presentation show problems and management of breathing emergencies - as apart of primary survey in ER

1. B Y
D R . AH M E D AB D E LTAWA B AZ AB
E M E R G E N C Y C O N S U LTAN T
AM E R I C A N H E AR T AS S O C I AT I O N I N S T R U C TO R
E M E R G E N C Y L E C T U R E R

2. E M E R G E N C I E S O F B R E AT H I N G

3. BREATHING EMERGENCIES
• Patent airway
• O2 mask
• Assessment of ventilation:
• Inspection
• Palpation
• Percussion.
• Auscultation

5. LOWER AIRWAY ANATOMY
•Lung
•Pleura
•Ribs
•Intercostal muscles –
diaphragm.

8. LUNGS

9. Lung
• Pneumonia:
o Fever + cough.
o Respiratory distress.
o Generalized symptoms.
• Consideration:
o age group: adult – pediatric – geriatric
o CURP – 65 score.
• Safety of your self.
• Safety of your patient.

10. Lung
• COPD.
o Cough.
o Smoker.
o Home O2.
• Consideration:
o O2 supply
o Bronchodilator.
o Avoid hyperventilation.

11. Lung
• Bronchial asthma:
o Inflammatory reaction.
o Triggering factor.
o Cough – SOB
• Consideration:
o Severity of attack.
o Bronchodilator.
o O2

12. Pleura
• Pleurisy:
o Pleuritic chest pain.
o Related to breathing.
o Underlying pathology.
• Consideration:
o Investigations.
o Management.
o Reassurance.

13. Pleura
• Pneumothorax:
• Accumulation of air in pleural space
• Common types:
o Spontaneous:
• Chest pain.
• SOB increased gradually.
• Young – athlete – underlying lung disease.
• Diagnosed by X – Ray.
• Management: according to age and size.

14. Pneumothorax
• Open pneumothorax:
o Trauma.
o Open chest wall wound.
o Dangerous.
• Management:
• Closure of the wound with 3 sides sealing

18. Pneumothorax
• Tension pneumothorax.
• Most dangerous – hidden.
• Manifestations:
o Trauma.
o Tachycardia.
o Tachypnea.
o Desaturation.
o Hypotension – distended neck veins
o Chest examination: inspection – palpation – percussion –
auscultation.

19. Pneumothorax
• Tension pneumothorax.
• Management:
o Airway – C-spine – O2 mask.
o Needle thoracotomy.
o Chest tube

21. Pleura
• Hemothorax.
• Accumulation of blood in pleural space.
• Clinical manifestation:
o Like pneumothorax
o Except dullness in percussion.

22. Pleura
• Hemothorax
• Management:
o Chest tube.
o Massive when:
• Gush of 1500 ml blood or more at time of tube insertion.
• Bleeding is > 200 mL/h for > 2 to 4 h and causes
respiratory or hemodynamic compromise or the need for
repeated blood transfusions
o Open thoracotomy

24. Ribs
• Fracture rib
• Fracture ribs.
• Flail chest.
• Flail segment.

26. Ribs
• Complications:
o Pain.
o Respiratory distress.
o SOB.
o Lung contusion.
o Paradoxical breathing.
o Pneumo or Hemothorax.

27. CO inhalation
• Tachypnea
• Tachycardia
• Respiratory distress
• History of smoke – closed room stay
• Normal O2 saturation

29. Management
• O2 supply – high flow O2
• Hyperbaric O2

30. Assessment of good
respiration
• Normal breathing
• Equal bilateral air entry
• Equal bilateral chest wall movement
• Pulse oximeter

31. Inspection
Palpation
Percussion
Auscultation

32. • Diagnosis
And in the same time
• Management.