Respiratory Emergencies
Chapter 11
Respiratory System:
Anatomy and Function of the Lung:
Characteristics of Adequate Breathing:
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Normal rate and depth
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Equal rise and fall of chest
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Regular breathing pattern
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Pink, warm, dry skin
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Good breath sounds on both sides of the
chest
Causes of Inadequate Breathing:
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Pulmonary vessels become obstructed.
•
Blood flow to the lungs is obstructed.
•
Alveoli are damaged.
•
Pleural space is filled.
•
Air passages are obstructed.
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Pale or cyanotic skin
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Cool, damp (clammy) skin
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Shallow or irregular respirations
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Pursed lips
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Nasal flaring
Signs of Inadequate Breathing:
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Slower than 12 breaths/min or faster than
20 breaths/min
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Unequal chest expansion
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Decreased breath sounds
•
Muscle retractions
Dyspnea:
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Shortness of breath or difficulty breathing
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Patient may not be alert enough to complain of shortness of breath.
Upper or Lower Airway Infection:
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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.
Upper or Lower Airway Infection (treatment):
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Administer warm, humidified oxygen.
•
Do not attempt to suction the airway or insert an oropharyngeal airway in a patient with suspected
epiglottitis.
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Transport patient in position of comfort.
Acute Pulmonary Edema:
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Fluid build-up in the lungs
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Signs and symptoms
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Dyspnea
•
Frothy pink sputum
•
History of chronic congestive heart failure
•
Recurrence high
Acute Pulmonary Edema (treatment):
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Administer 100% oxygen.
•
Suction secretions.
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Transport in position of comfort.
Chronic Obstructive Pulmonary Disease (COPD):
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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
COPD Patients:
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COPD patients cannot handle pulmonary infections well
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Usually age 50 or older
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History of recurring lung problems
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Long-term smokers
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Tightness in chest/constant fatigue
Chronic Obstructive Pulmonary Disease(treatment):
•
Assist with prescribed inhaler if patient has one.
•
Transport promptly in position of comfort.
Asthma:
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Common but serious disease
•
Asthma is an acute spasm of the bronchioles.
•
Wheezing may be audible without a stethoscope.
Asthma (treatment):
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Obtain history.
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Assess vital signs.
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Assist with inhaler if patient has one.
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Administer oxygen.
•
Transport promptly.
Spontaneous Pneumothorax:
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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
Spontaneous Pneumothorax (treatment):
•
Administer oxygen.
•
Transport in position of comfort.
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Monitor closely.
Anaphylactic Reactions:
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An allergen can trigger an asthma attack.
•
Asthma and anaphylactic (allergic) reactions can be similar.
•
Hay fever is a seasonal response to allergens.
Pleural Effusion:
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Collection of fluid outside lung
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Causes dyspnea
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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
Pleural Effusion (treatment):
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Definitive treatment is performed in a hospital.
•
Administer oxygen and support measures.
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Transport promptly.
Mechanical Obstruction of the Airway:
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Be prepared to treat quickly.
•
Obstruction may result from the position of head, the tongue, aspiration of vomitus, or a foreign body.
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Opening the airway with the head tilt-chin lift maneuver may solve the problem.
Obstruction of the Airway (treatment):
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Clear airway.
•
Administer oxygen.
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Transport promptly.
Pulmonary Embolism:
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A blood clot that breaks off and circulates through the venous system
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Signs and symptoms
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Dyspnea
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Cyanosis
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Acute pleuritic pain
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Tachypnea
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Hemoptysis
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Varying degrees of hypoxia
Pulmonary Embolism (treatment):
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Administer oxygen.
•
Place patient in comfortable position, usually sitting.
•
Assist breathing as necessary.
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Keep airway clear.
•
Transport promptly.
Hyperventilation:
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Overbreathing resulting in a decrease in the level of carbon dioxide
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Signs and symptoms
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Anxiety
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Dizziness
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Numbness
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Tingling in hands and feet
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A sense of dyspnea despite rapid
breathing
Hyperventilation (treatment):
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Complete initial assessment and history of the event.
•
Assume underlying problems.
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Do not have patient breathe into a paper bag.
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Give oxygen.
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Reassure patient and transport.
You are the provider:
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You and your EMT-B partner are dispatched to a 33-year-old woman with difficulty breathing.
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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.
•
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 twoword response, “can’t breathe.”
•
You hear audible wheezes.
Scene size up:
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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?
Initial Assessment:
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Perform initial assessment.
•
Place the patient on oxygen.
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If patient is in respiratory distress, ventilate.
•
Check pulse.
Signs and Symptoms:
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Difficulty breathing
•
Irregular breathing
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Altered mental status
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Cyanosis
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Anxiety or restlessness
•
Pale conjunctivae
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Increased or decreased
respirations
•
Abnormal breath
sounds
Increased heart rate
•
•
Difficulty speaking
You are the provider:
•
You arrange to rendezvous with ALS.
•
You apply high-flow oxygen and obtain the following vital signs:
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Respirations: 42 breaths/min
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Pulse oximetry: 90%
•
The patient indicates that she has used the inhaler twice already.
•
What can you do before you meet ALS?
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Another pulse oximetry reading reveals a reading of 72%.
•
The patient is using accessory muscles to breathe.
•
What do these signs indicate?
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Use of accessory
muscles
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Coughing
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Tripod position
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Barrel chest
Focused History and Physical Exam:
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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
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Normal blood pressure
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Rapid, occasionally irregular pulse
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Respirations rapid or very slow
Interventions:
•
Treat immediate life threats
•
Possible interventions
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Oxygen via nonrebreathing mask at
15 L/min
–
Positive pressure ventilations
–
Airway adjuncts
–
Positioning
–
Respiratory medications
Detailed Physical Exam:
•
Performed only once life threats are addressed.
•
May not be able to do if busy treating airway or breathing problems.
Ongoing assessment:
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Carefully watch patients for shortness of breath.
•
Reassess vital signs.
•
Ask patient if treatment has made a difference.
•
Check for accessory muscle use.
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.
Medications in MDI:
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Trade names
•
–
Proventil
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Albuterol
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Ventolin
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Metaproterenol
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Alupent
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Terbutaline
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Metaprel
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Brethine
Prescribed Inhalers:
•
•
Generic names
Actions
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Relax the muscles surrounding the bronchioles
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Enlarge the airways leading to easier passage of air
Side effects
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Increased pulse rate
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Nervousness
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Muscle tremors
Prior to Administration:
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Read label carefully.
•
Verify it has been prescribed by a physician for this patient.
•
Consult medical control.
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Make sure the medication is indicated.
•
Check for contraindications.
Contraindications for MDI:
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Patient unable to help coordinate inhalation
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Inhaler not prescribed for patient
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No permission from medical control
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Maximum dose prescribed has been taken.
Administration of MDI:
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Obtain order from medical control or local protocol.
•
Check for right medication, right patient, right route.
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Make sure the patient is alert.
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Check the expiration date.
•
Check how many doses have been taken.
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Make sure inhaler is at room temperature or warmer.
•
Shake inhaler.
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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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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.
Reassessment:
•
Carefully watch for shortness of breath.
•
5 minutes after administration:
–
Obtain vital signs again.
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Perform focused reassessment.
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Transport and continue to assess breathing