Figure : 16-0101 Title: lungs and diaphragm - relaxed (photo w/overlay) Caption: The process of respiration.

Figure : 16-0102 Title: lungs and diaphragm - contracted (photo w/overlay) Caption: The process of respiration.

Figure : 16-0103 Title: lungs and diaphragm with arrows showing inspiration Caption: The process of respiration.

Figure : 16-0104 Title: lungs and diaphragm with arrows showing expiration Caption: The process of respiration.

Figure : 16-01-01T02 Title: Dupe new T6-1a Caption: Adequate breathing

Figure : 16-01-02T02 Title: Dupe new T6-1b Caption: Inadequate breathing

Figure : 16-01-03T02 Title: Dupe new T6-1c Caption: Patient is not breathing at all

Figure : 16-02 Title: signs/symptoms of breathing difficulty Caption: Signs and symptoms of breathing difficulty.

Figure : 16-03 Title: (art) Auscultation sites Caption: Auscultate for breath sounds on the upper and lower chest, the upper and lower back, and at the mid-axillary line

Figure : 16-04 Title: COPD patient Caption: A patient with chronic obstructive pulmonary disease (COPD)

Figure : 16-05 Title: bronchioles, healthy and diseased Caption: Chronic bronchitis and emphysema are chronic obstructive pulmonary diseases.

Figure : 16-06 Title: Spacer device Caption: A spacer between inhaler and patient makes the timing during inhaler use less critical.

Figure : 16-07 Title: Advair inhaler Caption: The Advair inhaler. (GlaxoSmithKline)

Figure : 16-07-01S0101 Title: inhaler: patient has indications Caption: The patient has the indications for use of an inhaler: signs and symptoms of breathing difficulty and an inhaler prescribed by a physician

Figure : 16-07-02S0102 Title: inhaler: contact medical direction Caption: Contact medical direction and obtain an order to assist the patient with the prescribed inhaler.

Figure : 16-07-04S0104 Title: inhaler: coach patient in use Caption: Coach the patient in the use of inhaler. Tell him he should exhale deeply, press inhaler to activate spray, inhale, and hold breath in so medication can be absorbed.

Figure : 16-07-05S0105 Title: inhaler: reassess patient Caption: After use of inhaler, reassess the patient: take vital signs, perform a focused exam, and determine if breathing is adequate

Figure : 16-07-06S02 Title: patient using prescribed inhaler without aerochamber Caption:

Figure : 16-07-07S02 Title Caption:

Figure : 16-07-08S0301 Title: Nebulizer scan photo a: Identify patient as a candidate for nebulized medication per protocol (e.g. asthma history with respiratory distress). Administer oxygen and assess vital signs. Be sure the patient is not allergic to the medication Caption: Identify patient as a candidate for nebulized medication per protocol (e.g., history of asthma with respiratory distress). Administer oxygen and assess vital signs. Be sure the patient is not allergic to the medication.

Figure : 16-07-09S0302 Title: Nebulizer scan photo b: Obtain permission from medical direction to administer or assist with the medication Caption: Obtain permission from medical direction to administer or assist with the medication.

Figure : 16-07-10S0303 Title: Nebulizer scan photo c: Assure the four rights. (right patient, right medication, right dose, right route) - EMT examines medication label ... Prepare the nebulizer. Put the liquid medication in the chamber. Attach the oxygen tubing and set oxygen flow for 6 - 8 liters per minute (or according to manufacturer's recommendations) Caption: Assure the four rights (right patient, right medication, right dose, right route). Prepare the nebulizer. Put the liquid medication in the chamber. Attach the oxygen tubing and set oxygen flow for 6–8 liters per minute (or according to manufacturer’s recommendations).

Figure : 16-07-11S0304 Title: Nebulizer scan photo d: Have the patient seal his lips around the mouthpiece and breathe deeply. Instruct the patient to hold his breath for 2 - 3 seconds if possible. Continue until medication is gone from the chamber Caption: Have the patient seal his lips around the mouthpiece and breathe deeply. Instruct the patient to hold his breath for 2 to 3 seconds if possible. Continue until medication is gone from the chamber.

Figure : 16-07-12S0305 Title: Nebulizer scan photo e: Alternative device - mask delivering medication Caption: Alternative device—a mask delivers the medication.

Figure : 16-07-13S0306 Title: Nebulizer scan photo f: Reassess the patient's level of distress and vital signs. Additional doses may be authorized by medical control if the patient continues to be in distress and the patient is not having adverse erects from the medication Caption: Reassess the patient’s level of distress and vital signs. Additional doses may be authorized by medical control if the patient continues to be in distress and the patient is not having adverse effects from the medication.

Figure : 16-07-14UN Title: sample documentation Caption: