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First Aid: Respiratory Emeregencies


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First Aid: Respiratory Emeregencies

  1. 1. 8 Respiratory Emergencies Anas Bahnassi PhD
  2. 2. Anas Bahnassi PhD CDM CDE 2
  3. 3. Respiratory System: • The primary function of the respiratory system is to supply the blood with oxygen in order for the blood to deliver oxygen to all parts of the body. • Respiration is achieved through the mouth, nose, trachea, lungs, and diaphragm. • Oxygen enters through the mouth and the nose. • The oxygen then passes through the larynx and the trachea which is a tube that enters the chest cavity. • The trachea splits into two smaller tubes called the bronchi. • Each bronchus then divides again forming the bronchial tubes. These divide into many smaller tubes which connect to tiny sacs called alveoli. • The inhaled oxygen passes into the alveoli and then diffuses through the capillaries into the arterial blood. • The waste-rich blood from the veins releases its carbon dioxide into the alveoli. Anas Bahnassi PhD CDM CDE 3
  4. 4. Respiratory System: Adequate Breathing Rates: o Adults o Children o Infant Anas Bahnassi PhD CDM CDE 12-20/min. 15-30/min. 25-50/min. 4
  5. 5. Adequate breathing: o Usually regular rhythm o Rhythm may be slightly irregular influenced by talking o Breath sounds are present and equal. o Chest expansion is adequate and equal. o Minimal effort. o Adequate tidal volume.
  6. 6. Inadequate breathing: o Breathing rate outside normal range. o Rhythm may be irregular at rest. o Inadequate depth. o Shallow volume. o Diminished or absent breathing sounds. o Unequal or inadequate chest expansion. o Increased effort and use of accessory muscles to breathe.
  7. 7. Inadequate breathing: o Pale or blue skin. o Cool clammy skin. o Occasional gasp.
  8. 8. Respiratory Emergencies: Primary Assessment: Scene Size-up: Scene safety: 1. Ensure safe access to patient. 2. Consider that the patient may be in distress because of exposure to toxic materials. 3. Use a HEPA respirator if there is evidence of communicable diseases. 4. Assess the need for additional resources. Anas Bahnassi PhD CDM CDE 8
  9. 9. Respiratory Emergencies: Primary Assessment: Scene Size-up: Mechanism of Injury: 1. Observe the scene and look for possible MoI. 2. Ensure that the RE is not a result of traumatic injury. 3. Question the patient, family members, or bystanders for possible MoI. 4. Observe for signs of urticaria, chest pain, and fever. Anas Bahnassi PhD CDM CDE 9
  10. 10. Respiratory Emergencies: Primary Assessment: Form a general impression: 1. Perform a rapid scan to the patient. 2. Is the patient in a tripod position? 3. Does the patient have a barrel chest? 4. AVPU? 5. Set priorities depending on MoI. 6. Call emergency… Anas Bahnassi PhD CDM CDE 10
  11. 11. Respiratory Emergencies: Primary Assessment: Airway and Breathing: 1. Ensure airways are open. 2. If closed open using jaw thrust. 3. A person with altered level of consciousness, may need emergency help. 4. Consider nasopharyngeal or oropharyngeal airway. 5. Assess for gurgling or stridor. 6. Suction as needed. Anas Bahnassi PhD CDM CDE 11
  12. 12. Respiratory Emergencies: Primary Assessment: Airway and Breathing: 1. Evaluate the patient’s ventilatory status for rate, depth, effort, and tidal volume. 2. Inspect the chest for DCAP-BTLS 1. Deformities 2. Contustions 3. Abrasions Determine if the 4. Punctures/Penetrations breathing is adequate 5. Burns or not… 6. Tenderness 7. Lacerations 8. Swelling Anas Bahnassi PhD CDM CDE 12
  13. 13. Respiratory Emergencies: Primary Assessment: Circulation: 1. Evaluate distal pulse rate, strength, and rhythm. 2. Tachycardia  respiratory distress.  shock. 3. Bradycardia  possible cardiac emergency.  medication reaction or poisoning. 4. Observe skin color, temperature, and condition. 5. Look for life-threatening bleeding and treat accordingly. 6. Transport of O2 may be reduced due to lack or RBC. 7. If distal pulse is not palpable, assess central pulse. Anas Bahnassi PhD CDM CDE 13
  14. 14. Respiratory Emergencies: Primary Assessment: Transport Decision: Airway or Breathing Problem? Lifethreat? Internal Bleeding? Anas Bahnassi PhD CDM CDE 14
  15. 15. Respiratory Emergencies: History Taking: Investigate the chief complaint: 1. Monitor patient for mental changes. 2. Ask OPQRST, and SAMPLE questions. 3. Identify pertinent negatives. 4. Has the patient done anything for their breathing problem? 5. If inhaler was used, how many does? 6. Is the patient coughing? 7. Can he sleep lying down? Anas Bahnassi PhD CDM CDE 15
