Introduction to Emergency Medical Care 1

Introduction to Emergency Medical Care 1
Advance Preparation Prepare anatomy models for demonstration. Research related multimedia links for illustration purposes. Prepare airway manikins for psychomotor sessions. Prepare airway equipment for demonstration and psychomotor sessions. Invite assistant instructors to assist with psychomotor sessions.

OBJECTIVES 19.1 Define key terms introduced in this chapter. Slides 14–15, 41, Describe the anatomy and physiology of respiration. Slides 13– Differentiate between adequate and inadequate breathing based on the rate, rhythm, and quality of breathing. Slides 16–18 continued

OBJECTIVES 19.4 Discuss differences between the adult and pediatric airways and respiratory systems. Slide Recognize signs of inadequate breathing in pediatric patients. Slide Provide supplemental oxygen and assisted ventilation as needed for patients with inadequate breathing. Slides 22–23 continued

OBJECTIVES 19.7 Assess the effectiveness of artificial ventilation. Slides 22– Discuss how to recognize and assess the patient with difficulty breathing. Slides 27– Discuss the care to provide for the patient with difficulty breathing. Slides 39–40 continued

OBJECTIVES 19.10 Recognize the indications, contraindications, risks, and side effects of CPAP. Slides 41– Use CPAP to assist the patient with difficulty breathing, as permitted by medical direction. Slides 44–47 continued

OBJECTIVES 19.12 Assist a patient with administration of a prescribed bronchodilator by inhaler or small volume nebulizer, as permitted by medical direction. Slides 83–87, 90–91 continued

OBJECTIVES 19.13 Describe the pathophysiology, signs, and symptoms of COPD, asthma, pulmonary edema, pneumonia, spontaneous pneumothorax, pulmonary embolism, epiglottitis, cystic fibrosis, and viral respiratory infections. Slides 49–79

MULTIMEDIA Slide 80 Chronic Obstructive Pulmonary Diseases Video
Slide 81 Spontaneous Pneumothorax Video Slide 88 Using a Metered Dose Asthma Inhaler and Spacer Video These videos appear later in the presentation; you may want to preview them prior to class to ensure they load and play properly. Click on the links above in slideshow view to go directly to the slides.

How to identify adequate breathing
How to identify inadequate breathing How to identify and treat a patient with breathing difficulty Use of continuous positive airway pressure (CPAP) to relieve difficulty continued

Use of a prescribed inhaler and how to assist a patient with one
Use of a prescribed small-volume nebulizer and how to assist a patient with one

Topics Respiration Breathing Difficulty Respiratory Conditions
The Prescribed Inhaler The Small-Volume Nebulizer Planning Your Time: Plan 125 minutes for this chapter. Respiration (20 minutes) Breathing Difficulty (45 minutes) Respiratory Conditions (30 minutes) The Prescribed Inhaler (15 minutes) The Small-Volume Inhaler (15 minutes) Note: The total teaching time recommended is only a guideline.

Respiration Teaching Time: 20 minutes
Teaching Tips: Identification of inadequate breathing is one of the most important lessons that you will teach. Spend time here to ensure comprehension. This lesson lends itself well to multimedia presentations. Anatomical models and web graphics will enhance your presentation on physiology and pathophysiology. Reach back to the lessons of previous chapters. Add assessment to physiology and pathophysiology as previously discussed. Teach that inadequate breathing means intervention. Prepare students to face a difficult decision that requires action.

Respiratory A&P

Inspiration Active process: uses muscle contraction to increase size of chest cavity Intercostal muscles and diaphragm contract Diaphragm moves down; ribs move upward and outward Air is pulled into lungs Point to Emphasize: Contraction of chest muscles and the diaphragm changes pressures in the chest to enable the movement of air. Talking Points: Students should review Chapters 5, 6, 8, and 9 prior to this lesson.

