Respiratory Emergencies

Chapter Respiratory Emergencies Thirteen

Chapter
How to recognize adequate and inadequate breathing
How to assist a patient with breathing difficulty in using a prescribed inhaler
Thirteen CORE CONCEPTS

R ESPIRATORY SYSTEM

Respiratory System

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

Cricoid is not well developed
(less rigid) .
Trachea is softer, more flexible than an adult’s.
Chest wall is softer.
Pediatric Airway Anatomy

Process of Respiration

Oxygen-rich air enters alveoli.
Oxygen-poor blood passes around alveoli.
Oxygen enters capillaries; carbon dioxide enters alveoli.
Gas Exchange: Alveolar Capillary

Cells give off carbon dioxide to capillaries.
Capillaries give off oxygen to cells.
Gas Exchange: Capillary Cellular

Adequate Breathing: Normal Rates (Continued)
Adults
Children
Infant
12-20/min. 15-30/min. 25-50/min.

Usually regular
May be slightly irregular and influenced by talking
(Continued) Adequate Breathing: Rhythm

Breath sounds: Present, equal
Chest expansion: Adequate, equal
Effort : Minimal or no
use of accessory muscles
Depth:
Adequate Breathing: Quality Adequate tidal volume

Rate: Outside normal ranges
Rhythm: May be irregular
Depth: Inadequate or shallow
(Continued) Inadequate Breathing volume

Breath sounds: Diminished or absent
Chest expansion: Unequal or
inadequate (Continued) Inadequate Breathing

Effort
(Continued) Inadequate Breathing Increased use of accessory muscles, especially in infants and children

Pale or cyanotic (blue) skin
Cool, clammy skin
Agonal (occasional) gasp (seen just before death)
Inadequate Breathing

Inadequate Breathing: Infants and Children Retractions Nasal Flaring See-Saw Breathing Diaphragmatic Breathing

Artificial Ventilation
Performed with a pocket
mask or bag-mask device.
Must be performed
ADEQUATELY.

Chest rises and falls.
Rate:
10–12/min. for adults 12–20/min. for infants/children
Heart rate returns to normal.
Artificial Ventilation — Adequate

Chest does not rise and fall.
Rate is too slow or too fast.
Heart rate does not return
to normal. Artificial Ventilation Inadequate

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

Breathing Difficulty A chief complaint representing a patient’s feeling of labored or difficult breathing K EY TERM

Patient ASSESSMENT Breathing Difficulty Signs and Symptoms
Shortness of breath
Restlessness
Increased pulse rate
Breathing rate increased or
decreased (Continued)

Skin color changes
Cyanotic
Pale
Flushed
(Continued)

Noisy breathing
Crowing
Audible wheezing
Gurgling
Snoring
Stridor
(Continued)

Inability to speak
Retractions/accessory muscle use
Abdominal breathing
Irregular breathing pattern

Signs of Breathing Difficulty

Sign of Breathing Difficulty Tripod Position

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

Focused History and Physical Exam
Apply oxygen.
Assess baseline vital signs.
(Continued)

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.

Prescribed Inhaler

Medication Name Prescribed Inhaler
Generic (albuterol ,
isoetharine, etc.)
Trade (Proventil,
Ventolin, Alupent, etc.)

Indications Patient must meet all criteria. Prescribed Inhaler
Signs/symptoms of
breathing difficulty
Prescribed by physician
Specific authorization by
medical direction

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

Metered dose inhaler
Medication Form Dosage
Number of inhalations
based on physician’s order Prescribed Inhaler

Obtain orders from medical direction.

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

Right Patient? Right Medication? Right Dose? Right Route? Right Time? Right Documentation?

Shake vigorously.

Have patient exhale deeply.
Have patient place lips
around inhaler opening. Prescribed Inhaler

Depress handheld inhaler as patient inhales deeply. Instruct patient to hold breath.

Allow patient to breathe. Repeat dose if ordered. Reevaluate patient.

Spacer Device

Actions
Beta agonist
Dilates bronchioles
Reduces airway resistance
Prescribed Inhaler

Side Effects
Increased pulse rate
Tremors
Nervousness
Prescribed Inhaler

Reassessment
Vital signs
Focused reassessment
Be alert for development
of inadequate breathing Prescribed Inhaler

Prescribed Inhaler: Children
Commonly prescribed.
Retractions more common.
Coughing more common
than wheezing.

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

Respiratory Emergencies

by paramedicbob on Jun 23, 2011

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Respiratory Emergencies Presentation Transcript