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Respiratory Emergencies for the EMT

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on 3 May 2014

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Transcript of Respiratory Emergencies for the EMT

Respiratory
Emergencies

Physiology
of Respiration
Sick, or not sick??
Etiology of
Respiratory Emergencies
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

Acidosis
Alkalosis
Ventilation
Diffusion
Perfusion
Respiration

Apnea
Dyspnea
Orthopnea
Tachypnea
Bradypnea
Hypercarbia

Definitions

Chest Wall
Airways
Alveolar & Capillary units
Pulmonary Circulation
CNS or brain stem
98% of inspired oxygen attaches to the protein, hemoglobin in RBC

Cellular respiration
creates ATP!

Disposes of wastes

Carbon dioxide

Excess water

CO2 + H2O

O2 + Glucose

The Cell

The mechanics...
Autonomic Function

Primary drive:
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

Adequate Breathing

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

Inadequate Breathing

Central hypoventilation
CVA
head trauma
Depressant drug toxicity
Narcotics
Sedative-hypnotics
Ethyl alcohol

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.

Neuromuscular
transmission failure

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
Aspiration
Asthma
Chronic Obstructive Pulmonary Disease (COPD), Bronchitis

Airway failure

Morbid obesity
Pneumothorax (+ tension), hemothorax
Other trauma: rib fractures, flail chest
Diaphragmatic hernia
Pleural effusion


Chest wall
and pleural space failure


Collapse
Flooding: edema (cardiogenic/non), blood, pus, aspiration
Fibrosis
Pneumonia
Emphysema
Toxic inhalations

Alveolar unit failure

Pulmonary embolism
difficulty breathing, chest pain on inspiration, and palpitations. Clinical signs include low blood oxygen saturation and cyanosis, rapid breathing, and a rapid heart rate
Pulmonary hypertension
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

Some conditions,
and what you can do about them
Bronchitis
Common cold
Diphtheria
Pneumonia
Croup
Epiglottitis
Severe Acute Respiratory Syndrome

*See Protocol 2230

Upper Airway Infections

.

Dyspnea (paroxysmal nocturnal)
Orthopnea
Chest pain
Frothy, pink sputum
Pedal edema
Rales, wheezes
Hypertension

Pulmonary Edema
(Cardiogenic)

Suggested by the presence of risk factors including
sepsis
trauma
aspiration
blood transfusions

Non-cardiogenic edema

Damaged lungs from repeated infections or inhalation of toxic agents.

Chronic cough
Rhonchi, wheezing
SpO2 88-92%
Clubbing
Pursed lip breathing

Treatment goals
Relief of hypoxia
Bronchodilators *See Protocol 2230

COPD

Chronic condition similar to emphysema

Reduction in ventilation due to increased mucus production. Productive cough, copious sputum.

Treatment goals
relief of hypoxia
reversal of bronchoconstriction


Bronchitis

Clubbing

Common but serious disease

Acute bronchiole constriction with increased mucus production

Wheezing
Patient looks tired
Cyanosis



*See Protocol 2230

Asthma

Spontaneous or trauma induced

Accumulation of air in the pleural space

Dyspnea
Unilateral chest pain
Absent or decreased breath sounds

Pneumothorax

Characterized by respiratory distress and hypotension.

Usually results from body response to allergen.

Airway obstruction due to angiodema is major concern

Anaphylaxis

Infection usually caused by bacteria or virus. Rarely a fungal cause.

sick appearance
febrile
shaking
productive cough
increased sputum
Increased respiratory rate/effort
tachycardic
wheezes/rales

Pneumonia

Blood clot that breaks off, circulating through venous system.

Dyspnea/tachypnea
Cyanosis
Sudden onset acute pleuritic pain
Hemoptysis
Hypoxia

Pulmonary Embolism

Pulmonary Embolism

Over-breathing resulting in a decrease in the level of CO2 (alkalosis)

Anxiety
Tingling in hands & feet (carpal-pedal spasms)
A sense of dyspnea despite rapid breathing
Dizziness
Numbness

Hyperventilation

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

ARDS

Patient
Assessment
BSI/Scene Safety
Primary Survey (Sick/Not Sick)
Secondary Assessment
Vitals
Reassessment

Patient Assessment

Level of consciousness
Airway & breathing (rate and effort)
Circulation (rate & signs of adequate perfusion)
Identify and correct immediate life threats – ABCs!

Transport decision!
Primary Survey

Signs and symptoms
Allergies (med allergies)
Medications
Past medical history
Last meal or intake
Events leading to call

History and
Secondary Assessment

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!

Onset
Provocation
Quality
Radiation
Severity
Time

History and
Secondary Assessment

…they will tell exactly what is wrong!

Listen to the patient…

Stridor

FBAO
Croup
Anaphylaxis
Epiglottitis
Airway burn

Wheezing
Asthma
CHF
COPD

Crackles (Rales)
CHF
Pneumonia

Rhonchi

Pneumonia
Aspiration
COPD
Sometimes Asthma

Secondary Assessment
Pulse
Respiratory rate and quality
Blood pressure
SpO2
SpCO2
Lung sounds

Vital Signs

Transport/ALS?
Reassess/monitor vitals
Patient in position of comfort
Oxygen via ?
Assist with medications
Maintain body temperature
Calm and reassure
Minimize patient movement


Plan



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!



Patient Management

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

http://www.thoracic.org/clinical/critical-care/clinical-education/respiratory-failure-mechanical-ventilation.pdf

Respiratory Emergencies, Provena Regional EMS. www.provena.org/usmc/documents/Respiratory%20Emergencies.ppt‎



for the EMT
*See Protocol 2230
*See Protocol 2010
Full transcript