Expiration Passive process Muscles and diaphragm relax
Size of chest cavity decreases Air flows out of lungs Discussion Topic: Describe the physiology of respiration.

Adequate Breathing Breathing sufficient to support life Signs
No obvious distress Ability to speak in full sentences Normal color, mental status, and orientation Point to Emphasize: Adequate breathing is breathing that is sufficient to support life. Normal rate, rhythm, and quality are typical signs of adequate breathing. continued

Adequate Breathing May be determined by observing rate, rhythm, quality 12–20 breaths/minute for adult 15–30 breaths/minute for child 25–50 breaths/minute for infant Rhythm usually regular Breath sounds normally present and equal Discussion Topic: Describe the assessment findings of adequate respiration.

Inadequate Breathing Breathing not sufficient to support life Signs
Rate out of normal range Irregular rhythm Diminished or absent lung sounds Poor tidal volume Point to Emphasize: Inadequate breathing is breathing that is not sufficient to support life. An abnormally fast rate, irregular rhythm, and poor air movement are signs that point to inadequate breathing. Class Activities: Discuss the signs and symptoms of a variety of patients with difficulty breathing. Work with the class to develop strategies to identify rapidly those patients in respiratory failure. Assign a take-home assignment similar to the previous activity. List signs and symptoms; then have students identify respiratory distress or respiratory failure. continued

Inadequate Breathing Signs of inadequate breathing in infants and children Nasal flaring Grunting Seesaw breathing Retractions Knowledge Application: Use multimedia graphics to present patients in respiratory distress. Discuss the classification of inadequate breathing and have students defend their decisions.

Pediatric Note Structure of an infant’s and child’s airway differs from that of an adult Smaller airway easily obstructed Proportionately larger tongues Smaller, softer, more flexible trachea Less developed, less rigid cricoid cartilage Heavy dependence on diaphragm for respiration Point to Emphasize: Assessment of breathing adequacy must be adjusted to account for the anatomical differences of pediatric patients.

Patient Care: Inadequate Breathing
Assisted ventilation with supplemental oxygen Pocket face mask with supplemental oxygen Two-rescuer/one rescuer BVM with supplemental oxygen Flow-restricted, oxygen-powered ventilation device Point to Emphasize: Care for inadequate breathing must include ventilatory support with supplemental oxygen. Talking Points: The means of providing artificial ventilation were discussed in Chapter 9. Discussion Topic: Describe the treatment steps for dealing with inadequate respiration. Knowledge Application: Use programmed patients to simulate patients in respiratory distress. Have groups of students assess and determine adequacy of breathing and simulate treatment.

Artificial Ventilation
Can be adequate or inadequate Chest rise and fall should be visible with each breath Adequate artificial ventilation rates 12 breaths per minute for adults 20 breaths per minute for infants and children Talking Points: If the chest does not rise and fall with each artificial ventilation, or the pulse does not return to normal, increase the force of ventilations. If the chest still does not rise, check that you are maintaining an open airway. continued

Artificial Ventilation
Increasing pulse rates can indicate inadequate artificial ventilation in adults Decreasing pulse rates can indicate inadequate artificial ventilation in pediatric patients Talking Points: When adult patients experience a decrease in oxygen in the bloodstream (hypoxia), their pulse increases. In infants and children with respiratory difficulties, you may observe a slight increase in pulse early, but soon the pulse will drop significantly. A low (or bradycardic) pulse in infants and small children in the setting of a respiratory emergency usually means trouble! Discussion Topic: Describe the assessment findings of inadequate ventilation. Critical Thinking: What role does reassessment play when treating a patient with adequate respirations? How can your initial findings change?

Think About It How might you recognize the progression from adequate breathing to inadequate breathing in the assessment of your patient? How might your patient change during this transition? Talking Points: Look for changes in patient status. Mental status is always an important clue. Look also for respiratory fatigue, slowing respiratory rates, and irregular respiratory rhythm. Look for tachycardia and bradycardia (especially in children).

