Transcript SECTION 2 - Sam Scheller
Section 4: Medical Emergencies
Chapter 10 Respiratory Emergencies
Chapter 10: Respiratory Emergencies
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.
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Chapter 10: Respiratory Emergencies
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.
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Chapter 10: Respiratory Emergencies Respiratory System 5
Chapter 10: Respiratory Emergencies Anatomy and Function of the Lung 6
Chapter 10: Respiratory Emergencies 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.
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Chapter 10: Respiratory Emergencies 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 8
Chapter 10: Respiratory Emergencies 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 9
Chapter 10: Respiratory Emergencies Dyspnea • Shortness of breath or difficulty breathing • Patient may not be alert enough to complain of shortness of breath.
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Chapter 10: Respiratory Emergencies 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.
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Chapter 10: Respiratory Emergencies Acute Pulmonary Edema • Fluid build-up in the lungs • Signs and symptoms – Dyspnea – Frothy pink sputum • History of chronic congestive heart failure • Recurrence high 12
Chapter 10: Respiratory Emergencies 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 13
Chapter 10: Respiratory Emergencies 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 14
Chapter 10: Respiratory Emergencies 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.
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Chapter 10: Respiratory Emergencies 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 16
Chapter 10: Respiratory Emergencies 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.
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Chapter 10: Respiratory Emergencies 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 18
Chapter 10: Respiratory Emergencies 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 19
Chapter 10: Respiratory Emergencies Treatment of Dyspnea • Perform initial assessment.
• Place the patient on oxygen.
• If patient is in respiratory distress, ventilate.
• Check pulse.
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Chapter 10: Respiratory Emergencies Signs and Symptoms (1 of 2) • Difficulty breathing • Anxiety or restlessness • Decreased respirations • Cyanosis • Abnormal breath sounds • Difficulty speaking • Accessory muscles 21
Chapter 10: Respiratory Emergencies Signs and Symptoms (2 of 2) • Altered mental status • Coughing • Irregular breathing rhythm • Tripod position • Barrel chest • Pale conjunctivae • Increased pulse and respirations 22
Chapter 10: Respiratory Emergencies 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.
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Chapter 10: Respiratory Emergencies Inhaler Medications • Trade names – Proventil – Ventolin – Alupent – Metaprel – Brethine • Generic names – Albuterol – Metaproterenol – Terbutaline 24
Chapter 10: Respiratory Emergencies 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 25
Chapter 10: Respiratory Emergencies 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.
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Chapter 10: Respiratory Emergencies 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 27
Chapter 10: Respiratory Emergencies 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.
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Chapter 10: Respiratory Emergencies 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.
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Chapter 10: Respiratory Emergencies 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.
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Chapter 10: Respiratory Emergencies Reassessment • Carefully watch for shortness of breath.
• 5 minutes after administration: – Obtain vital signs again.
– Perform focused reassessment.
• Transport and continue to assess breathing.
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Chapter 10: Respiratory Emergencies 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 .
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Chapter 10: Respiratory Emergencies Acute Pulmonary Edema • Administer 100% oxygen.
• Suction secretions.
• Transport in position of comfort.
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Chapter 10: Respiratory Emergencies Chronic Obstructive Pulmonary Disease (COPD) • Assist with prescribed inhaler if patient has one.
• Transport promptly in position of comfort.
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Chapter 10: Respiratory Emergencies Spontaneous Pneumothorax • Administer oxygen.
• Transport in position of comfort.
• Monitor closely.
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Chapter 10: Respiratory Emergencies Asthma or Allergic Reactions • Obtain history.
• Assess vitals signs.
• Assist with inhaler if patient has one.
• Administer oxygen.
• Transport promptly.
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Chapter 10: Respiratory Emergencies Pleural Effusion • Definitive treatment is performed in a hospital.
• Administer oxygen and support measures.
• Transport promptly.
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Chapter 10: Respiratory Emergencies Mechanical Obstruction of the Airway • Clear airway.
• Administer oxygen.
• Transport promptly.
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Chapter 10: Respiratory Emergencies Pulmonary Embolism • Administer oxygen.
• Place patient in comfortable position, usually sitting. • Assist breathing as necessary.
• Keep airway clear.
• Transport promptly.
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Chapter 10: Respiratory Emergencies 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.
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