Chapter 17 - Cutsumbis PDF

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Chapter 17- Respiratory Emergencies 

Respiration o Inspiration or inhalation- active process; intercostal (rib) muscles and the diaphragm contract, expanding the size of the chest cavity and causing air to flow into the lungs o Expiration or exhalation- passive process; intercostal (rib) muscles and the diaphragm relax, causing the chest cavity to decrease in size and forcing air from the lungs o Adequate breathing- sufficient to support life  Determined by:  Rate o 12-20 for adult o 15-30 for child

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25-50 for infant

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rhythm quality o Inadequate breathing- not sufficient to support life  Life threatening illness- need to fix right away  Shallow breaths  Too fast or too slow of breaths  Irregular rhythm  Provide Nonbreather mask with 15 L of 02 for adequate breather  Need to provide artificial respiration when inadequate:  Pocket face mask with supplemental 02  Two rescuer bag-valve mask with supplemental 02  Flow restricted, oxygen-powered ventilation device (FROPVD)  One rescuer bag- valve mask with supplemental 02 o Inadequate and adequate artificial ventilation  Rate for artificial ventilation  12 per minute- adult  20 per minute- child and infants  do not hyperventilate patient unless told to do so  leads to elimination of more c02, which changes blood chemistry, and can result in constriction of blood vessel sin the brain, leading to decreased perfusion of the brain  artificial ventilation without chest compressions- monitor pulse carefully  rate should return to normal  adults- pulse that remains the same or increases may mean ventilation is not working  child- pulse that stays the same or lower may mean ventilation is not working  if pulse disappears- do CPR Breathing difficulty o Frequent chief complaint- representing a patient’s feeling or labored breathing  Mostly subjective perception of patient o Difficulty breathing can be either adequate or inadequate

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Patient Assessment of breathing difficulty?  OPQRST

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O- onset P-provocation Q-quality R-radiation S-severity T-time  Observe  Auscultate  Evaluate vital sign changes  Pulse oximetry reading  Write down reading before and during ventilation- should improve during ventilation  No matter the reading- anyone in respiratory distress needs to be given supplemental oxygen  Lung sounds – listen on both sides (back and front) (upper and lower)  Wheezing- high pitched sounds; heard on expiration  Crackles- fine crackling or bubbling sound  Rhonchi- low pitched sounds; resemble snoring and rattling  Stridor- high pitched sound; heard on inspiration Patient Care  Assessment  Asses airway and ventilations  Oxygen  Respiratory distress- use Nonbreather mask 15 L per minute  Minor/moderate distress- use nasal cannula  Inadequate breathing- provide supplemental 02 while performing artificial ventilation  Positioning  Breathing difficulty- put in position of comfort  Inadequate breathing- supine position  Prescribed inhaler  Help with the delivery of this medication  Done after getting medical direction and during transport  Continuous positive airway pressure (CPAP) CPAP- form of noninvasive positive pressure ventilation (NPPV) consisting of mask and a means of blowing 02 or air into the mask to prevent airway collapse or to help alleviate difficulty breathing  Blowing 02 or air continuously at low pressure into airway prevents alveoli from collapsing at end of exhalation and it can push fluid out of alveoli back into capillaries that surround them  Common uses:  Pulmonary edema and drowning – fluid in alveoli that can be pushed out of alveoli and back into capillaries  Asthma & COPD- alveoli are at risk of closing at end of exhalation  Respiratory failure  Contraindications:  Anatomic-physiologico Mental status depressed that patient cannot protect his airway or follow instruction

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Lack of normal respiratory rate – increase volume of air the patient breather but does not increase the patients respiratory rate

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Penetrating chest trauma

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High 02 levels will lead them to respiratory distress

Shock Upper GI bleeding or recent gastric surgery

Any condition that would prevent good mask seal  Side effects EMT need to be aware of:  Less blood able to return of heart through veins – drop in BP o Need BP of atleast 90 (systolic) to use  Can cause rupture to a weak area- leading to a lung collapse  Can cause aspiration of patients who are vomiting  Can make corneas dry  Apply CPAP:  Asses patient and ensure he meets criteria  Explain device- mask and snug seal may initially cause patient to feel smothered and anxious  Apply mask to patient’s face- continue to calm and reassure them  Use settings defined by protocols  Reassess and monitor the patient  Discontinue CPAP and ventilate if patient’s breathing becomes inadequate Respiratory Conditions o Chronic Obstructive Pulmonary Disease (COPD)  Middle age or older patient –develop in tissues in respiratory tract react to irritants  Ex.  Chronic bronchitis- bronchiole lining is inflamed and excess mucus is formed  Emphysema- walls of alveoli break down which reduce the surface area for respiratory exchange o Rely on low oxygen levels to tell them to breathe rather than increasing c02 levels

