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Respiratory Emergencies

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  • 1. Chapter Respiratory Emergencies Thirteen
  • 2. Chapter
    • How to recognize adequate and inadequate breathing
    • How to assist a patient with breathing difficulty in using a prescribed inhaler
    Thirteen CORE CONCEPTS
  • 3. R ESPIRATORY SYSTEM
  • 4. Respiratory System
  • 5.
    • Airway structures are smaller
    (more easily obstructed).
    • Tongue is proportionately larger than an adult’s.
    • Trachea is more narrow
    (more easily obstructed). (Continued) Pediatric Airway Anatomy
  • 6.
    • Cricoid is not well developed
    (less rigid) .
    • Trachea is softer, more flexible than an adult’s.
    • Chest wall is softer.
    Pediatric Airway Anatomy
  • 7. Process of Respiration
  • 8.
    • Oxygen-rich air enters alveoli.
    • Oxygen-poor blood passes around alveoli.
    • Oxygen enters capillaries; carbon dioxide enters alveoli.
    Gas Exchange: Alveolar Capillary
  • 9.
    • Cells give off carbon dioxide to capillaries.
    • Capillaries give off oxygen to cells.
    Gas Exchange: Capillary Cellular
  • 10. Adequate Breathing: Normal Rates (Continued)
    • Adults
    • Children
    • Infant
    12-20/min. 15-30/min. 25-50/min.
  • 11.
    • Usually regular
    • May be slightly irregular and influenced by talking
    (Continued) Adequate Breathing: Rhythm
  • 12.
    • Breath sounds: Present, equal
    • Chest expansion: Adequate, equal
    • Effort : Minimal or no
    use of accessory muscles
    • Depth:
    Adequate Breathing: Quality Adequate tidal volume
  • 13.
    • Rate: Outside normal ranges
    • Rhythm: May be irregular
    • Depth: Inadequate or shallow
    (Continued) Inadequate Breathing volume
  • 14.
    • Breath sounds: Diminished or absent
    • Chest expansion: Unequal or
    inadequate (Continued) Inadequate Breathing
  • 15.
    • Effort
    (Continued) Inadequate Breathing Increased use of accessory muscles, especially in infants and children
  • 16.
    • Pale or cyanotic (blue) skin
    • Cool, clammy skin
    • Agonal (occasional) gasp (seen just before death)
    Inadequate Breathing
  • 17. Inadequate Breathing: Infants and Children Retractions Nasal Flaring See-Saw Breathing Diaphragmatic Breathing
  • 18. Artificial Ventilation
    • Performed with a pocket
    mask or bag-mask device.
    • Must be performed
    ADEQUATELY.
  • 19.
    • Chest rises and falls.
    • Rate:
    10–12/min. for adults 12–20/min. for infants/children
    • Heart rate returns to normal.
    Artificial Ventilation — Adequate
  • 20.
    • Chest does not rise and fall.
    • Rate is too slow or too fast.
    • Heart rate does not return
    to normal. Artificial Ventilation Inadequate
  • 21. The concept of adequate vs. inadequate breathing is one that must be stressed to new EMT-Bs. The mere thought of providing artificial ventilation to a person who has some respiratory effort is confusing. Ventilating a nonbreathing patient is difficult, let alone one who is breathing. Explain to new EMT-Bs that they should work with the patient’s respiratory effort and coach the patient when appropriate. P RECEPTOR P EARL
  • 22. Breathing Difficulty A chief complaint representing a patient’s feeling of labored or difficult breathing K EY TERM
  • 23. Patient ASSESSMENT Breathing Difficulty Signs and Symptoms
    • Shortness of breath
    • Restlessness
    • Increased pulse rate
    • Breathing rate increased or
    decreased (Continued)
  • 24. Patient ASSESSMENT Breathing Difficulty Signs and Symptoms
    • Skin color changes
    • Cyanotic
    • Pale
    • Flushed
    (Continued)
  • 25. Patient ASSESSMENT Breathing Difficulty Signs and Symptoms
    • Noisy breathing
    • Crowing
    • Audible wheezing
    • Gurgling
    • Snoring
    • Stridor
    (Continued)
  • 26. Patient ASSESSMENT Breathing Difficulty Signs and Symptoms
    • Inability to speak
    • Retractions/accessory muscle use
    • Abdominal breathing
    • Irregular breathing pattern
  • 27. Signs of Breathing Difficulty
  • 28. Sign of Breathing Difficulty Tripod Position
  • 29. Patient CARE Breathing Difficulty Emergency Care Steps
    • Focused History and Physical Exam
    (Continued) Onset Provocation Quality Radiation Severity Time = = = = = = O P Q R S T
  • 30. Patient CARE Breathing Difficulty Emergency Care Steps
    • Focused History and Physical Exam
    • Apply oxygen.
    • Assess baseline vital signs.
    (Continued)
  • 31. Patient CARE Breathing Difficulty Emergency Care Steps
    • Determine what interventions the
    patient has used.
    • Determine what medications patient takes (types, doses, times used).
    • If medical direction approves,
    facilitate use of prescribed inhaler.
  • 32. Prescribed Inhaler
  • 33. Medication Name Prescribed Inhaler
    • Generic (albuterol ,
    isoetharine, etc.)
    • Trade (Proventil,
    Ventolin, Alupent, etc.)
  • 34. Indications Patient must meet all criteria. Prescribed Inhaler
    • Signs/symptoms of
    breathing difficulty
    • Prescribed by physician
    • Specific authorization by
    medical direction
  • 35.
    • Patient is unable to use device.
    • Inhaler was not prescribed.
    • No permission has come from medical direction.
    • Patient has used maximum dose.
    Contraindications Prescribed Inhaler
  • 36.
    • Metered dose inhaler
    Medication Form Dosage
    • Number of inhalations
    based on physician’s order Prescribed Inhaler
  • 37. Obtain orders from medical direction.
  • 38.
    • Check expiration date.
    • Inhaler should be at room temp
    to use device. Prescribed Inhaler or warmer.
    • Has patient used one yet?
    • Make sure patient is alert and able
  • 39. Right Patient? Right Medication? Right Dose? Right Route? Right Time? Right Documentation?
  • 40. Shake vigorously.
  • 41.
    • Have patient exhale deeply.
    • Have patient place lips
    around inhaler opening. Prescribed Inhaler
  • 42. Depress handheld inhaler as patient inhales deeply. Instruct patient to hold breath.
  • 43. Allow patient to breathe. Repeat dose if ordered. Reevaluate patient.
  • 44. Spacer Device
  • 45. Actions
    • Beta agonist
    • Dilates bronchioles
    • Reduces airway resistance
    Prescribed Inhaler
  • 46. Side Effects
    • Increased pulse rate
    • Tremors
    • Nervousness
    Prescribed Inhaler
  • 47. Reassessment
    • Vital signs
    • Focused reassessment
    • Be alert for development
    of inadequate breathing Prescribed Inhaler
  • 48. Prescribed Inhaler: Children
    • Commonly prescribed.
    • Retractions more common.
    • Coughing more common
    than wheezing.
  • 49. 1. Describe signs of adequate and inadequate breathing. 2. Explain the indications and contraindications of a prescribed inhaler. 3. List the “rights” of medication administration. R EVIEW QUESTIONS

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