Breathing Difficulty Teaching Time: 45 minutes
Teaching Tips: This lesson lends itself well to multimedia presentations. Very good web-based graphics exist. Consider using these types of examples to underscore your lecture. Expand upon the initial lesson on inadequate breathing. Put it now in the context of the larger respiratory assessment. Use programmed patients (or other students) to practice respiratory evaluations. There is no substitute for actual lung sounds. Give students every opportunity to practice this skill.

Breathing Difficulty Patient’s subjective perception
Feeling of labored, or difficult, breathing Amount of distress felt may or may not reflect actual severity of condition Points to Emphasize: For the patient, difficulty breathing is a subjective perception. The amount of distress that the patient feels may or may not reflect the actual severity of the condition. Further assessment of a patient in respiratory distress includes observation, auscultation, and evaluation of vital signs. Assessment of breathing adequacy is an important element of assessing any patient with difficulty breathing.

OPQRST Onset—When did it begin?
Provocation—What were you doing when this came on? Quality—Do you have a cough? Are you bringing anything up with it? Point to Emphasize: OPQRST is a memory aid that can be very useful for gathering a history from a patient in respiratory distress. continued

OPQRST Radiation—Do you have pain or discomfort anywhere else in your body? Severity—On a scale of 1 to 10, how bad is your breathing trouble? Time—How long have you had this feeling? Discussion Topic: List and explain the components of the OPQRST memory aid as they apply to a patient with respiratory distress.

Assessment: Observation
Altered mental status Unusual anatomy Barrel chest Patient’s position Tripod position Sitting with feet dangling, leaning forward Point to Emphasize: Further assessment of a patient in respiratory distress includes observation, auscultation, and evaluation of vital signs. Knowledge Application: Have students work in small groups. Assign each group an element of the respiratory assessment. Have each group demonstrate the application of its portion of the assessment. continued

Work of breathing Retractions Use of accessory muscles Flared nostrils Pursed lips Number of words patient can say without stopping continued

Pale, cyanotic, or flushed skin Pedal edema Sacral edema Coughing continued

continued

Noisy breathing Audible wheezing (heard without stethoscope) Gurgling Snoring Crowing Stridor Talking Points: Often sounds of breathing may be audible without a stethoscope. Discussion Topic: Describe the observational elements of a respiratory assessment. Knowledge Application: Using programmed patients, have students complete simulated respiratory assessments. Include patients with both adequate and inadequate breathing.

Assessment: Auscultation
Lung sounds on both sides during inspiration and expiration Discussion Topic: Describe the correct locations for assessing lung sounds. Class Activity: Ask students to listen to each other’s lung sounds. Have students practice auscultation of lung sounds on the student next to them. continued

Wheezes—high-pitched sounds created by air moving through narrowed air passages Crackles—fine crackling caused by fluid in alveoli or by opening of closed alveoli Talking Points: Some people refer to crackles as rales. You may observe changes over time when listening to lung sounds. An asthmatic patient who has used an inhaler may feel that breathing is easier and the wheezes have diminished. Be careful, however. Sometimes the wheezes will also disappear when a patient worsens and breathing becomes inadequate. continued

Rhonchi—low sounds resembling snoring or rattling, caused by secretions in larger airways Stridor—high-pitched, upper-airway sounds indicating partial obstruction of trachea or larynx Discussion Topic: Describe the etiology of the following abnormal lung sounds: wheezes, crackles, rhonchi. Class Activity: Assign 20 lung sound evaluations as homework. Ask students to document and describe the assessments in a journal. Knowledge Application: Have students work in small groups. Assign each group an abnormal lung sound. Have the group research and discuss how the sound is generated and associated conditions. Critical Thinking: Children often will present with a condition referred to as “silent chest.” In this case, what is the significance of hearing no lung sounds at all?

