Respiratory Emergencies CHAPTER 17. Anyone who has experienced respiratory difficulty knows that the...
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Respiratory Respiratory EmergenciesEmergencies
CH
AP
TER
17
CH
AP
TER
17
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Anyone who has
experienced respiratory
difficulty knows that the
inability to breathe is
TERRIFYING!
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Respiratory System Respiratory System ReviewReviewRespiratory System Respiratory System ReviewReview
AnatomyAnatomy
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Respiratory System Anatomy
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The Upper Airway
NasopharynxNasopharynx
OropharynxOropharynx
EpiglottisEpiglottis
Vocal cordsVocal cords
TracheaTrachea
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The Lower Airway
UpperUpperlobelobe
MiddleMiddlelobelobe
LowerLowerlobelobe
TracheaTrachea
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Due to their
anatomy,
Infants and
children are
more prone
to
respiratory
emergencies
.
Adult (20 mm)
Infant(4
mm)
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PhysiologyPhysiologyPhysiologyPhysiology
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BreathingBreathingInhalationInhalation ExhalationExhalation
Chest Chest contractscontracts
Chest Chest relaxesrelaxes
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Alveolar/capillary Alveolar/capillary interfaceinterface
Cellular/capillary Cellular/capillary interfaceinterface
Alveolus
Body cells
Gas ExchangeGas Exchange
Blood
Blood
Capillary
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Breathing AssessmentBreathing AssessmentBreathing AssessmentBreathing Assessment
Adequate BreathingAdequate Breathing
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Normal Respiratory Rates Normal Respiratory Rates
Adult:Adult: 12 - 20/minute12 - 20/minute
Children:Children: 15 - 30/minute15 - 30/minute
Infants:Infants: 25 - 50/minute25 - 50/minute
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Normal Breathing Normal Breathing Both lungs expand equallyBoth lungs expand equally
Breath sounds are present and equalBreath sounds are present and equal
Chest wall expands equally on both sidesChest wall expands equally on both sides
Breathing takes place with little effortBreathing takes place with little effort
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Listen forListen for breath soundsbreath sounds at four at four points.points.
MidaxillaryMidaxillaryLineLine
MidclavicularMidclavicularLineLine
2345
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Use a Use a stethoscopestethoscope to listen to to listen to
breath sounds.breath sounds.
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Tidal volume:Tidal volume:
Amount of air exchanged in Amount of air exchanged in one breath.one breath.
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Breathing Breathing DifficultyDifficulty
Breathing Breathing DifficultyDifficulty
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Patients who are Patients who are breathingbreathing TOO FASTTOO FAST oror TOO SLOWLYTOO SLOWLY
may not be receiving may not be receiving adequate amounts of adequate amounts of oxygen.oxygen.
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Difficulty Breathing Difficulty Breathing GeneralGeneral
Shortness of breathShortness of breath Restlessness or anxietyRestlessness or anxiety Patient position Patient position (preference for sitting up)(preference for sitting up) Altered mental statusAltered mental status Skin cool and/or clammySkin cool and/or clammy Increased or decreased breathing rateIncreased or decreased breathing rate Increased pulse rate Increased pulse rate (increased or decreased in infants and children)(increased or decreased in infants and children)
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Difficulty Breathing continued Difficulty Breathing continued VisualVisual
Skin color Skin color (blue-gray, pale, flushed)(blue-gray, pale, flushed) Unusual anatomyUnusual anatomy Retractions/use of accessory musclesRetractions/use of accessory muscles Abdominal breathingAbdominal breathing Nasal flaringNasal flaring
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AuditoryAuditory Noisy breathingNoisy breathing Inability to speak due to breathing effortsInability to speak due to breathing efforts CoughingCoughing Irregular breathing rhythmIrregular breathing rhythm Unequal breath soundsUnequal breath sounds
Difficulty Breathing continued Difficulty Breathing continued
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Retractions may indicate labored breathing.
SternalSternal
SupraclavicularSupraclavicular
IntercostalIntercostal
SubsternalSubsternal
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Nasal Flaring
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Stridor:Stridor:
A harsh sound heard during A harsh sound heard during breathing (usually inhalation) that breathing (usually inhalation) that indicates an upper airway indicates an upper airway obstruction.obstruction.
Obstruction may be due to: Swelling Mucous Disease Foreign body
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Barrel Chest
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Agonal respirations:Agonal respirations:
Gasping respirations that are Gasping respirations that are sudden, short inspirations with sudden, short inspirations with long pauses in between.long pauses in between.
Often occurs just before death - a grave sign!
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Focused History and Focused History and Physical Physical
ExaminationExamination
Focused History and Focused History and Physical Physical
ExaminationExamination
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O O nsetnset
P P rovocationrovocation
Q Q ualityuality
R R adiationadiation
S S everityeverity
T T imeime
S S ignsigns & symptoms& symptoms
A A llergiesllergies
M M edicationsedications
P P ertinentertinent medical historymedical history
L L astast oral intakeoral intake
E E ventsvents leading to illnessleading to illness
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Emergency Medical Emergency Medical CareCareEmergency Medical Emergency Medical CareCare
OxygenOxygen
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Use a Use a NRB NRB
maskmask at 15 at 15
L/minute.L/minute.
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Ventilate as necessary.
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OxygenOxygen is theis the most most
importantimportant
medicationmedication you can you can
give a patient in give a patient in
respiratory respiratory
distress!distress!
