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Caring for Respiratory Emergencies

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Presentation on theme: "Caring for Respiratory Emergencies"— Presentation transcript:

1 Caring for Respiratory Emergencies
14 Caring for Respiratory Emergencies

2 Review respiratory anatomy and physiology in Chapter 4.
Objectives Review respiratory anatomy and physiology in Chapter 4. Define the following terms: Accessory muscles Asthma Bronchitis Chronic Obstructive Pulmonary Disease (COPD) Cyanosis Dyspnea Emphysema Hypercarbia (continued)

3 Define the following terms:
Objectives Define the following terms: Hyperventilation Hypoxia Respiratory compromise Respiratory distress Respiratory failure Tripod position Wheezing (continued)

4 Explain common causes of respiratory compromise.
Objectives Explain common causes of respiratory compromise. Describe the signs and symptoms of a patient experiencing respiratory compromise. Explain the pathophysiology of respiratory compromise. Describe the appropriate assessment and care for a patient experiencing respiratory compromise. (continued)

5 Recognize the fear that a respiratory emergency can cause.
Objectives Demonstrate the ability to appropriately assess and care for a patient experiencing respiratory compromise. Recognize the fear that a respiratory emergency can cause. Value the importance of reassurance when caring for a patient with a respiratory emergency.

6 Media Slide 19 Asthma Video Slide 20 Angina Video Slide 21 Chronic Obstructive Pulmonary Disease Video

7 Topics Overview of Respiratory Anatomy Respiratory Compromise

8 OVERVIEW OF RESPIRATORY ANATOMY

9 Overview of Respiratory Anatomy
Pathways where air enters body (nose and mouth); areas at back of throat (nasopharynx and oropharynx). Oropharynx leads down throat into top of trachea (larynx), where vocal chords are positioned. Class Activity: Direct students to tilt their head back and feel the front of their neck to note the ridges of their trachea (sometimes referred to as the “windpipe.”) (continued)

10 Overview of the respiratory system.

11 Overview of Respiratory Anatomy
Upper airway All spaces and structures above vocal chords. Lower airway All structures and spaces below vocal chords. Carina Where trachea splits into right and left main stem bronchi. Class Activity: Dissect a sheep/cow trachea and lungs. Identify key structures. (continued)

12 Overview of Respiratory Anatomy
Bronchioles Smaller airways. Alveoli Where exchange of oxygen and carbon dioxide takes place. Control center for respiratory is within the brain. Talking Point: Victims of trauma can lose their ability to breathe on their own when the respiratory control center is cut off due to a spinal cord injury; such was the case with actor Christopher Reeve. (continued)

13 Think About It What two functions does respiration accomplish?
What mechanical problems might impede the movement of air?

14 RESPIRATORY COMPROMISE

15 Respiratory Compromise
Inability of person to breath adequately. Hypoxia: when the body's cells do not receive adequate supply of oxygen. Signs: altered mental status, pale skin, cyanosis of nail beds/mucous membranes. Hypercarbia: condition of having too much carbon dioxide in blood. Critical Thinking: What does cyanosis of the nail beds and mucous membranes look like? Why is it so important to recognize? Answer: Cyanosis is a blue tinge to the skin; it's a sign that requires immediate action!

16 Respiratory Compromise
Respiratory Distress (Dyspnea) Result of not getting adequate supply of oxygen; increased in levels of carbon dioxide in blood Increased work of breathing Increased respiratory rate Use of accessory muscles Critical Thinking: Why should the EMR ensure that an Advanced Life Support (ALS with paramedics) is dispatched to the patient with respiratory distress?

17 Respiratory Compromise
Respiratory Failure When body's normal compensatory mechanisms fail. Breathing rate begins to slow. Tidal volume begins to get shallower. Talking Point: Respiratory Failure is a critical emergency. Respiratory failure can rapidly lead to respiratory arrest.

18 Respiratory Compromise
Common causes: Hyperventilation Asthma Chronic bronchitis Emphysema Exposure to poison Allergic reaction Discussion Question: Is it important to learn what is causing respiratory compromise before beginning treatment? Answer: No! Treatment for dyspnea should be initiated immediately.

19 Click here to view a video on the topic of asthma.
BACK TO DIRECTORY

20 Click here to view a video on the topic of angina.
BACK TO DIRECTORY

21 Click here to view a video on the topic of chronic obstructive pulmonary disease.
BACK TO DIRECTORY

22 Respiratory Compromise
Normal Breathing Sufficient to support life. Easy and effortless (adequate). Do not work hard to breathe. Able to speak full sentences without having to catch breath. Normal respiratory rate, depth, and very little effort or work of breathing.

23 Respiratory Compromise
Characteristics of Normal Breathing Normal rate (number breaths per minute): 12 to 24 for adult; 16 to 32 for child; 24 to 48 for infant. Normal depth (size of each breath): tidal volume; normal breaths not too shallow and not too deep. Class Activity: Using a watch or clock with a sweep hand; direct students to work in pairs to determine the respiratory rate of their partner; share results. (continued)

24 Respiratory Compromise
Characteristics of Normal Breathing Work of breathing: effort it takes for patient to move each breath in and out. Respiratory rhythm regular.

