Acute Respiratory Distress Powerpoint


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  • Acute Respiratory Distress Powerpoint

    1. 1. BIEMS CEU Course <ul><li>Acute Respiratory Distress </li></ul>
    2. 2. Introduction <ul><li>ARD patients are a challenge for BLS technicians. </li></ul><ul><li>Many states limit the level of care that a BLS tech can provide. </li></ul><ul><li>Therefore, it is critical for basic EMS providers to have extremely sharp BLS level skills and to know when to pass the patient off to an ALS tech. </li></ul><ul><li>Much can still be done at the BLS level to save the patient’s life, as we’ll learn in today’s program. </li></ul>
    3. 3. Learning Objectives <ul><li>Identify and treat acute respiratory distress (ARD) secondary to congestive heart failure/pulmonary edema. </li></ul><ul><li>Identify and treat ARD secondary to chronic obstructive pulmonary disease (emphysema and/or chronic bronchitis) and asthma. </li></ul><ul><li>Identify and treat ARD caused by other common and not-so-common problems. </li></ul><ul><li>Discuss adjuncts of respiratory therapy commonly used by EMS provider with the ARD patient. </li></ul>
    4. 4. Learning Objective: Congestive Heart Failure (CHF) <ul><li>Condition in which the heart cannot pump enough blood into other organs, causing a backup of fluid into the lungs </li></ul><ul><li>Common cause of ARD </li></ul><ul><li>Risk factors </li></ul><ul><ul><li>Coronary artery disease </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Smoking </li></ul></ul><ul><ul><li>Alcohol and drug use </li></ul></ul>
    5. 5. Signs and Symptoms of CHF <ul><li>Tachycardia (rate of over 100 per minute) </li></ul><ul><li>Shortness of breath (dyspnea) </li></ul><ul><li>Normal or elevated blood pressure </li></ul><ul><li>Cyanosis </li></ul><ul><li>Pulmonary edema </li></ul><ul><li>Anxiety or confusion </li></ul><ul><li>Pedal edema </li></ul><ul><li>Engorged pulsating jugular (neck) veins </li></ul>
    6. 6. Signs and Symptoms of CHF (cont.) <ul><li>Adventitious lung sounds </li></ul><ul><li>Weight gain </li></ul><ul><li>Fatigue </li></ul><ul><li>Difficulty sleeping </li></ul><ul><li>Cough </li></ul><ul><li>Decreased urine output </li></ul><ul><li>Chest pain </li></ul><ul><li>Need for home oxygen therapy </li></ul>
    7. 7. Pre-hospital Treatment of CHF <ul><li>Scene safety </li></ul><ul><li>ABCs </li></ul><ul><li>Stable vs. unstable? </li></ul><ul><li>Vital signs </li></ul><ul><li>History (SAMPLE) </li></ul><ul><li>Lung sounds </li></ul><ul><li>Pulse oximetry (if available) </li></ul>
    8. 8. Pre-hospital Treatment of CHF (cont.) <ul><li>Physical exam as appropriate </li></ul><ul><li>Proper patient positioning (i.e., sitting upright) </li></ul><ul><li>Oxygen administration via: </li></ul><ul><ul><li>A—nasal cannula </li></ul></ul><ul><ul><li>B—facemask (simple, partial re-breather or non-rebreather) </li></ul></ul><ul><li>Re-evaluate </li></ul>
    9. 9. Knowledge Assessment <ul><li>What are five symptoms of CHF that EMS providers may see in a patient with possible CHF? </li></ul>
    10. 10. Learning Objective: Chronic Obstructive Pulmonary Disease <ul><li>Chronic obstructive pulmonary disease (COPD) is chronic but may have acute bouts of ARD. </li></ul><ul><li>Types of COPD: </li></ul><ul><ul><li>Emphysema </li></ul></ul><ul><ul><li>Chronic bronchitis </li></ul></ul>
    11. 11. Chronic Bronchitis <ul><li>Inflammation of lung tissue </li></ul><ul><li>Long-term disease </li></ul><ul><li>Presentation and treatment similar to emphysema </li></ul><ul><li>Caused by: </li></ul><ul><ul><li>Cigarette, pipe, or cigar smoking </li></ul></ul><ul><ul><li>Exposure to toxins or irritants (dust, chemicals, coal dust, etc.) </li></ul></ul><ul><ul><li>Frequent lung infections </li></ul></ul><ul><ul><li>Family history/other genetic factors </li></ul></ul>
    12. 12. Emphysema <ul><li>Also known as “black lung” </li></ul><ul><li>Caused by cigarette smoking, toxic exposure, or repeated infections </li></ul><ul><li>Takes years to be noticed </li></ul><ul><li>Risk factors: </li></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Tobacco use and second-hand smoke </li></ul></ul><ul><ul><li>Occupational (toxic fumes, vapors, etc.) </li></ul></ul><ul><ul><li>Pollution (both indoor and outdoor) </li></ul></ul><ul><ul><li>Heredity </li></ul></ul><ul><ul><li>Connective tissue disorders </li></ul></ul>
