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Respiratory Emergencies for the EMT
Transcript of Respiratory Emergencies for the EMT
Sick, or not sick??
Coughing, hacking, wheezing...
A respiratory emergency is a result of inadequate gas exchange due to dysfunction of one or more essential components of the respiratory system
Alveolar & Capillary units
CNS or brain stem
98% of inspired oxygen attaches to the protein, hemoglobin in RBC
Disposes of wastes
CO2 + H2O
O2 + Glucose
Increase in arterial CO2
Secondary (hypoxic) drive:
Decrease in arterial O2
Normal rate and depth
Regular breathing pattern
Good bilateral breath sounds
Equal chest rise and fall
Pink, warm, dry skin
Breathing rate < 12 or > 20*
Shallow or irregular respirations
Unequal chest expansion
Decreased or absent lung sounds
Accessory muscle usage
Pale or cyanotic skin color
Cool, clammy skin appearance
Depressant drug toxicity
Nervous system failure
Underlying neurologic disease
incl. neuropathies, myasthenia gravis, poliomyelitis
Symptoms include rapid, shallow breathing secondary to severe muscle weakness or abnormal motor neuron function.
Myopathies, incl. muscular dystrophies, inflammatory, infectious, metabolic causes (even rhabdo!)
Congestive Heart Failure
Muscle (pump) failure
Obstruction or dysfunction
Foreign body obstruction
Facial trauma and inhalation injuries (burns)
Epiglottitis and Croup
Chronic Obstructive Pulmonary Disease (COPD), Bronchitis
Pneumothorax (+ tension), hemothorax
Other trauma: rib fractures, flail chest
and pleural space failure
Flooding: edema (cardiogenic/non), blood, pus, aspiration
Alveolar unit failure
difficulty breathing, chest pain on inspiration, and palpitations. Clinical signs include low blood oxygen saturation and cyanosis, rapid breathing, and a rapid heart rate
shortness of breath, fatigue, non-productive cough, angina pectoris, fainting or syncope, peripheral edema (swelling around the ankles and feet), and rarely hemoptysis (coughing up blood)
Pulmonary vasculature failure
and what you can do about them
Severe Acute Respiratory Syndrome
*See Protocol 2230
Upper Airway Infections
Dyspnea (paroxysmal nocturnal)
Frothy, pink sputum
Suggested by the presence of risk factors including
Damaged lungs from repeated infections or inhalation of toxic agents.
Pursed lip breathing
Relief of hypoxia
Bronchodilators *See Protocol 2230
Chronic condition similar to emphysema
Reduction in ventilation due to increased mucus production. Productive cough, copious sputum.
relief of hypoxia
reversal of bronchoconstriction
Common but serious disease
Acute bronchiole constriction with increased mucus production
Patient looks tired
*See Protocol 2230
Spontaneous or trauma induced
Accumulation of air in the pleural space
Unilateral chest pain
Absent or decreased breath sounds
Characterized by respiratory distress and hypotension.
Usually results from body response to allergen.
Airway obstruction due to angiodema is major concern
Infection usually caused by bacteria or virus. Rarely a fungal cause.
Increased respiratory rate/effort
Blood clot that breaks off, circulating through venous system.
Sudden onset acute pleuritic pain
Over-breathing resulting in a decrease in the level of CO2 (alkalosis)
Tingling in hands & feet (carpal-pedal spasms)
A sense of dyspnea despite rapid breathing
Pulmonary edema caused by fluid accumulation in the interstitial spaces, interfering with diffusion causing hypoxia (fluid balance)
Underlying etiology includes sepsis, pneumonia, inhalation injuries, emboli, tumors
Mortality rate >70%
Supportive care at the BLS level
Primary Survey (Sick/Not Sick)
Level of consciousness
Airway & breathing (rate and effort)
Circulation (rate & signs of adequate perfusion)
Identify and correct immediate life threats – ABCs!
Signs and symptoms
Allergies (med allergies)
Past medical history
Last meal or intake
Events leading to call
Steroids (Advair, Flovent, Pulmicort)
Bronchodilators (albuterol, metaproterenol)
Emphysema/COPD (all of the above)
Antibiotics (-mycin, -acin)
Cardiac drugs (-pril, -lol, Lasix, Digoxin)
Medications are good clues!
…they will tell exactly what is wrong!
Listen to the patient…
Respiratory rate and quality
Patient in position of comfort
Oxygen via ?
Assist with medications
Maintain body temperature
Calm and reassure
Minimize patient movement
If you are thinking about giving O2, then give it!
If you can’t tell whether a patient is breathing adequately, then they aren’t!
If you’re thinking about assisting a patient’s breathing, you probably should be!
When a patient quits fighting it does not mean that they are getting better!
Respiratory Emergenecies “ All that Wheezes Is Not Asthma” http://facweb.northseattle.edu/.../ppt/...%20Respiratory.../Respiratory%20Emer...%E2%80%8E
Pathophysiology of Respiratory Failure and Use of Mechanical Ventilation Use of Mechanical Ventilation. Puneet Katyal, MBBS, MSHI, Ognjen Gajic Ognjen Gajic , MD, Mayo Clinic, Rochester, MN, USA Mayo Clinic, Rochester, MN, USA
Respiratory Emergencies, Provena Regional EMS. www.provena.org/usmc/documents/Respiratory%20Emergencies.ppt
for the EMT
*See Protocol 2230
*See Protocol 2010