Respiratory Emergencies Chapter 13 Respiratory Emergencies 1

Objectives 13.1 Define the following terms: diffusion dyspnea respiration 13.2 List the major anatomical structures of the lower airway. 13.3 Identify the primary muscle of respiration. 13.4 List the accessory muscles of respiration. 13.5 Describe the physiology of breathing. continued 2

Objectives 13.6 Compare and contrast normal breathing and abnormal breathing. 13.7 List the normal breathing rate for individuals in the following age groups: infant child adult 13.8 Identify the most common cause of airway obstruction. continued 3

Objectives 13.9 List the signs and symptoms of acute respiratory distress. 13.10 List the signs and symptoms of the following respiratory emergencies: asthma COPD hyperventilation pulmonary embolism spontaneous pneumothorax continued 4

Objectives 13.11 Describe and demonstrate how to assess a patient who is having difficulty breathing. 13.12 Describe and demonstrate the appropriate treatment of a patient in respiratory distress. 5

Topics Anatomy and Physiology Common Respiratory Emergencies Assessment Management Inhalers

Case Presentation You respond to evaluate a patient with “breathing problems.” Upon arrival, you find a 62-year-old male complaining of severe shortness of breath, cough, and chest pain. Additional questioning reveals the man is from out of state and took the gondola to the top to see the view before the gondola stopped running. He hiked around the summit with his wife for about 30 minutes before he began to have breathing problems. The patient admits to a long history of cigarette smoking and appears to be in considerable distress. Discussion Point – What should you do?

Anatomy and Physiology Lower Airway Normal Breathing Discussion Points: List the major anatomical structures of the lower airway. Identify the primary muscle of respiration. List the accessory muscles of respiration.

Anatomy and Physiology Copyright Eddie Lawrence/ Dorling Kindersley Media Library

Anatomy and Physiology

Anatomy and Physiology Copyright Dorling Kindersley Media Library

Common Respiratory Emergencies Obstruction/Choking Chronic Obstructive Pulmonary Disease Asthma Hyperventilation Syndrome Discussion Points: Compare and contrast normal and abnormal breathing List the normal breathing rate for the following:  Infant  Child  Adult continued

Common Respiratory Emergencies continued

Common Respiratory Emergencies continued

Common Respiratory Emergencies continued

Common Respiratory Emergencies Pulmonary Embolus Spontaneous Pneumothorax Other Respiratory System-Related Conditions Discussion Points: Identify the most common cause of airway obstruction. List the signs and symptoms of acute respiratory distress.

Common Respiratory Emergencies

Common Respiratory Emergencies

Case Update You notify dispatch to have ALS awaiting the patient’s arrival at the gondola base and then place the patient on a non-rebreather mask at 15 LPM of supplemental oxygen. He is diaphoretic, somewhat pale, and is sitting upright in a tripod position. Audible wheezing is noted during his single-word responses to questions. His heart rate is 118, respiratory rate is 42 and shallow, and he has a blood pressure of 168/104. She removes the patient’s inhaler from her purse and hands it to you. Discussion Point: What do you think is wrong? What should you do? 19

Assessment ABCDs AVPU Signs and symptoms of dyspnea Choking or gagging Inability to speak Open mouth breathing Panting, gasping Discussion Points: List the signs and symptoms of acute respiratory distress. continued

Assessment continued

Assessment Signs and symptoms of dyspnea Breathing through pursed lips Tachypnea (> 30 RPM, adult) Bradypnea (< 10 RPM, adult) Cyanosis Nasal flaring Tracheal tugging Level of responsiveness changes Discussion Points: List the signs and symptoms of the following respiratory emergencies:  Asthma  COPD  Hyperventilation  Pulmonary embolus  Spontaneous pneumothorax

Management Determine if patient is choking Speak Conscious Oxygen High Fowler’s Tripod Oxygen Mask Cannula Pulmonary Embolism Discussion Points: Describe and demonstrate how to assess a patient with difficulty breathing.

Management Copyright Edward McNamara

Inhalers MDI Do not use another person’s Steps for assisting a patient Discussion Points: Describe and demonstrate the appropriate treatment of a patient with respiratory distress.

Inhalers Copyright Edward McNamara

Inhalers

Case Disposition You believe the patient is in an acute respiratory distress due to an asthma attack. You quickly obtain a SAMPLE history and perform a secondary assessment. You assist the patient in self- administering his albuterol inhaler. During the trip down, you continue administering supplemental high- flow oxygen with a non-rebreather mask and monitor the patient’s vital signs and breath sounds. By the time you reach the base, the patient appears to be breathing much easier. You give a quick hand-off report to ALS providers. Discussion Point: List SAMPLE. What would the hand off report would include? 28

Chapter Summary Respiratory emergencies are among the most common emergencies that the OEC technician will face. Respiratory emergencies are among the most urgent cries for help that you will receive as an OEC technician. Discussion Point: Name signs and symptoms for respiratory emergencies. continued

Chapter Summary The ability to identify quickly the signs and symptoms of acute respiratory distress and provide life-saving interventions can truly save a person’s life. OEC technicians must provide an airway and administer oxygen when needed. Discussion Point: Review oxygen flow for various situations. continued

Chapter Summary Although respiratory emergencies can be very frightening for both the patient and rescuer alike, with early recognition and rapid intervention, OEC technicians can dramatically reduce the morbidity and mortality associated with this common emergency. continued

Chapter Summary Accessory muscle use is a sign of acute respiratory failure. Start oxygen therapy high and titrate low. Check your local, state, or provincial protocols to determine if you may assist a patient in the self-administration of a metered dose inhaler. Discussion Point: What is our state provincial protocol for administration of inhaler? continued 32

Chapter Summary In a patient with significant respiratory distress, use high flow oxygen with a non-rebreather mask The most common obstruction of the airway is the tongue Discussion Point: How do you lift the tongue off the airway? 33

Chapter Summary Establish protocols following local, state, or provincial laws in order to provide patients oxygen, with your local medical advisor's assistance. Discussion Point: Review protocols following local, state, or provincial laws to provide patients oxygen. 34