1. Section 4: Medical Emergencies

2. Respiratory Emergencies
Chapter 10
Respiratory Emergencies

3. 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.

4. 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.

5. Respiratory System

6. Anatomy and Function of the Lung

7. 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.

8. 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

9. 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

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

11. 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.

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

13. 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

14. 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

15. 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.

16. 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

17. 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.

18. 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

19. 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

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

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

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

23. 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.

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

25. 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

26. 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.

27. 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

28. 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.

29. 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.

30. 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.

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

32. 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.

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

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

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

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

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

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

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

40. 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.