Assessment: Vital Sign Changes
Increased or decreased pulse rate Changes in breathing rate Changes in breathing rhythm Hypertension or hypotension Oxygen saturation Talking Points: Although an oximeter reading between 96 and 100 percent is normal, oxygen should be administered to all patients with respiratory distress regardless of their oxygen saturation readings. Even a patient with a saturation reading of 100 percent should receive oxygen if he has any signs of respiratory distress.

Patient Care Assure adequate ventilations
If breathing is inadequate, begin artificial ventilation If breathing is adequate, non-rebreather mask at 15 Lpm Talking Points: Use a nasal cannula only in cases where the patient will not tolerate a mask. If the patient has inadequate breathing, provide supplemental oxygen while performing artificial ventilation. continued

Patient Care Place patient in position of comfort
Administer prescribed inhaler Administer continuous positive airway pressure (CPAP) Talking Points: If the patient has a prescribed inhaler, you may be able to assist the patient in taking this medication. This would be done after consultation with medical direction, often during transportation to the hospital.

Patient Care: CPAP Simple principles
Blowing oxygen or air continuously at low pressure into airway Prevents alveoli from collapsing at end of exhalation Can prevent fluid shifting into alveoli from surrounding capillaries continued

Patient Care: CPAP Common uses Pulmonary edema Drowning
Asthma and COPD Respiratory failure in general Talking Points: The use of CPAP in EMS is relatively new and rapidly evolving. Always follow local protocol. continued

Patient Care: CPAP Contraindications Severely altered mental status
Lack of normal, spontaneous respiratory rate Hypotension/shock Nausea and vomiting Penetrating chest trauma Upper GI bleeding Conditions preventing good mask seal continued

Patient Care: CPAP Side effects Hypotension Pneumothorax
Increased risk of aspiration Drying of corneas

Patient Care: Using CPAP
Explain procedure to patient Start with low level CPAP Talking Points: Always follow local protocol. continued

Reassess mental status, vital signs, and dyspnea level frequently Raise CPAP level if no relief within a few minutes continued

If patient deteriorates, remove CPAP and ventilate with bag-mask

Respiratory Conditions
Teaching Time: 30 minutes Teaching Tips: This lesson lends itself well to multimedia presentations. Very good web-based pathophysiology graphics exist. Show media-based examples of dysfunction to underscore your points. Use real-life examples. Adults grasp pathophysiology best when they can apply it to actual situations. For each subsection of disorder, discuss actual examples and move from theory to reality. Link dysfunction to your previous discussions of normal function. Recall concepts such as alveolar ventilation and internal and external respiration. There is a great deal of information here. Consider assigning take-home work and reading assignments.

Chronic Obstructive Pulmonary Disease
Broad classification of chronic lung diseases Includes emphysema, chronic bronchitis, and black lung Overwhelming majority of cases are caused by cigarette smoking Point to Emphasize: The term chronic obstructive pulmonary disease (COPD) refers to a variety of chronic lung diseases. EMS typically becomes involved when a secondary problem worsens the ongoing disease.

COPD: Chronic Bronchitis
Bronchiole lining inflamed Excess mucus produced Cells in bronchioles that normally clear away mucus accumulations are unable to do so continued

COPD: Chronic Bronchitis

COPD: Emphysema Alveoli walls break down—surface area for respiratory exchange is greatly reduced Lungs lose elasticity Results in air being trapped in lungs, reducing effectiveness of normal breathing Talking Points: Many COPD patients exhibit characteristics of both emphysema and chronic bronchitis. continued

COPD: Emphysema

Asthma Chronic disease with episodic exacerbations
During attack, small bronchioles narrow (bronchoconstriction); mucus is overproduced Results in small airway passages practically closing down, severely restricting air flow Talking Points: There is no known way to prevent asthma, but episodes of distress can often be prevented by use of appropriate medications and careful attention to avoiding items that trigger attacks. continued

Asthma Air flow mainly restricted in one direction
Inhalation—expanding lungs exert outward pull, increasing diameter of airway and allowing air flow into lungs Exhalation—opposite occurs and air becomes trapped in lungs Point to Emphasize: Asthma is a chronic disease that has episodic exacerbations. Narrowing of small bronchial tubes and overproduction of mucus impedes airflow and causes gas exchange problems. continued

Asthma Talking Points: Air trapping in an asthma attack requires the patient to exhale the air forcefully, producing the characteristic wheezing sounds associated with asthma.

