mask

28 Temple College EMS Program28 Initial Management Patient unresponsive, breathing adequate –Open/maintain airway –Place nasopharyngeal or oropharyngeal airway –Suction airway as needed –Provide oxygen by non-rebreather mask –Frequently reassess

29 Temple College EMS Program29 Initial Management Patient unresponsive, breathing inadequate Open/maintain airway Place nasopharyngeal or oropharyngeal airway Suction airway as needed Assist ventilations –Mouth to Mask –2-person Bag-valve Mask –Manually Triggered Ventilator –1-person Bag-valve Mask Frequently reassess

30 Temple College EMS Program30 Initial Management Patient not breathing –Open airway –Place nasopharyngeal or oropharyngeal airway –Ventilate patient Mouth-to-Mask 2-Person Bag-Valve Mask Manually Triggered Ventilator 1-Person Bag-Valve Mask –Frequently reassess

31 Temple College EMS Program31 Initial Management Golden Rules –If you think about giving O 2, give it!!! –If you decide to give oxygen, give a lot of it!!! –If you can’t tell whether a patient is breathing adequately, he isn’t ! –If you’re thinking about assisting a patient’s breathing, you probably should be!

32 Temple College EMS Program32 Focused History and Physical Chief Complaint –Dyspnea Subjective sensation that breathing is excessive, difficult, or uncomfortable –Respiratory Distress Objective observations that indicate breathing is difficult or inadequate

33 Temple College EMS Program33 Focused History and Physical History of Present Illness (OPQRST) –Gradual or sudden onset? –What aggravates or alleviates? –How long has dyspnea been present? –Coughing? Productive cough? –What does sputum look/smell like? –Pain present? What does pain feel like? How bad? Does it radiate? Where?

34 Temple College EMS Program34 Focused History and Physical Past History If Then??? Hypertension, MI, Diabetes CHF with Pulmonary Edema Chronic Cough, Smoking, COPD “Recurrent” Flu Allergies, Acute Episodes of SOB Asthma Lower Extremity Trauma,Pulmonary Embolism Recent Surgery, Immobilization

35 Temple College EMS Program35 Focused History and Physical Medications If Then??? “Breathing” Pills, Inhalers Asthma or COPD AlbuterolMontelukast AminophyllineOxtriphylline IpratropiumCromolyn TerbutalinePrednisone Salbumatol Zafirlukast

36 Temple College EMS Program36 Focused History and Physical Medications If Then??? Lasix, hydrodiuril, digitalis CHF Coumadin, BCP’s Pulmonary embolism

37 Temple College EMS Program37 Focused History and Physical Exam Crackles (Rales) –Fine, “crackling” –Fluid in smaller airways, alveoli Rhonchi –Coarse, “rumbling” –Fluid, mucus in larger airways Stridor –High pitched, “crowing” –Upper airway restriction Wheezing –“Whistling” –Usually more pronounced on exhalation –Generalized: narrowing, spasm of the smaller airways –Localized: foreign body aspiration

38 Temple College EMS Program38 Mild Breathing Difficulty May be hypoxic Can move adequate tidal volume Can answer questions, speak in complete sentences, is alert High concentration O 2 by non-rebreather mask Consider bronchodilators if patient wheezing

39 Temple College EMS Program39 Moderate Breathing Difficulty May be hypoxic May be moving adequate tidal volume Having difficulty answering questions, speaks in choppy sentences, is restless/irritable High concentration O 2 by non-rebreather mask Get ready to assist ventilations if needed (patient may resist assistance at this time) Consider bronchodilators if patient wheezing

40 Temple College EMS Program40 Severe Breathing Difficulty Getting sleepy Not speaking or speaking with very few words Previously wild, now seems “cooperative” Assist ventilations with BVM and oxygen Time BVM ventilation with patient’s ventilatory efforts Interpose extra ventilations if necessary


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