Respiratory Emergencies

Anatomy Review Nose and mouth Pharynx –Oropharynx –Nasopharynx Epiglottis – a leaf-shaped structure that prevents food and liquid from entering the trachea during swallowing Trachea (windpipe) Cricoid cartilage – firm cartilage ring forming the lower portion of the larynx Larynx (voice box) Bronchi – two major branches of the trachea to the lungs. Bronchus subdivides into smaller air passages ending at the alveoli Alveoli – site of oxygen and carbon dioxide exchange

Adequate Breathing Normal Rate > Adult 12 – 20 bpm > Child 15 – 30 bpm > Infant 25 – 50 bpm Rhythm – regular Quality – Breath sounds diminished or absent Chest expansion – adequate/equal Depth (tidal volume) – normal/adequate (500cc/air)

Inadequate Breathing Rate – > outside normal ranges 29 Rhythm – irregular > Agonal respirations (dying respirations) are sporadic, irregular, or “gasping” Quality –  diminished or absent breath sounds  unequal chest expansion, use of accessory muscles. ** Children – seesaw breathing, nasal flaring, grunting, retractions. **Have smaller airways so easier to obstruct Skin –  pale or cyanotic, cool and clammy

Retractions

Flared Nostrils in an Infant

Artificial Ventilation (BVM/Pocket Mask) Chest should rise and fall with each ventilation. Exhalation (passive) –Diaphragm, ribs & muscles relax –Decrease in chest size –Diaphragm moves up Inhalation (active) –Diaphragm moves downward –Ribs move up and out –Air flows in

Breathing Difficulty This is subjective – need to do a thorough assessment.

Breathing Difficulty Signs and Symptoms –Shortness of breath –Restlessness –Noisy breathing – crowing, wheezing, gurgling, snoring, stridor (harsh sound/upper airway obstruction) –Silent chest – found in asthma patients –Inability to speak due to breathing efforts –Increased or decreased pulse rate –Skin color changes –Tripod position –Change in breathing rate –Unusual anatomy (barrel chest)

Barrel Chest

Emergency Care OPQRSTI Apply oxygen – how would you provide this????? Baseline vital signs Prescribed inhaler if available with medical direction

Diseases of the Respiratory System

Chronic Obstructive Pulmonary Disease (COPD) Examples > emphysema > chronic bronchitis > black lung *Found in middle age or older *Develops as tissues of the respiratory tract react to irritants – cigarettes most common

Emphysema *Walls of the alveoli break down, the lungs lose elasticity. Patient will develop a hypoxic drive. This patient will breathe based on the levels of oxygen in their system instead of the levels of carbon dioxide. *Amount of surface area has been reduced for respiratory exchange.

Lung Cancer Cells

Chronic Bronchitis Bronchiole lining is inflamed and excess mucus is formed Cilia have been damaged or destroyed

Black Lung Coal worker's pneumoconiosis – due to the inhalation of coal dust. Enlarged heart – suffer from right side heart failure.

Black Lung

pneumonoultramicroscopicsilicovolcanoconiosis

Asthma Can be triggered by an allergic reaction, pollutants, infection, exercise, etc. Young and old can have this Can be episodic There is an over production of thick mucus that close down the small passages restricting air flow.

Asthma

Pulmonary Edema Fluid in/around alveoli, small airwaysFluid in/around alveoli, small airways CausesCauses –Left heart failure –Toxic inhalants –Aspiration –Drowning –Trauma

Pulmonary Edema Signs/SymptomsSigns/Symptoms –Labored breathing –Coughing –Rales, rhonchi, crackles –Wheezes –Pink, frothy sputum –Increased swelling in the extremities

Pulmonary Edema ManagementManagement –Place the patient in a full fowlers position –High concentration O 2 –Assist ventilation –Be prepared to suction

Pulmonary Embolism Clot from venous circulationClot from venous circulation Passes through right side of the heartPasses through right side of the heart Lodges in pulmonary circulationLodges in pulmonary circulation Shuts off blood flow past part of alveoliShuts off blood flow past part of alveoli

Pulmonary Embolism Associated with:Associated with: –Prolonged bed rest or immobilization –Casts or orthopedic traction –Pelvic or lower extremity surgery –Phlebitis – inflammation of a vein

Pulmonary Embolism Signs/SymptomsSigns/Symptoms –Dyspnea –Chest pain –Tachycardia –Hemoptysis – coughing up blood Sudden Dyspnea + No Readily Identifiable Cause = Pulmonary Embolism

Pulmonary Embolism ManagementManagement –Oxygen –Assisted ventilation –Transport

Respiratory Emergencies in Infants & Children EpiglottitisEpiglottitis –Bacterial infection –Causes edema of the epiglottis –Children age 4-7 years –Rapid onset, high fever, stridor, sore throat, excessive drooling –Can progress to complete obstruction –Do not look in throat –Do not use obstructed airway maneuver

Respiratory Emergencies in Infants & Children CroupCroup –Viral infection –Causes edema of larynx/trachea –Children ages 6 months to 4 years –Slow onset, mild fever, hoarseness, brassy cough, nightime stridor (seal-like bark), dyspnea –Looks less ill than epiglottis patient –When in doubt, manage as epiglottitis

Respiratory Emergencies in Infants & Children Croup/EpiglottitisCroup/Epiglottitis –Management Blow-by oxygenBlow-by oxygen Assist ventilations as neededAssist ventilations as needed Do not excite patientDo not excite patient DO NOT look or stick anything in the throatDO NOT look or stick anything in the throat Cool night air or steam from a shower may help a child with croupCool night air or steam from a shower may help a child with croup Consider ALS interceptConsider ALS intercept