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Inability to sit up Hypertension Pathologico Nausea and vomiting

Asthma  Chronic disease- has episodic exacerbations or flares  Asthma attack can be life threatening  Small bronchioles that lead to the air sac of the lings become narrowed because of contractions of the muscles that make up the airway Pulmonary Edema  CHF patients  Abnormal accumulation of fluid in the alveoli of the lungs  Usually have left and right sided heart failure- CHF  Usally have left sided heart failure- Pulmonary edema  Can also have JVD  Symptoms:  Feeling worse each night

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Weight gain Anxiety Pale and sweaty skin Hypertension Respirations that are rapid and labored Low 02 saturation  Treatment:  High concentration 02 by mask  Ventilate patient if inadequate  Keep patients leg in dependent position if possible (hanging down) Pneumonia  Infection of one or both lungs caused by bacteria, viruses, or fungi  Results from inhalation of certain microbes that grow in lungs and cause inflammation  People with COPD and respiratory diseases are more likely to get it  Signs and symptoms:  Coughing, fever, chest pain, sever chills, shortness of breath, fatigue and confusion  Could hear crackles when auscultating the chest  Immunization for it Spontaneous Pneumothorax  Lung collapse without injury or any other obvious cause  Result of a bleb, small section of the lung that is weak  Smokers and tall, thin people are at risk for this  Signs and symptoms:  Pleuritic chest pain  Shortness of breath  Tire easily  Breathe fast  Low 02 saturation  Exhibit cyanosis  When auscultating- will see absent breaths on the injured lung  Place catheter should be inserted between the ribs Pulmonary Embolism  When something that is not blood- such as blood clot, air, or fat- tries to go through blood vessles, it gets stuck and blocks an artery in the lungs  Ex. o Deep vein thrombosis (DVT)- clot in leg or pelvis  Usually from cancer  Signs and symptoms Sudden onset of sharp, pleuritic chest pain  Shortness of breath  Anxiety  Cough- sometimes with blood  Sweaty skins that is pale or cyanotic  Pain or swelling in one or both legs  Administer 02 and treat patient like any one else out of breath

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Epiglottitis  Infection inflames the area around and above the epiglottis, tissue swells  Swells a lot- can close off the airway  Adults  Usually male in 40s  Recent cold- trouble swallowing and sore throat  Stridor  Child- sudden onset  Tripod position  Drooling  Appearing to be in distress  Do not inspect throat; try to deliver 02 if possible  Go straight to hospital- adults can deal with it longer than children  Vaccination of haemophilus influenza type B – to prevent it in kids o Cystic Fibrosis (CF)  Causes thick, sticky mucus that accumulates in the lungs and digestive system  S & S:  Coughing with large amounts of mucous from lungs  Fatigue  Frequent occurrences of pneumonia  Abdominal pain and distention  Coughing up blood  Nausea  Weight loss  No known prevention- lots of research o Viral Respiratory Infections  Start with sore or scratchy throat with sneezing, runny nose, and fatigue  Can spread of lungs- shortness of breath  Viral- antibiotics do not work and may make it worse  Should administer 02 and care for patient like any other in respiratory distress  Good hygiene can help prevent it The prescribed inhaler o Get permission from medical direction to help patient use it  Standing order, phone, or radio  Determine exactly when and how many times inhalers has been used- give information to medical director o Inhaler- gives a metered dose/exact dose o Given to patients with:  Bronchoconstriction- constriction or blockage of the bronchi that lead from the trachea to the lungs  Inhaler- helps dilate the air passages to make breathing easier o Make sure they are inhaling when using- powder has to come in direct contact with lungs o Patient assessment and management  Patient has indications for use of inhaler; signs and symptoms of breathing difficulty and an inhaler prescribed by a physician

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Contact medical direction and obtain an order to assist the patient with the prescribed inhaler Ensure the 5 “rights”- right patient, right time, right medication, right dose, right route Check expiration date, shake inhaler, make sure inhaler is room temperature or warmer, and make sure patient is alert  Coach patient in use of inhaler  After use of inhaler, reassess patient: take vital signs, perform a focused exam, and determine if breathing is adequate The Small Volume Nebulizer o Medications used in metered- dose inhalers can also be administered by small volume nebulizer (SVN)  Nebulizing a medication involved running 02 or air through a liquid medication  Patient breathes the vapors creasted o Nebulizer can be used for many breaths- greater exposure to medication...