Pulmonary Edema Abnormal accumulation of fluid in alveoli
Congestive heart failure (CHF) patients may experience difficulty breathing because of this Point to Emphasize: Pulmonary edema typically occurs due to a dysfunction of the left ventricle. Fluid accumulates in and around the alveoli and disrupts gas exchange. continued

Pulmonary Edema Pressure builds up in pulmonary capillaries
Fluid crosses the thin barrier and accumulates in and around alveoli Fluid occupying lower airways makes it difficult for oxygen to reach blood Patient experiences dyspnea Talking Points: Patients with CHF often have both left-sided heart failure and right-sided heart failure. Since the right side of the heart receives its blood from the systemic circulation, pressure backs up into the systemic circulation. This becomes visible as edema in the lower parts of the body, typically the lower legs. In bedridden patients, the legs are not the lowest part of the body. Instead, fluid accumulates in the sacral area of the lower back. Sometimes, the CHF patient will also have jugular vein distention (JVD) and accumulation of fluid in the abdominal cavity. continued

Pulmonary Edema Common signs and symptoms Dyspnea Anxiety
Pale and sweaty skin Tachycardia Hypertension Low oxygen saturation Talking Points: Patients frequently describe nocturnal dyspnea and weight gain leading up to the pulmonary edema event. Knowledge Application: Have students work in small groups. Assign one type of respiratory dysfunction to each group. Have the groups research their dysfunction and present their findings to the class. Findings should include a discussion of the ways in which their dysfunction interferes with normal function of the respiratory system. continued

Pulmonary Edema Common signs and symptoms
In severe cases, crackles or sometimes wheezes may be audible Patients may cough up frothy sputum, usually white, but sometimes pink-tinged continued

Pulmonary Edema Treatment Assess for and treat inadequate breathing
High-concentration oxygen If possible, keep patient’s legs in dependent position CPAP

Think About It Might it be possible for a patient to have multiple respiratory disorders? Could a person with an underlying diagnosis of COPD also have pulmonary edema? Talking Points: This is absolutely possible. In fact many COPD patients also have an underlying diagnosis of CHF. Often obtaining a specific cause of respiratory symptoms is challenging. In these cases EMTs must do their best to treat the symptoms in general and wait for a more precise diagnosis at the hospital.

Pneumonia Infection of one or both lungs caused by bacteria, viruses, or fungi Results from inhalation of certain microbes Microbes grow in lungs and cause inflammation Point to Emphasize: Pneumonia occurs due to an infection in the lungs and can interfere with normal gas exchange. continued

Pneumonia Signs and symptoms
Shortness of breath with or without exertion Coughing Fever and severe chills Chest pain (often sharp and pleuritic) Headache Pale, sweaty skin Fatigue Confusion Talking Points: Sometimes an older person will have only a few other signs or symptoms of pneumonia besides confusion. continued

Pneumonia Treatment Care mostly supportive
Assess for and treat inadequate breathing Oxygenate Transport

Spontaneous Pneumothorax
Lung collapses without injury or other obvious cause Tall, thin people, and smokers are at higher risk for this condition Point to Emphasize: A pneumothorax occurs when air builds up in the space between the lung and the chest wall. The pressure can collapse the lung. Talking Points: Spontaneous pneumothorax is usually the result of rupture of a bleb, a small section of the lung that is weak. Once the bleb ruptures, the lung collapses and air leaks into the thorax. continued