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Position and Position and TransportTransport
Position and Position and TransportTransport
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Patients should be Patients should be
transported in a transported in a
position position THEY THEY
find most find most
comfortable.comfortable.
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Artificial Artificial VentilationVentilationArtificial Artificial
VentilationVentilation
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Mouth-to-maskMouth-to-mask VentilationVentilation
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Two-personTwo-person BVM BVM TechniqueTechnique
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One-personOne-person BVM BVM TechniqueTechnique
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InhalersInhalersInhalersInhalers
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Typical Inhaler Devices
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Most inhalers (metered-
dose inhalers) administer a
medication belonging to a
class of drugs known as
beta-agonist
bronchodilators.
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Inhaler Medications Inhaler Medications Trade NameTrade Name Generic NameGeneric Name
ProventilProventil albuterolalbuterol
VentolinVentolin albuterol albuterol
BronkosolBronkosol isoetharineisoetharine
AlupentAlupent metaproterenolmetaproterenol
BrethineBrethine terbutalineterbutaline
MetaprelMetaprel metaproterenolmetaproterenol
AtroventAtrovent ipatropium bromideipatropium bromide
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Indications for an Inhaler Indications for an Inhaler Signs and symptoms of respiratory distressSigns and symptoms of respiratory distress
Patient has own physician-prescribed inhalerPatient has own physician-prescribed inhaler
Authorization to aid patients in inhaled medications Authorization to aid patients in inhaled medications On-line or off-line medical directionOn-line or off-line medical direction
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Contraindications for an Inhaler Contraindications for an Inhaler
Disoriented patientsDisoriented patients
Medications prescribed for Medications prescribed for someone elsesomeone else
Situations with lack of approval Situations with lack of approval (medical direction)(medical direction)
Patient has already taken maximum recommended dosePatient has already taken maximum recommended dose
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Have patient Have patient inhale deeplyinhale deeply and and hold breath.hold breath.
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Inhaler with a SpacerInhaler with a Spacer
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Assisting with an Inhaler Assisting with an Inhaler
Check inhaler’s expiration dateCheck inhaler’s expiration date
Ask if any doses have already been takenAsk if any doses have already been taken Compare with prescribed dosageCompare with prescribed dosage
Make sure inhaler is at room temperatureMake sure inhaler is at room temperature
Shake inhaler vigorously several timesShake inhaler vigorously several times
Remove oxygen mask Remove oxygen mask Nasal cannulas can be left in placeNasal cannulas can be left in place
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Assisting with an Inhaler continued Assisting with an Inhaler continued
Have patient place inhaler in mouthHave patient place inhaler in mouth
Have patient inhale slowly and deeply while depressing the inhalerHave patient inhale slowly and deeply while depressing the inhaler
Have patient hold breath for as long Have patient hold breath for as long as comfortableas comfortable
Allow patient to breath a few times, then repeat second dose, if orderedAllow patient to breath a few times, then repeat second dose, if ordered
Record time, dose, medication, vital signs and any changesRecord time, dose, medication, vital signs and any changes
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Inhaler Side Effects Inhaler Side Effects Increased heart rateIncreased heart rate
TremorsTremors
NervousnessNervousness
Nausea or vomitingNausea or vomiting
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Respiratory DiseasesRespiratory DiseasesRespiratory DiseasesRespiratory Diseases
Obstructive Airway Disease
Obstructive Airway Disease
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Emphysema:Emphysema:
An abnormal condition of the lungs An abnormal condition of the lungs characterized by overinflation and characterized by overinflation and destructive changes of the alveoli, destructive changes of the alveoli, resulting in decreased lung resulting in decreased lung elasticity and impaired gas elasticity and impaired gas exchange.exchange.
These patients are sometimes referred to as “pink puffers.”
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Chronic bronchitis:Chronic bronchitis:
A chronic condition characterized A chronic condition characterized by excessive mucous secretions by excessive mucous secretions and inflammatory changes in the and inflammatory changes in the bronchial tree.bronchial tree.
These patients are sometimes referred to as “blue bloaters.”
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CChronichronic
OObstructivebstructive
PPulmonaryulmonary
DDiseaseisease
Emphysema
Chronic Bronchitis
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Asthma:Asthma:
A lung disorder characterized A lung disorder characterized by recurring episodes of by recurring episodes of breathing difficulty, wheezing breathing difficulty, wheezing on exhalation due to on exhalation due to constriction of the bronchi, constriction of the bronchi, coughing, and lung secretions.coughing, and lung secretions.
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Pneumonia:Pneumonia:
An infection of the lungs that An infection of the lungs that may be caused by bacteria, may be caused by bacteria, viruses or fungi.viruses or fungi.
Characterized by fever, shortness of breath and a cough.
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Hyperventilation:Hyperventilation:
An abnormally high respiratory An abnormally high respiratory rate and depth of breathing.rate and depth of breathing.
CAUTION! Can be caused by anxiety or actual respiratory problems.
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Hyperventilation Syndrome Hyperventilation Syndrome
Increased respiratory rateIncreased respiratory rate
Numbness and tingling in hands and feet Numbness and tingling in hands and feet (paresthesias)(paresthesias)
Muscle spasms in fingers and toesMuscle spasms in fingers and toes
Chest pain associated with respirationsChest pain associated with respirations
Anxiety and agitationAnxiety and agitation
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SU
MM
AR
YS
UM
MA
RY Respiratory System ReviewRespiratory System Review
Breathing AssessmentBreathing Assessment
Emergency Medical CareEmergency Medical Care
Respiratory DiseasesRespiratory Diseases