25 Respiratory Compromise
Abnormal Breathing Inadequate; not sufficient to support life. Left untreated, will result in death. Common signs: Increased work of breathing Increased respiratory rate Critical Thinking: If respiratory compromise can lead to respiratory arrest, what can respiratory arrest soon lead to? Answer: Cardiac arrest. (continued)

26 Respiratory Compromise
Abnormal Breathing Common signs: Decreased respiratory rate Respirations that are too deep or too shallow Irregular breathing rhythm Audible breath sounds (gurgling, snoring or wheezing) (continued)

27 Respiratory Compromise
Abnormal Breathing Tripod position: seated or standing with hands on knees, shoulders arched upward, head forward. Accessory muscles: muscles of neck, chest, abdomen that assist during respiratory difficulty. Critical Thinking: What is the purpose of the tripod position? Class Activity: Direct students to slouch in chair and observe own breathing; next have students sit in the tripod position and observe their breathing. They should notice the reduction of effort.

28 Signs and symptoms of respiratory distress.
Talking Point: This patient is in trouble! Signs and symptoms of respiratory distress.

29 Respiratory Compromise
Signs and Symptoms of Respiratory Compromise Labored or difficulty breathing; a feeling of suffocation. Audible breathing sounds. Rapid or slow rate of breathing. Abnormal pulse rate (too fast or too slow). (continued)

30 Respiratory Compromise
Signs and Symptoms of Respiratory Compromise Changes in skin color, particularly of lips and nail beds. Tripod position. Altered mental status. Critical Thinking: Why would a patient suffering from respiratory compromise experience altered mental status? Answer: They're not getting sufficient oxygen to the brain.

31 Respiratory Compromise
Chronic Obstructive Pulmonary Disease Conditions: asthma, chronic bronchitis, emphysema Signs and symptoms: History of heavy cigarette smoking Persistent cough Chronic shortness of breath Pursed-lip breathing Talking Point: Many patients with COPD from advanced emphysema have oxygen delivered to their home. They typically receive oxygen via nasal cannula. (continued)

32 Respiratory Compromise
Chronic Obstructive Pulmonary Disease Signs and symptoms: Maintaining tripod position Fatigue Tightness in chest Wheezing

33 Respiratory Compromise
Asthma Condition affecting lungs, characterized by narrowing of air passages and wheezing. Caused by sensitivity to irritants (pollen, pollutants, exercise). Narrowing air passages cause wheezing. Talking Point: Patients having an asthma attack are usually aware of their history of asthma and may have medication inhalers on scene. (continued)

34 Respiratory Compromise
Asthma Signs and symptoms: Moderate to severe shortness of breath Wheezing Anxiety Nonproductive cough (continued)

35 Asthma causes the bronchioles to become narrow and filled with mucus.

36 Respiratory Compromise
Asthma Little/no symptoms between attacks. Medication in metered-dose inhaler. Critical Thinking: Why do some asthma sufferers wait to call EMS until it appears to be “too late”? Answer: Many asthma sufferers experience attacks frequently and are often able to gain control of their attacks by self-medicating with their prescribed inhalers. At times, their attack rapidly progresses and Advanced Life Support Paramedics are needed. (continued)

37 Metered-Dose Inhaler

38 Metered-Dose Inhaler with Spacer

39 Respiratory Compromise
Asthma If left untreated, asthma attack can be severe enough to cause respiratory arrest and even death. Critical Thinking: Why do some asthma sufferers wait to call EMS until it appears to be “too late”? Answer: Many asthma sufferers experience attacks frequently and are often able to gain control of their attacks by self-medicating with their prescribed inhalers. At times, their attack rapidly progresses and Advanced Life Support Paramedics are needed.

40 Respiratory Compromise
Bronchitis Causes swelling and thickening of walls of bronchi and bronchioles. Causes overproduction of mucus in air passages. Chronic bronchitis: productive cough for three consecutive months and occurs at least two consecutive years. (continued)

41 Emphysema affects the alveoli, and bronchitis affects the bronchioles.

42 Emphysema affects the alveoli, and bronchitis affects the bronchioles.

43 Emphysema affects the alveoli, and bronchitis affects the bronchioles.

44 Respiratory Compromise
Bronchitis Signs and symptoms: Overweight Mild to moderate shortness of breath Pale complexion Productive cough Wheezes Critical Thinking: What causes wheezing? How can it be recognized?