Signs and symptoms Sharp, pleuritic chest pain Decreased or absent lung sounds on side with injured lung Shortness of breath/dyspnea on exertion Low oxygen saturation, cyanosis Tachycardia Talking Points: As the severity of the pneumothorax increases, so will the level of symptoms. Auscultation is not always a reliable finding as some patients with a pneumothorax may have perfectly normal breath sounds. continued

Treatment Transport for definitive care, as patients frequently require chest tube Administer oxygen CPAP contraindicated Talking Points: Spontaneous pneumothorax patients can rapidly decompensate. Reassess frequently.

Pulmonary Embolism Blockage in blood supply to lungs
Commonly caused by deep vein thrombosis (DVT) Increased risk from limb immobility, local trauma, abnormally fast blood clotting Point to Emphasize: Pulmonary emboli are arterial obstructions in the pulmonary blood flow. These blockages can disrupt perfusion of lung tissue. Talking Points: Patients at increased risk for developing a DVT include women on birth control pills, patients with cancer, patients with lower extremity injuries (such as casted fractures), and anyone who is in the same position for a long period of time (such as transcontinental air travelers). continued

Pulmonary Embolism Signs and symptoms Chest pain Shortness of breath
Low oxygen saturation/cyanosis Tachycardia Wheezing Talking Points: Pulmonary embolism patients will present with very common signs and symptoms. Often differentiating these signs and symptoms from other disorders will be very difficult. continued

Pulmonary Embolism Treatment Difficult to differentiate in field
Transport to definitive care Oxygenate Discussion Topic: Describe the pathophysiology and treatment modalities of each of the following respiratory disorders: COPD, asthma, pulmonary edema, pneumothorax, pulmonary embolism, pneumonia. Critical Thinking: Finding the specific nature of the respiratory disorder often may not be possible. What common treatment steps can an EMT take, even when the diagnosis is unclear?

Epiglottitis Infection causing swelling around glottic opening
In severe cases, swelling can cause airway obstruction Talking Points: Epiglottitis used to be a disease of children, but it is now much less common in children than in adults in the United States. This is primarily the result of childhood vaccination against Haemophilus influenzae type B, the bacterium that used to cause most cases of epiglottitis in children. continued

Epiglottitis Signs and symptoms
Sore throat, drooling, difficult swallowing Preferred upright or tripod position Sick appearance Muffled voice Fever Stridor continued

Epiglottitis Treatment Keep patient calm and comfortable
Do not inspect throat Administer high-concentration oxygen if possible without alarming patient Transport

Cystic Fibrosis Genetic disease typically appearing in childhood
Causes thick, sticky mucus accumulating in the lungs and digestive system Mucus can cause life-threatening lung infections and serious digestion problems continued

Cystic Fibrosis Signs and symptoms
Coughing with large amounts of mucus Fatigue Frequent occurrences of pneumonia Abdominal pain and distention Coughing up blood Nausea Weight loss continued

Cystic Fibrosis Treatment
Caregiver often best resource for baseline assessment of patient Caregivers can often guide treatment Assess for, and treat, inadequate breathing Transport Knowledge Application: Use programmed patients and simulate specific respiratory dysfunctions. Have teams of students practice assessment and simulate care.

Viral Respiratory Infections
Infection of respiratory tract Usually minor but can be serious, especially in patients with underlying respiratory diseases like COPD continued

Viral Respiratory Infections
Often starts with sore or scratchy throat with sneezing, runny nose, and fatigue Fever and chills Infection can spread into lungs, causing shortness of breath Cough can be persistent; may produce yellow or greenish sputum Class Activity: Assign a research paper. Give students a specific topic and have them research and write a paper.

