Respiratory
Emergencies
…or all that wheezes is NOT
asthma
Definitions
Apnea
Dypsnea
Orthopnea
Tachypnea
Bradypnea
Hypercarbia
Acidosis
Alkalosis
Ventilation
Diffusion
Perfusion
Respiration
Anatomy
Anatomy
Physiology
Takes in oxygen
Disposes of wastes
O2 + Glucose
– Carbon dioxide
– Excess water
The Cell
CO2 + H2O
Physiology
Physiology
Inspiration
Active process
Chest cavity expands
Intrathoracic pressure falls
Air flows in until pressure
equalizes
Expiration
Passive process
Chest cavity size decreases
Intrathoracic pressure rises
Air flows out until pressure
equalizes
Physiology
Autonomic Function
Primary drive: increase in
arterial CO2
Secondary (hypoxic) drive:
decrease in arterial O2
Adequate Breathing
Normal rate and depth
Regular breathing pattern
Good breath sounds on both sides
of lungs
Equal chest rise and fall
Pink, warm, dry skin
Inadequate 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
Obstructive Pathophysiology
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Tongue
Foreign body obstruction
Anaphylaxis and angiodema
Facial trauma and inhalation
injuries (burns)
• Epiglottitis and Croup
• Aspiration
Restrictive Pathophysiology
• Asthma
• COPD
• Emphysema
• Chronic Bronchitis
Diffusion Pathophysiology
• Pulmonary Edema:
• Left-sided heart failure
• Toxic inhalations
• Near drowning
• Pneumonia
• Pulmonary Embolism:
• Blood clots
• Amniotic fluid
• Fat embolism
Ventilation Pathophysiology
• Trauma: rib fractures, flail chest, spinal
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cord injuries
Pneumothorax, hemothorax, SCW
Diaphragmatic hernia
Pleural effusion
Morbid obesity
Neurological/muscular diseases: polio,
MD, myasthenia gravis
Control System Pathophysiology
• Head trauma
• CVA
• Depressant drug toxicity
• Narcotics
• Sedative-hypnotics
• Ethyl alcohol
FBAO
• Obstruction may
result from head
position, tongue,
aspiration, or foreign
body.
• Be prepared to treat
quickly and
aggressively.
• Head-tilt/chin-lift to
open airway
Upper Airway Infections
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Bronchitis
Common cold
Diphtheria
Pneumonia
Croup
Epiglottitis
Severe Acute Respiratory Syndrome
Upper Airway Infections
Signs & Symptoms
• Dyspnea or respiratory distress
• Seal-bark cough
• Acute angiodema
• Excessive salivation
• Stridor
• Sniff positioning
Acute Pulmonary Edema
• Fluid buildup in lungs
• History of CHF
• High recurrence
• Signs & symptoms:
• Dypsnea
• Frothy, pink sputum
• Pedal edema, ascities
• Rales, wheezes
• Hypertension
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Pedal Edema
Ascites
Bronchitis
• Chronic condition similar to emphysema
• Reduction in ventilation due to increased
mucus production.
• Productive cough, copious sputum
• “Blue bloaters”
• Treatment goals: relief of hypoxia, reversal
of bronchoconstriction
COPD
• Damaged lungs from
repeated infections or
inhalation of toxic
agents.
• Signs & symptoms:
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Chronic cough
Rhonchi, wheezing
SpO2 88-92%
Clubbing
Pursed lip breathing
Clubbing
Asthma
• Common but serious
disease
• Acute bronchiole
constriction with
increased mucus
production
• Signs & symptoms:
• Wheezing
• Patient looks tired
• Cyanosis
Pneumothorax
• Spontaneous or
trauma induced
• Accumulation of air in
the pleural space
• Signs & symptoms:
• Dypsnea
• One-sided chest pain
• Absent or decreased
breath sounds
Anaphylaxis
• Characterized by
respiratory distress
and hypotension
• Usually results from
body response to
allergen.
• Airway obstruction
due to angiodema is
major concern
Pneumonia
5th leading cause of death in the U.S.
Infection usually caused by bacteria or
virus, rare instances fungal
Patient will present with sick appearance,
febrile, shaking, productive cough,
increased sputum.
Patient with increase respiratory
rate/effort, tachycardic,
wheezes/rales/consolidated lung sounds
Pleural Effusion
• Collection of fluid
outside the lung
• Caused by irritation,
infection, or cancer
• Signs & symptoms:
• Dypsnea
• Decreased breath
sounds over effected
area
• Positional comfort
Pulmonary Embolism
• Blood clot that breaks
off, circulating through
venous system.
• Signs & symptoms:
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Dypsnea/tachypnea
Cyanosis
Acute pleuritic pain
Hemoptysis
Hypoxia
Pulmonary Embolism
Hyperventilation
• Over-breathing resulting in a decrease in
the level of CO2 (alkalosis)
• Signs and symptoms:
• Anxiety
• Tingling in hands & feet (carpal-pedal
spasms)
• A sense of dypsnea despite rapid breathing
• Dizziness
• Numbness
ARDS
• 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
Patient Assessment
BSI/Scene Safety
Initial Assessment (Sick/Not Sick)
Focused Exam
Detailed Exam
Assessment
Treatment and Plan
Initial Assessment
• Initial Impression:
• Body position
• Skin signs and color
• Respiratory rate and effort
• Mental status
• Pulse (rate & character)
• Determine Sick/Not Sick (Oxygen?)
• Identify and correct immediate life
threats – ABCS!
Focused Exam (S)
Signs and symptoms
Allergies (med allergies)
Medications
Past medical history
Last meal or intake
Events leading to call
Focused Exam (S)
• Onset
• Provocation
• Quality
• Radiation
• Severity
• Time
Listen to the patient…
…they will tell exactly what is
wrong!
Focused Exam (O)
• Vital signs:
• Skin (signs of adequate perfusion)
• Level of consciousness
• Respiratory rate and effort
• Lung sounds (SpO2?)
• Pulse rate and character
• Blood pressure (bilateral?)
• Pupillary reaction
Focused Exam (O)
Crackles (Rales)
CHF
Pneumonia
Rhonchi
Pneumonia
Aspiration
COPD
Sometimes Asthma
Stridor
FBAO
Croup
Anaphylaxis
Epiglottitis
Airway burn
Wheezing
Asthma
CHF
COPD
Focused Exam (O)
• Based upon your clinical findings.
• Observe the patient while they
are talking to you, note any
distress.
• Watch for critical signs: JVD,
tracheal deviation, paradoxial
chest movement.
Detailed Exam
• Complete and thorough head,
neck-to-toe exam with non critical
patients.
• Elicit further information and
necessary interventions.
• Key in on critical signs!
Assessment (A)
This is your best guess (or rule out) as
to what is going on with the patient.
It is based upon YOUR Subjective and
Objective findings and should help
you develop and implement a Plan.
Plan
Medics?
ABC’s/Monitor vitals
Patient in position of comfort.
Oxygen via ?
Assist with medications.
Maintain body temperature.
Calm and reassure.
Minimize patient movement.
Rapid transport!
PT Management (P)
Golden Rules:
• 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!
Tools of the Trade