45 Respiratory Compromise
Emphysema Associated with cigarette smoking; disease of lungs that causes permanent damage to alveoli. Causes destruction of alveoli, making them useless for exchange of oxygen and carbon dioxide. (continued)

46 Respiratory Compromise
Emphysema Loss of lung elasticity and accumulation of air cause chest wall to become extended over time; “barrel chest.” Class Activity: Distribute a drinking straw to each student. Direct them to attempt to breathe through the straw to simulate the feeling that patient's with emphysema experience. (continued)

47 Respiratory Compromise
Emphysema Signs and symptoms: Moderate to severe shortness of breath Very thin in appearance Large chest (barrel chest) Nonproductive cough Extended exhalations

48 Respiratory Compromise
Hyperventilation Syndrome Occurs when person breathes out and eliminates excess amount of carbon dioxide. Most cases caused by anxiety and do not represent medical emergency. (continued)

49 Respiratory Compromise
Hyperventilation Syndrome Can be a sign of something serious. Be alert for cyanosis. Monitor for changes in vital signs. Reduce anxiety by reassuring and comforting patient. Critical Thinking: What serious medical condition could cause hyperventilation? Answer: Myocardial Infarction (heart attack). Patients suffering a heart attack may feel a sense of impending doom which is frightening and can lead to hyperventilation. (continued)

50 Respiratory Compromise
Hyperventilation Syndrome Signs and symptoms: Moderate to severe shortness of breath Anxiety Numbness or tingling of fingers, lips, and/or toes Dizziness Spasm of fingers and/or toes Chest discomfort Critical Thinking: How can the EMR tell if someone is having a true respiratory emergency or is simply hyperventilating due to anxiety? Answer: The EMR must treat all patients with respiratory distress as a true emergency regardless of the underlying cause. When hyperventilation is suspected, focus on calming the patient in a reassuring, comforting manner. Never withhold oxygen from a patient who is experiencing shortness of breath.

51 Respiratory Compromise
Emergency Care for Respiratory Compromise Observe body language. Determine characteristics of breathing. Pay attention to level of distress and facial expression. Reassure patient. Talking Point: The EMR can help reduce the stress that the respiratory compromise patient feels by providing reassurance and comfort. (continued)

52 Respiratory Compromise
Emergency Care for Respiratory Compromise Gather a history. Ability to speak clearly and in full sentences. Listen for sounds as patient breathes.

53 Respiratory Compromise
Take appropriate BSI precautions. Perform primary assessment; support ABCs. Ensure patent airway; administer oxygen per local protocols. Allow patient to maintain position of comfort. Arrange for ALS response if available. Critical Thinking: In what position will the patient experiencing respiratory distress most likely be most comfortable? Answer: Fowler's (continued)

54 Respiratory Compromise
Assist with prescribed medication per local protocols and medical direction. Obtain vital signs. Continue to monitor patient and provide reassurance. Teaching Tip: Review local protocols for assisting with prescribed medications.

55 Algorithm for emergency care of patients with respiratory distress.

56 Respiratory Compromise
Positive Pressure Ventilations Use bag-mask device to provide rescue breaths when breathing determined to be inadequate. Place mask firmly over patient's face; provide rescue breaths at rate appropriate for patient's age. Talking Point: Providing rescue breaths via bag-mask is done if a patient loses consciousness.

57 When breathing is inadequate, provide positive pressure ventilations with a bag-mask device.

58 Respiratory Compromise
Metered-Dose Inhalers (MDI) Small device that stores and delivers medication that patient inhales into lungs. Encourage patient to take medication exactly as prescribed. Check expiration date. Discussion Question: What information can the EMR be ready to provide to EMS in the verbal report for patients prescribed a metered-dose inhaler?

59 Think About It You are treating a patient with severe respiratory distress. You notice that his/her respiratory rate is slowing down. Is this a good sign or bad sign? How would you tell the difference? Would your observation warrant updating the responding ambulance?

60 SUMMARY

61 Summary Respiratory compromise is one of the most common calls encountered. Causes include asthma, bronchitis, emphysema, hyperventilation. Characterized by increased work of breathing, increased breathing rate, use of accessory muscles.

62 Summary Left untreated, can lead to respiratory failure; respiratory arrest; death. Asthma: disease of the lower airways characterized by spasm and swelling of bronchioles, resulting in narrowing of airways. Triggered by allergies, dust, stress, and/or exercise.

63 Summary Bronchitis: inflammation of bronchi and bronchioles.
Results in overproduction of mucus over inside lining of airways; may last for months at a time. Characterized by productive cough.

64 Summary Emphysema: loss of elasticity of lung tissue and destruction of alveoli. Results in poor gas exchange and trapping of excess carbon dioxide within lungs. Slow, progressive disease that results in severe respiratory distress.

65 Summary Hyperventilation syndrome: associated with situations of high stress or anxiety. Begins when stress of situation causes patient to breath fast. If not controlled, will result in loss of too much carbon dioxide. Usually treated by helping patient calm down and control breathing.

66 Summary Care includes support of ABCs, providing supplemental oxygen, calming and reassuring patient. Allow patient to maintain position of comfort and do not force patient to lie down unless unresponsive.

67 Summary Often a true emergency, and rapid transport by ALS ambulance is often most appropriate care. If available, encourage patient to self-administer prescribed meter-dose inhaler as prescribed.

68 REVIEW QUESTIONS

69 What are the common causes of respiratory compromise?
Review Questions What are the common causes of respiratory compromise? What are the signs and symptoms of a patient experiencing respiratory compromise? Why is it important to recognize the fear that a respiratory emergency can cause? What is the appropriate assessment and care for a patient experiencing respiratory compromise?

70 Please visit www. bradybooks
Please visit and follow the Resource Central links to access content for this text.


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