11: Respiratory Emergencies
Cognitive Objectives
(1 of 3)
4-2.1 List the structure and functions of the respiratory
system.
4-2.2 State the signs and symptoms of a patient with
difficulty breathing.
4-2.3 Describe the emergency medical care of the
patient with breathing difficulty.
4-2.4 Recognize the need for medical direction to assist
in the emergency medical care of the patient with
breathing difficulty.
2
Cognitive Objectives (2 of 3)
4-2.5 Describe the care of a patient with breathing
distress.
4-2.6 Establish the relationship between airway
management and breathing difficulty.
4-2.7 List signs of adequate air exchange.
3
Cognitive Objectives
(3 of 3)
4-2.8 State the generic name, forms, dose,
administration, actions, indications, and
contraindications for the prescribed inhaler.
4-2.9 Distinguish between the emergency medical care
of the infant, child, and adult patient with breathing
difficulty.
4-2.10 Differentiate between upper airway obstruction
and lower airway disease in the infant and child
patient.
4
Affective Objectives
4-2.11 Defend EMT-B treatment regimens for various
respiratory emergencies.
4-2.12 Explain the rationale for administering an
inhaler.
5
Psychomotor Objectives
4-2.13 Demonstrate the emergency medical care for
breathing difficulty.
4-2.14 Perform the steps in facilitating the use of an
inhaler.
6
Respiratory System
7
Anatomy
and Function
of the Lung
8
Characteristics of
Adequate Breathing
• Normal rate and depth
• Regular breathing pattern
• Good breath sounds on both sides
of the chest
• Equal rise and fall of chest
• Pink, warm, dry skin
9
Characteristics of
Inadequate Breathing
• Pulmonary vessels become obstructed.
• Alveoli are damaged.
• Air passages are obstructed.
• Blood flow to the lungs is obstructed.
• Pleural space is filled.
10
Signs of
Inadequate Breathing
• Slower than 12
breaths/min or faster than
20 breaths/min
• Unequal chest expansion
• Decreased breath sounds
• Muscle retractions
• Pale or cyanotic skin
• Cool, damp (clammy)
skin
• Shallow or irregular
respirations
• Pursed lips
• Nasal flaring
11
Dyspnea
• Shortness of breath or difficulty breathing
• Patient may not be alert enough to complain
of shortness of breath.
12
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.
13
Acute Pulmonary Edema
• Fluid build-up in the lungs
• Signs and symptoms
– Dyspnea
– Frothy pink sputum
• History of chronic congestive heart
failure
• Recurrence high
14
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
15
Asthma
• Common but serious disease
• Asthma is an acute spasm of the bronchioles.
• Wheezing may be audible without a
stethoscope.
16
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
17
Anaphylactic Reactions
• An allergen can trigger an asthma attack.
• Asthma and anaphylactic (allergic) reactions can
be similar.
• Hay fever is a seasonal response to allergens.
18
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
19
Mechanical Obstruction
of the Airway
• Be prepared to treat quickly.
• Obstruction may result from the position of head, the
tongue, aspiration of vomitus, or a foreign body.
• Opening the airway with the head tilt-chin lift
maneuver may solve the problem.
20
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
21
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
22
You
thepartner
Provider
• You and
yourare
EMT-B
are dispatched to
1465 Dalles Military Rd for a 33-year-old woman
with difficulty breathing.
• You arrive at the office building and an upset man
identifies himself as the patient’s coworker.
• He tells you that the patient has had breathing
problems before, but he’s never seen it this bad.
23
You are the Provider (continued)
• He leads you to a woman who is standing with her
arms outstretched on the desk with a metered-dose
inhaler in hand.
• She acknowledges your presence with a nod.
When you ask her what is wrong, she answers with
a two-word response, “can’t breathe.”
• You hear audible wheezes.
24
Scene Size-UP
• How significant is the person’s response to your
question and why?
• What should you do next? Should you transport
this patient or wait for ALS to arrive on scene?
25
Initial Assessment
• Perform initial assessment.
• Place the patient on oxygen.
• If patient is in respiratory distress, ventilate.
• Check pulse.
26
Signs and Symptoms (1 of 2)
•
•
•
•
•
•
•
Difficulty breathing
Altered mental status
Anxiety or restlessness
Increased or decreased respirations
Increased heart rate
Irregular breathing
Cyanosis
27
Signs and Symptoms (2 of 2)
•
•
•
•
•
•
•
Pale conjunctivae
Abnormal breath sounds
Difficulty speaking
Use of accessory muscles
Coughing
Tripod position
Barrel chest
28
• You
to rendezvous
with(continued)
ALS.
Youarrange
are the
Provider
• You apply high-flow oxygen and obtain the
following vital signs:
– Pulse: 42 breaths/min
– Pulse oximetry: 90%
• The patient indicates that she has used the inhaler
twice already.
29
Youcan
are
Provider
(continued)
• What
youthe
do before
you meet
ALS?
• Another pulse oximetry reading reveals a reading
of 72%.
• The patient is using accessory muscles to breathe.
• What do these signs indicate?
30
COPD Patients
• COPD patients cannot handle pulmonary
infections well
• Usually age 50 or older
• History of recurring lung problems
• Long-term smokers
• Tightness in chest/constant fatigue
31
Focused History and Physical Exam
• Abnormal breath sounds are symptomatic
of COPD
• Long history of dyspnea with sudden
increase in shortness of breath
• Recent chest cold with fever
• Vital signs
– Normal blood pressure
– Rapid, occasionally irregular pulse
– Respirations rapid or very slow
32
Interventions
• Treat immediate life threats
• Possible interventions
– Oxygen via nonrebreathing mask at 15 L/min
– Positive pressure ventilations
– Airway adjuncts
– Positioning
– Respiratory medications
33
Detailed Physical Exam
• Performed only once life threats are
addressed.
• May not be able to do if busy treating
airway or breathing problems.
34
Ongoing Assessment
• Carefully watch patients for shortness of
breath.
• Reassess vital signs.
• Ask patient if treatment has made a
difference.
• Check for accessory muscle use.
35
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.
36
Medications in MDI
• Trade names
– Proventil
– Ventolin
– Alupent
– Metaprel
– Brethine
• Generic names
– Albuterol
– Metaproterenol
– Terbutaline
37
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
38
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.
39
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.
40
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.
41
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.
42
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.
43
Reassessment
• Carefully watch for shortness of breath.
• 5 minutes after administration:
– Obtain vital signs again.
– Perform focused reassessment.
• Transport and continue to assess breathing.
44
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.
45
Acute Pulmonary Edema
• Administer 100% oxygen.
• Suction secretions.
• Transport in position of comfort.
46
Chronic Obstructive Pulmonary
Disease (COPD)
• Assist with prescribed inhaler if patient
has one.
• Transport promptly in position of comfort.
47
Spontaneous Pneumothorax
• Administer oxygen.
• Transport in position of comfort.
• Monitor closely.
48
Asthma
• Obtain history.
• Assess vital signs.
• Assist with inhaler if patient has one.
• Administer oxygen.
• Transport promptly.
49
Pleural Effusion
• Definitive treatment is performed in a
hospital.
• Administer oxygen and support
measures.
• Transport promptly.
50
Obstruction of the Airway
• Clear airway.
• Administer oxygen.
• Transport promptly.
51
Pulmonary Embolism
• Administer oxygen.
• Place patient in comfortable position,
usually sitting.
• Assist breathing as necessary.
• Keep airway clear.
• Transport promptly.
52
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.
53