  16. 16. Respiratory Emergencies: Secondary Assessment: Physical Exam: 1. 2. 3. 4. 5. 6. 7. 8. Perform Head-to-Toe exam. Check for DCAP-BTLS. Focus on respiratory efforts, and respiratory adequacy. The sounds you hear when you auscultate will help you determine lung function. Accessory muscle use, nasal flaring, pursed lips, confusion, and tachypnea are signs of respiratory distress. Look for hives. Examine skin color, cyanosis is a sign of hypoxia. Monitor mental status. Anas Bahnassi PhD CDM CDE 16
  17. 17. Respiratory Emergencies: Secondary Assessment: Vital signs: 1. Obtain baseline vital signs. 2. Repeat every 5-15 mins. 3. Vital signs should include BP by ausculation, pulse rate and quality, respiration rate and quality, and skin assessment for perfusion. 4. Level of concousness. 5. Pulse oximeter to determine perfusion status. Anas Bahnassi PhD CDM CDE 17
  18. 18. Respiratory Emergencies: Reassessment: Interventions: 1. Reassess the primary examination, vital signs, and chief complaint. 2. Assist breathing as required. 3. Administer high flow O2. 4. Assist patient with prescribed meds. 5. Check interventions rendered. 6. Be prepared to modify treatment. 7. Support the cardio-vascular system. 8. Do not delay transport. Anas Bahnassi PhD CDM CDE 18
  19. 19. Respiratory Emergencies: General Management of RE: 1. Managing life-threatening ABCs and ensuring high flow O2 delivery are the major concerns. 2. Patients breathing with less than 8 breaths/min or more than 30 breaths/min should have ventilations assisted with a bagmask device. 3. Continually assess mental health. 4. Transport in the position of comfort. 5. Use precautions (HEPA mask). Anas Bahnassi PhD CDM CDE 19
  20. 20. Respiratory Emergencies: Upper or lower airway infections: 1. Dyspnea may be from croup or epiglottitis. 2. Patient should receive humidified O2 if available, 3. Patient sitting forward, seem lethargic, or are drooling may have epiglottitis. 4. Don’t force patient to lie down or to insert an oropharyngeal tube. It may cause spasm and complete obstriction. Transport rapidly. 5. In lower infections, provide O2, monitor signs, and transport to hospital Anas Bahnassi PhD CDM CDE 20
  21. 21. Respiratory Emergencies: Acute pulmonary edema: 1. Congestive heart failure or toxic inhalation may cause pulmonary edema. 2. Place the patient in position of comfort (sitting-up). 3. Administer high flow O2. 4. Provide ventilatory support and suction. 5. Continuous positive air can be provided. 6. Transport quickly to hospital. Anas Bahnassi PhD CDM CDE 21
  22. 22. Respiratory Emergencies: COPD: 1. Patient maybe semiconscious or unconscious due to hypoxia. 2. They may appear to have respiratory distress or cyanotic. 3. They may have pursed lips and may be using accessory muscles to breathe (shoulders and neck). 4. Assist with patient’s prescribed inhaler. Document time and effect of each use. 5. Many may overuse their inhalers. 6. Keep patient in sit-upright position. 7. Treat with full-flow oxygen using a non-rebreathing mask. Anas Bahnassi PhD CDM CDE 22
  23. 23. Respiratory Emergencies: Asthma, hay fever, and anaphylaxis: 1. Not all wheezing is related to asthma…. 2. If patient is asthmatic help with inhaler/nebulizer. 3. Hay fever requires support. If accompanied with cold symptoms, oxygen might be needed. 4. Anaphylaxis is a true emergency that requires transporting the patient to the hospital. 5. Use epinephrine shot if the patient was prescribed it. 6. Inject the epinephrine in the thigh at 90° angle. Anas Bahnassi PhD CDM CDE 23
  24. 24. Respiratory Emergencies: Pneumothoax: Result of trauma Spontaneous Place patient in comfortable position Support the ABCs CPR if necessary Prompt transport Anas Bahnassi PhD CDM CDE 24
  25. 25. Respiratory Emergencies: Pleural effusion: Removal of fluid collected outside the Lungs. Provide Oxygen Support the ABCs Prompt transport Anas Bahnassi PhD CDM CDE 25
  26. 26. Respiratory Emergencies: Airway obstruction: Use age-appropriate foreign body to maneuver and clear the airway. Provide Oxygen Prompt transport Anas Bahnassi PhD CDM CDE 26
  27. 27. Respiratory Emergencies: Pulmonary embolism: Ventilation perfusion mismatch No gas exchange takes place Patient is hypoxic Cardiac arrest may occur Anas Bahnassi PhD CDM CDE Sitting position is preferred Clear airway from hymoptysis Provide Oxygen 27
  28. 28. Respiratory Emergencies: Hyperventilation: Investigate history to determine cause Don’t have the patient breathe into paper bag Reassure patient Provide Oxygen Prompt transport Anas Bahnassi PhD CDM CDE 28
  29. 29. Clinical Pharmacy VI: First Aid Anas Bahnassi PhD CDM CDE