Chronic Obstructive Pulmonary Diseases Video
Video Clip Chronic Obstructive Pulmonary Diseases How old are most individuals when they are diagnosed with COPD? What are some of the causes associated with COPD? Describe the disease process of chronic bronchitis. What structures are affected most by emphysema? Differentiate between the presentation of a patient with chronic bronchitis and one with emphysema. Click here to view a video on the subject of chronic obstructive pulmonary diseases. Back to Directory

Spontaneous Pneumothorax Animation
Video Clip Spontaneous Pneumothorax What is a bleb? What usually causes a spontaneous pneumothorax? What signs and symptoms are common complaints associated with a spontaneous pneumothorax? What emergency care should an EMT provide to a patient with a spontaneous pneumothorax? Click here to view an animation on the subject of spontaneous pneumothorax. Back to Directory

The Prescribed Inhaler
Teaching Time: 15 minutes Teaching Tips: Have examples of metered-dose inhalers on hand. Allow students to familiarize themselves with the various types of inhalers. Training devices allow for simulation of the delivery of inhaled medications. This will allow students to practice the steps involved in using a metered-dose inhaler. Relate the use of a metered dose inhaler to pharmacology lessons learned in Chapter 18. Require students to consider the “five rights” prior to any administration of medications.

Metered-dose inhaler Provides a metered (exactly measured) inhaled dose of medication Most commonly prescribed for conditions causing bronchoconstriction Points to Emphasize: The metered-dose inhaler gets its name from the fact that each activation provides a measured dose of medication. A metered-dose inhaler is typically prescribed for patients with respiratory problems that cause bronchoconstriction. Knowledge Application: Have students use drug resources to research and then describe medications delivered in the form of metered-dose inhalers. Discuss indications. continued

Before administering inhaler Right patient, right medication, right dose, right route Check expiration date Shake inhaler vigorously Patient alert enough to use inhaler Use spacer device if patient has one Talking Points: As an EMT you may be allowed to assist a patient in using a prescribed inhaler. You will need to get permission from medical direction to help the patient use the inhaler. This may be accomplished by phone/radio or by standing order, depending on your local protocols. Art: Emergency Care 11 Ch. 16 PPT Slide 83

Spacer Device

To administer inhaler Have patient exhale deeply Have patient put lips around opening Press inhaler to activate spray as patient inhales deeply Make sure patient holds breath as long as possible so medication can be absorbed Point to Emphasize: Following the appropriate steps for administration of a metered-dose inhaler will optimize the delivery of inhaled medication. Discussion Topics: Explain how a metered dose inhaler delivers medication. List and describe the steps involved in administering a medication via a metered-dose inhaler. Knowledge Application: Have students work in small groups, with members taking turns explaining the use of metered-dose inhalers to each other (as they would for a patient). Critique and practice. Critical Thinking: Should metered-dose inhalers be administered to all patients with respiratory distress? What types of respiratory distress should not receive bronchodilator medications?

Using a Metered Dose Asthma Inhaler and Spacer Video
Video Clip Using a Metered Dose Asthma Inhaler and Spacer Explain how to use a metered-dose inhaler. Discuss how inhalers and spacers may vary in design, but reinforce that the process of using them remains the same. Click here to view a video on the subject of using a metered dose inhaler. Back to Directory

The Small-Volume Nebulizer
Teaching Time: 15 minutes Teaching Tips: Have examples of small-volume nebulizers on hand. Allow students to practice assembly and use. Simulate medication nebulization by using water. This provides a cheap and simple method of practicing the correct administration procedures. Build upon pathophysiology and pharmacology lessons that were discussed when reviewing metered-dose inhalers. Typically the same medications are used.

