Respiratory Emergencies

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Respiratory Emergencies

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