Section 4: Medical Emergencies

Respiratory Emergencies Chapter 10 Respiratory Emergencies

Objectives (1 of 2) List the structure and function of the respiratory system. State the signs and symptoms of a patient with difficulty breathing. Describe the emergency medical care of the patient with breathing difficulty.

Objectives (2 of 2) Distinguish between the emergency medical care of the infant, child, and adult patient with breathing difficulty. Describe the special considerations due to high altitude. Defend OEC treatment regimens for various respiratory emergencies. Demonstrate the emergency medical care for breathing difficulty.

Respiratory System

Anatomy and Function of the Lung

Characteristics of Poor Breathing Pulmonary vessels become obstructed. Alveoli are damaged. Air passages are obstructed. Blood flow to the lungs is obstructed. Pleural space is filled.

Characteristics of Normal Breathing Normal rate and depth Regular breathing pattern Good breath sounds on both sides of the chest Equal rise and fall of chest Movement of the abdomen

Signs of Abnormal Breathing Slower than 8 breaths/min or faster than 24 breaths/min Muscle retractions Pale or cyanotic skin Cool, damp (clammy) skin Shallow or irregular respirations Pursed lips Nasal flaring

Dyspnea Shortness of breath or difficulty breathing Patient may not be alert enough to complain of shortness of breath.

Upper or Lower Airway Infection Infectious diseases may affect all parts of the airway. The problem is some form of obstruction to the air flow or the exchange of gases.

Acute Pulmonary Edema Fluid build-up in the lungs Signs and symptoms Dyspnea Frothy pink sputum History of chronic congestive heart failure Recurrence high

Chronic Obstructive Pulmonary Disease (COPD) COPD is the result of direct lung and airway damage from repeated infections or inhalation of toxic agents. Bronchitis and emphysema are two common types of COPD. Abnormal breath sounds may be present. Rhonchi and wheezes

Spontaneous Pneumothorax Accumulation of air in the pleural space Caused by trauma or some medical conditions Dyspnea and sharp chest pain on one side Absent or decreased breath sounds on one side

Asthma or Allergic Reactions Asthma is an acute spasm of the bronchioles. Wheezing may be audible without a stethoscope. An allergen can trigger an asthma attack. Asthma and anaphylactic reactions can be similar.

Pleural Effusion Collection of fluid outside lung Causes dyspnea Caused by irritation, infection, or cancer Decreased breath sounds over region of the chest where fluid has moved the lung away from the chest wall Eased if patient is sitting up

Mechanical Obstruction of the Airway Be prepared to treat quickly. Obstruction may result from the position of the head, the tongue, aspiration of vomitus, or a foreign body. Opening the airway with the head tilt-chin lift maneuver may solve the problem.

Pulmonary Embolism A blood clot that breaks off and circulates through the venous system Signs and symptoms Dyspnea Acute pleuritic pain Hemoptysis Cyanosis Tachypnea Varying degrees of hypoxia

Hyperventilation Overbreathing resulting in a decrease in the level of carbon dioxide Signs and symptoms Anxiety Numbness A sense of dyspnea despite rapid breathing Dizziness Tingling in hands and feet

Treatment of Dyspnea Perform initial assessment. Place the patient on oxygen. If patient is in respiratory distress, ventilate. Check pulse.

Signs and Symptoms (1 of 2) Difficulty breathing Anxiety or restlessness Decreased respirations Cyanosis Abnormal breath sounds Difficulty speaking Accessory muscles

Signs and Symptoms (2 of 2) Altered mental status Coughing Irregular breathing rhythm Tripod position Barrel chest Pale conjunctivae Increased pulse and respirations

Emergency Medical Care Give supplemental oxygen at 10 to 15 L/min via nonrebreathing mask. Patients with longstanding COPD may be started on low-flow oxygen (2 L/min). Assist with inhaler if available. Consult medical control.

Inhaler Medications Trade names Generic names Proventil Albuterol Ventolin Alupent Metaprel Brethine Generic names Albuterol Metaproterenol Terbutaline

Prescribed Inhalers Actions Relax the muscles surrounding the bronchioles Enlarge the airways leading to easier passage of air Side effects Increased pulse rate Nervousness Muscle tremors

Prior to Administration Read label carefully. Verify it has been prescribed by a physician for this patient. Consult medical control. Make sure the medication is indicated. Check for contraindications.

Contraindications for MDI Patient unable to help coordinate inhalation Inhaler not prescribed for patient No permission from medical control Maximum dose prescribed has been taken

Administration of MDI (1 of 3) Obtain order from medical control or local protocol. Check for right medication, right patient, right route. Make sure the patient is alert. Check the expiration date. Check how many doses have been taken.

Administration of MDI (2 of 3) Make sure inhaler is at room temperature or warmer. Shake inhaler. Stop administration of oxygen. Ask the patient to exhale deeply and put lips around opening. If the inhaler has a spacer, use it.

Administration of MDI (3 of 3) Have the patient depress the inhaler and inhale deeply. Instruct the patient to hold his or her breath. Continue administration of oxygen. Allow the patient to breathe a few times, then repeat dose according to protocol.

Reassessment Carefully watch for shortness of breath. 5 minutes after administration: Obtain vital signs again. Perform focused reassessment. Transport and continue to assess breathing.

Upper or Lower Airway Infection Administer warm, humidified oxygen. Do not attempt to suction the airway or insert an oropharyngeal airway in a patient with suspected epiglottitis. Transport patient in position of comfort.

Acute Pulmonary Edema Administer 100% oxygen. Suction secretions. Transport in position of comfort.

Chronic Obstructive Pulmonary Disease (COPD) Assist with prescribed inhaler if patient has one. Transport promptly in position of comfort.

Spontaneous Pneumothorax Administer oxygen. Transport in position of comfort. Monitor closely.

Asthma or Allergic Reactions Obtain history. Assess vitals signs. Assist with inhaler if patient has one. Administer oxygen. Transport promptly.

Pleural Effusion Definitive treatment is performed in a hospital. Administer oxygen and support measures. Transport promptly.

Mechanical Obstruction of the Airway Clear airway. Administer oxygen. Transport promptly.

Pulmonary Embolism Administer oxygen. Place patient in comfortable position, usually sitting. Assist breathing as necessary. Keep airway clear. Transport promptly.

Hyperventilation Complete initial assessment and history of the event. Assume underlying problems. Do not have patient breathe into a paper bag. Give oxygen. Reassure patient and transport.