Medications in metered-dose inhalers can also be administered by a small-volume nebulizer (SVN) Nebulizing—running oxygen or air through liquid medication Patient breathes vapors created Points to Emphasize: Many medications administered in a metered-dose inhaler also can be administered through a small-volume nebulizer. Nebulization involves running oxygen or air through a liquid medication to create vapors that the patient can inhale. Talking Points: Small-volume nebulizers are often prescribed to treat chronic respiratory conditions such as asthma, emphysema, or chronic bronchitis. Knowledge Application: Have students work in small groups, with members taking turns explaining the use of a small-volume nebulizer. Critique each other and practice. continued

Produces continuous flow of aerosolized medication that can be taken in during multiple breaths over several minutes Gives patient greater exposure to medication Points to Emphasize: A nebulizer produces a continuous flow of aerosolized medication that can be taken in during multiple breaths over several minutes. Not all systems allow EMTs to use small-volume nebulizers. Providers always should follow local protocols. Discussion Topics: Explain the benefits of delivering respiratory medications through a small-volume nebulizer. Describe the steps involved in the proper administration of nebulized medications. Critical Thinking: You determine that a patient has inadequate respirations due to asthma. Should you administer inhaled respiratory medications immediately, or might you have other priorities?

Chapter Review

Chapter Review It is important to understand the anatomy, physiology, pathophysiology, assessment and care for patients experiencing respiratory emergencies. Patients with respiratory complaints may exhibit inadequate breathing. continued

Chapter Review Very slow and shallow respirations are often the end-point of a serious condition and are a precursor to death. continued

Chapter Review The history usually provides significant information about the patient’s condition. In addition to determining a pertinent past history and medications, determine the patient’s signs and symptoms with a detailed description including OPQRST and events leading up to the episode. continued

Chapter Review Important physical examination points include the patient’s work of breathing, accessory muscle use, pulse oximetry readings, assuring adequate and equal lung sounds bilaterally, and examining for excess fluid and vital signs. There are several medications which may help a patient’s difficulty breathing.

Remember Determine if the patient’s breathing is adequate, inadequate, or absent. Choose the appropriate oxygenation or ventilation therapy. continued

Remember Consider whether to assist a patient with or administer respiratory medications. Do I have protocols and medications that may help this patient? Does the patient have a presentation and condition that may fit these protocols? Are there any contraindications or risks to using medications in my protocols?

Questions to Consider What would you expect a patient’s respiratory rate to do when the patient gets hypoxic? Why? What would you expect a patient’s pulse rate to do when the patient gets hypoxic? Why? List the signs of inadequate breathing. Talking Points: In most patients the respiratory rate increases as the patient becomes hypoxic. However, the rate may slow as the patient fatigues. In adults, the heart rate generally increases as the patient becomes hypoxic. In children the heart rate often slows. The signs of inadequate breathing include improper rate, rhythm, altered mental status, and signs of hypoxia. continued

Questions to Consider Would you expect to assist a patient with their prescribed inhaler when they are experiencing congestive heart failure? Why or why not? List some differences between adult and infant/child respiratory systems. Talking Points: Inhalers are generally not used in CHF as they frequently cause increased cardiac workload. CHF patients typically do not benefit from this side effect and it can be dangerous. Children have smaller airways, larger tongues, more pliable chest walls and tracheas.

Critical Thinking A 72-year-old female complains of severe shortness of breath. Her husband notes she is confused. You note respiratory rate of 8 breaths/minute and cyanosis. Patient has a history of COPD and CHF. Discuss the treatment steps to assist this patient. Talking Points: With an altered mental status and a slow respiratory rate, this patient is in respiratory failure and needs immediate artificial ventilation. A more thorough assessment and history can be completed after the airway and breathing needs have been addressed.

Please visit Resource Central on www. bradybooks
Please visit Resource Central on to view additional resources for this text. Please visit our web site at and click on the mykit links to access content for this text. Under Instructor Resources, you will find curriculum information, lesson plans, PowerPoint slides, TestGen, and an electronic version of this instructor’s edition. Under Student Resources, you will find quizzes, critical thinking scenarios, weblinks, animations, and videos related to this chapter—and much more.

Introduction to Emergency Medical Care 1

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