EMR ch15

Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Emergency Care, Twelfth Edition
Daniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth Edition
Le Baudour • Bergeron • Wesley
CHAPTERCHAPTER
Caring for Respiratory EmergenciesCaring for Respiratory Emergencies
1515

OVERVIEW OF RESPIRATORYOVERVIEW OF RESPIRATORY
ANATOMYANATOMY

Overview of the respiratory system.

Overview of Respiratory AnatomyOverview of Respiratory Anatomy
• Upper airway
– All spaces and structures above vocal
chords.
• Lower airway
– All structures and spaces below vocal
chords.
• Carina
– Where trachea splits into right and left
main stem bronchi.
(continued)

Overview of Respiratory AnatomyOverview of Respiratory Anatomy
• Bronchioles
– Smaller airways.
• Alveoli
– Where exchange of oxygen and carbon
dioxide takes place.
• Control center for respiratory is within
the brain.
(continued)

RESPIRATORY COMPROMISERESPIRATORY COMPROMISE

Respiratory CompromiseRespiratory Compromise
• Inability of person to breath
adequately.
• Hypoxia: when the body's cells do not
receive adequate supply of oxygen.
– Signs: altered mental status, pale skin,
cyanosis of nail beds/mucous membranes.
• Hypercarbia: condition of having too
much carbon dioxide in blood.

• Respiratory Distress (Dyspnea)
– Result of not getting adequate supply of
oxygen; increased in levels of carbon
dioxide in blood
– Increased work of breathing
– Increased respiratory rate
– Use of accessory muscles

• Respiratory Failure
– When body's normal compensatory
mechanisms fail.
– Breathing rate begins to slow.
– Tidal volume begins to get shallower.

• Common causes:
– Hyperventilation
– Asthma
– Chronic bronchitis
– Emphysema
– Exposure to poison
– Allergic reaction

• Normal Breathing
– Sufficient to support life.
– Easy and effortless (adequate).
– Do not work hard to breathe.
– Able to speak full sentences without having
to catch breath.
– Normal respiratory rate, depth, and very
little effort or work of breathing.

• Characteristics of Normal Breathing
– Normal rate (number breaths per minute):
12 to 24 for adult; 16 to 32 for child; 24 to
48 for infant.
– Normal depth (size of each breath): tidal
volume; normal breaths not too shallow
and not too deep.
(continued)

• Characteristics of Normal Breathing
– Work of breathing: effort it takes for
patient to move each breath in and out.
– Respiratory rhythm regular.

• Abnormal Breathing
– Inadequate; not sufficient to support life.
– Left untreated, will result in death.
– Common signs:
 Increased work of breathing
 Increased respiratory rate
(continued)

– Common signs:
 Decreased respiratory rate
 Respirations that are too deep or too shallow
 Irregular breathing rhythm
 Audible breath sounds (gurgling, snoring or
wheezing)
(continued)

– Tripod position: seated or standing with
hands on knees, shoulders arched upward,
head forward.
– Accessory muscles: muscles of neck, chest,
abdomen that assist during respiratory
difficulty.

Signs and symptoms of respiratory distress.

• Signs and Symptoms of Respiratory
Compromise
– Labored or difficulty breathing; a feeling of
suffocation.
– Audible breathing sounds.
– Rapid or slow rate of breathing.
– Abnormal pulse rate (too fast or too slow).
(continued)

• Signs and Symptoms of Respiratory
Compromise
– Changes in skin color, particularly of lips
and nail beds.
– Tripod position.
– Altered mental status.

• Chronic Obstructive Pulmonary Disease
– Conditions: asthma, chronic bronchitis,
emphysema
– Signs and symptoms:
 History of heavy cigarette smoking
 Persistent cough
 Chronic shortness of breath
 Pursed-lip breathing
(continued)

• Chronic Obstructive Pulmonary Disease
 Maintaining tripod position
 Fatigue
 Tightness in chest
 Wheezing

• Asthma
– Condition affecting lungs, characterized by
narrowing of air passages and wheezing.
– Caused by sensitivity to irritants (pollen,
pollutants, exercise).
– Narrowing air passages cause wheezing.
(continued)

• Asthma
 Moderate to severe shortness of breath
 Wheezing
 Anxiety
 Nonproductive cough
(continued)

Asthma causes the bronchioles to become narrow and filled with
mucus.

• Asthma
– Little/no symptoms between attacks.
– Medication in metered-dose inhaler.
(continued)

Metered-Dose Inhaler

Metered-Dose Inhaler with Spacer

• Asthma
– If left untreated, asthma attack can be
severe enough to cause respiratory arrest
and even death.

• Bronchitis
– Causes swelling and thickening of walls of
bronchi and bronchioles.
– Causes overproduction of mucus in air
passages.
– Chronic bronchitis: productive cough for
three consecutive months and occurs at
least two consecutive years.
(continued)

Emphysema affects the alveoli, and bronchitis affects the
bronchioles.

• Bronchitis
 Overweight
 Mild to moderate shortness of breath
 Pale complexion
 Productive cough
 Wheezes

• Emphysema
– Associated with cigarette smoking; disease
of lungs that causes permanent damage to
alveoli.
– Causes destruction of alveoli, making them
useless for exchange of oxygen and carbon
dioxide.
(continued)

• Emphysema
– Loss of lung elasticity and accumulation of
air cause chest wall to become extended
over time; “barrel chest.”
(continued)

• Emphysema
 Very thin in appearance
 Large chest (barrel chest)
 Nonproductive cough
 Extended exhalations

• Hyperventilation Syndrome
– Occurs when person breathes out and
eliminates excess amount of carbon
dioxide.
– Most cases caused by anxiety and do not
represent medical emergency.
(continued)

– Can be a sign of something serious.
– Be alert for cyanosis.
– Monitor for changes in vital signs.
– Reduce anxiety by reassuring and
comforting patient.
(continued)

 Anxiety
 Numbness or tingling of fingers, lips, and/or
toes
 Dizziness
 Spasm of fingers and/or toes
 Chest discomfort

• Emergency Care for Respiratory
Compromise
– Observe body language.
– Determine characteristics of breathing.
– Pay attention to level of distress and facial
expression.
– Reassure patient.
(continued)

• Emergency Care for Respiratory
Compromise
– Gather a history.
– Ability to speak clearly and in full
sentences.
– Listen for sounds as patient breathes.

• Take appropriate BSI precautions.
• Perform primary assessment; support
ABCs.
• Ensure patent airway; administer
oxygen per local protocols.
• Allow patient to maintain position of
comfort.
• Arrange for ALS response if available.
(continued)

• Assist with prescribed medication per
local protocols and medical direction.
• Obtain vital signs.
• Continue to monitor patient and
provide reassurance.

• Positive Pressure Ventilations
– Use bag-mask device to provide rescue
breaths when breathing determined to be
inadequate.
– Place mask firmly over patient's face;
provide rescue breaths at rate appropriate
for patient's age.

When breathing is inadequate, provide positive pressure ventilations
with a bag-mask device.

• Metered-Dose Inhalers (MDI)
– Small device that stores and delivers
medication that patient inhales into lungs.
– Encourage patient to take medication
exactly as prescribed.
– Check expiration date.

EMR ch15

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (7)

Similar to EMR ch15

Similar to EMR ch15 (19)

More from djorgenmorris

More from djorgenmorris (20)

Recently uploaded

Recently uploaded (20)

EMR ch15

Editor's Notes