Signs of Inadequate Breathing
Medical Respiratory
Emergencies
Breathing - It Does Your Body Good!
• Rate: 12-20 adult;
15-30 child;
25-50 infant
• Rhythm - irregular may be neurologic
• Quality - sounds in the airway
– Stridor - upper airway obstruction
– Wheeze - bronchospasm
– Snore - tongue in the airway
• Depth - compared to Pt’s condition
Signs of Inadequate Breathing
• Skin condition
– pale / palor - lack of blood flow
– cyanosis - poorly oxygenated blood
• Other physical findings:
– retractions
– nasal flaring
– tripod position
– see saw breathing
Signs of Inadequate Breathing
• First sign of hypoxia is:
– Hold your breath:
• Anxiety is the first sign of hypoxia
• Changes in mentation are important
clues to cerebral perfusion
Assessment
• Initial Assessment
– LOC? - is there anxiety here? ” LOC
– Airway - sounds ?
– Breathing - breath with your Pt!
– Circulation - expect ↑ in pulse rate, Skin?
( Think Compensation)
Assessment
• Focused
–
–
–
–
Breath Sounds – listen for aliens
AMPLE
OPQRST - also, Pertinent Negatives
Vital signs
• Consider related problems
• # of words per breath?
• “How bad is this episode compared to
normal?”
1
Treatment in General
Respiratory Treatments
• Airway - ensure it is adequate!
• Oxygen - high flow , NRB time
• Calm and reassure - reduce the body’s need
for oxygen
• Fowler’s position
• Medications as indicated
• Bag Valve Mask - RR <8 or >28; use
common sense here
• Oxygen – 10-15 lpm for respiratory distress
Types of Respiratory Ailments
• COPD - Chronic Obstructive
Pulmonary Disease
– a groups of diseases
– from continued irritation of lungs
– very often from exposure to cigarette
smoke
– progressive from one to the next
– also sometimes the progression from
asthma
Emphysema
• The “Pink Puffer”
• Alveolar destruction / loss
of elasticity
• Airways close during
exhalation before all the
air is out
• leads to air trapping
• Volume expands giving Pt
a barrel chested
appearance
– to increase oxygenation of tissues
• BVM – to ensure adequate oxygen intake /
CO2 removal (ventilation)
• Albuterol – bronchodilator
– For treatment of bronchoconstriction evidenced
by wheezing / restricted airflow
Chronic Bronchitis
• The “Blue Bloater”
• Chronic
• caused by mucous
plugging
• Signs / Symptoms
– Productive cough
– Cyanosis “Blue”
• Often leads to right sided
heart failure
– this produces peripheral (body)
Edema - “Bloater”
– Jugular Vein Distention
zLung
sounds –
often Rhales /
rhonchi and
wheezing
Emphysema
• Breathing out against resistance helps hold open
the airways longer
• so Pt breaths out through pursed lips - “Puffer”
• Long term hypoxia leads to increased hemoglobin
production - gives a “pink” appearance
• often very thin due to high energy cost of
breathing
• Lung sounds – inspiration often of greater volume
than expiration, wheezes / ‘tight’ lung sounds
2
Oxygen use on COPDers
• ‘Normal’ people breath when they have too much
CO2 in them
• COPDers breath when they have too little O2 in
them
• So what happens if you give them lots of O2?
• You will NEVER withhold O2 from a respiratory
Pt
• Monitor rate AND depth of respirations - ventilate
if needed
Asthma
• Pts often sit bolt upright to ‘stretch’ open
airways.
• Treatment will include assisting with
Metered Dose Inhalers or Nebulizer
Asthma
• Irritation causes increased mucous
production and spasms in the airway
• Wheezing as air moves through narrowed
passages
Asthma vs. Status Asthmaticus
• Asthma often relieves itself or is relieved by
medications
• Status asthmaticus isn’t relieved by med.s very Life-threatening
• Fear the ‘quiet’ asthma attack
• What is the difference?
• Time! Be moving towards the hospital
while treating - don’t wait for effects of
med.s
Pneumonia
Break
• From an infection - viral, bacterial
• Bacterial secondary to aspiration has 80%
mortality rate
• S/S:
– cough with thick, colored mucous
– Hx of fever, infection
– Areas of consolidation may be heard
3
Anaphylaxis
• Allergic reaction, Allergic response,
Anaphylaxis
• The body is killing itself trying to defend
itself
– airway begins to swell shut and significant
bronchoconstriction occurs
• S/S
– Anxiety,hives, itching throat and tongue, watery
eyes/nose, sneezing, wheezing, SOB, Hypotension
Pulmonary Embolism
• Embolism that lodges in the lungs
• blocks off part of the lungs from blood/air
exchange
• Increases pressure in the area
• S/S: depend on size of blockage
–
–
–
–
Sudden dyspnea from no apparent cause,
pleuritic chest pain
possible diminished lung sounds in area
Hemoptysis from leaking alveoli
Pulmonary Embolism
• History may be the key
– recent surgery
– recent long-bone fx
– confinement to bed for long period
• All are events that could cause a clot that
might break free and become and embolism
• Other Risk factor group:
– Female, smoker, use of oral birth control
Spontaneous Pneumothorax
• A non-traumatic
pneumothorax
• build up of air doesn’t
allow the lung to expand
• In this case, air comes
from the lung itself
• Congenital bleb bursts,
allowing air to enter
pleural space
Spontaneous Pneumothorax
• S/S:
–
–
–
–
Sudden dyspnea with no other obvious cause
pleuritic chest pain
diminished or absent lung sounds on one side
possible tracheal deviation - easily become
tension pneumothorax
• Usually in blond, blue-eyed, 20ish males
4
Hyperventilation Syndrome
• ‘Syndrome’ indicates from no other medical
cause…
• rule everything else out!
• Breathing too fast - generally emotional
reasons
• Air not in lungs long enough for exchange
• Too much CO2 is removed
• need to slow breathing down
Hyperventilation Syndrome
Hyperventilation Syndrome
•
•
•
•
Chief Complaint:
SOB
possible head ache, chest pain (pleuritic)
Hx of argument or other anxiety-causing event
Lack of other abnormality!!!
• Cluebirds:
– tingling lips, nose, extremities
– carpo-pedal spasms
RULES TO LIVE BY:
• Tx:
– calm and reassure
– oxygen if needed - may help calm, may not
– may still be hypoxic
– “breath with me”
– ask questions that require long answers - you
can’t breath and talk at the same time
Childhood Diseases
• Croup
– a true childhood disease
– barking seal cough - see H.O.
• Epiglottitis
– even in adults
– muffled voice, drooling - see H.O.
• don’t look in the mouth if you suspect these
illnesses!
• There is no such thing as
Hyperventilation Syndrome
in the Trauma Patient
• No paper bags!
BVM Use
• 2 person is always better than 1 person
• Slow and steady
• Cryciod pressure - the Sellick
Maneuver – to reduce gastric
distention
• 30 < RR >8 or to push past obstuctions
/ spasming airways
5
Pulse Oximetry
Best Treatments
• Measures bound hemoglobin
• doesn’t even care if it’s bound to oxygen or
something else
• Oxygen - Can’t hurt, Might help,
Heck of a crowd pleaser!
• Calm and reassure reduces the
problem from the other side - lowers
oxygen demand on the body
– CO binds to hemoglobin too
• Only measures in the extremity the sensor is
on
• Treat the Pt, not the monitor...
6