    13. 13. Signs and Symptoms of COPD <ul><li>Early signs/symptoms </li></ul><ul><ul><li>Trouble breathing especially during activity </li></ul></ul><ul><ul><li>Morning coughing </li></ul></ul><ul><ul><li>Colds and respiratory infections more often than previously noted </li></ul></ul><ul><li>Later signs </li></ul><ul><ul><li>Skin, lips, nail beds turning blue </li></ul></ul><ul><ul><li>Pursed lips </li></ul></ul><ul><ul><li>More SOB with less exertion </li></ul></ul><ul><ul><li>Wheezing </li></ul></ul><ul><ul><li>Faster and more shallow breathing </li></ul></ul><ul><ul><li>Patient losing weight </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>Positional breathing (leaning forward) </li></ul></ul>
    14. 14. Treatment of COPD <ul><li>Stable patient </li></ul><ul><ul><li>Scene safety is paramount. </li></ul></ul><ul><ul><li>Wear personal protective equipment (PPE). </li></ul></ul><ul><ul><li>Conduct thorough patient exam. </li></ul></ul><ul><ul><li>Administer oxygen. </li></ul></ul><ul><ul><li>NEVER WITHHOLD OXYGEN FROM A PATIENT WHO NEEDS IT. </li></ul></ul>
    15. 15. Treatment of COPD (cont.) <ul><li>Unstable patient </li></ul><ul><ul><li>Provide ventilation </li></ul></ul><ul><ul><li>Bag valve mask is the “tool of choice” </li></ul></ul><ul><ul><li>In COPD patients, avoid PPV (can cause pneumothorax) </li></ul></ul>
    16. 16. Patient Medications <ul><li>Patient may already have respiratory nebulizers or atomizers. </li></ul><ul><li>EMS providers can usually assist patient with their prescribed inhaler. </li></ul><ul><ul><li>MAKE SURE THIS IS ALLOWED IN YOUR AREA. </li></ul></ul>
    17. 17. Recommendations for MDI or Nebulizer Assistance <ul><li>Examine the medications. </li></ul><ul><li>Ensure that the patient is alert enough to use the inhaler or nebulizer, and of significant importance is the patient’s tidal volume. </li></ul><ul><li>Shake the MID vigorously before use. Ensure it is not cold; room temperature is best. </li></ul><ul><li>Try and get the patient to exhale deeply before inhaling the medications. </li></ul>
    18. 18. Recommendations for MDI or Nebulizer Assistance (cont’d) <ul><li>After inhalation, see if the patient can hold his or her breath a bit for the medication to be absorbed. </li></ul><ul><li>The EMS provider's role is mainly “coaching” more than actually administering the medications. </li></ul><ul><li>Follow local protocol and consult medical direction as appropriate </li></ul><ul><li>REMEMBER: NEVER WITHHOLD OXYGEN! </li></ul>
    19. 19. Knowledge Assessment <ul><li>What is the “tool of choice” for providing ventilation to a patient in respiratory distress? </li></ul>
    20. 20. Learning Objective: Less Common Causes of ARD <ul><li>Anaphylaxis </li></ul><ul><li>Hyperventilation </li></ul><ul><li>Spontaneous pneumothorax </li></ul>
    21. 21. Anaphylaxis <ul><li>Allergic reaction shock that may be triggered by: </li></ul><ul><ul><li>insect (bee, fire ant, etc.) stings. </li></ul></ul><ul><ul><li>food allergies (peanuts, etc.). </li></ul></ul><ul><ul><li>drug allergies/reactions. </li></ul></ul>
    22. 22. Anaphylaxis <ul><li>Signs/symptoms: </li></ul><ul><ul><li>Tightness in the throat or chest </li></ul></ul><ul><ul><li>Cough </li></ul></ul><ul><ul><li>Labored, noisy breathing </li></ul></ul><ul><ul><li>Hoarse, muffled voice </li></ul></ul><ul><ul><li>Wheezing (sometimes audible without a stethoscope) </li></ul></ul><ul><ul><li>Altered mental status </li></ul></ul><ul><ul><li>Flushed, dry or pale, or cool and clammy skin </li></ul></ul><ul><ul><li>Nausea or vomiting </li></ul></ul><ul><ul><li>Changes in blood pressure (hypotension) </li></ul></ul>
    23. 23. Treatment of Anaphylaxis <ul><li>IMMEDIATE TREATMENT IS REQUIRED. </li></ul><ul><li>Assess ABCs and maintain an open airway. </li></ul><ul><li>Call for an ALS unit to intercept or rendezvous if available. </li></ul><ul><li>Start the patient on high-flow oxygen. </li></ul><ul><li>Evaluate respiratory effectiveness (tidal volume, effort, etc.). </li></ul><ul><li>Assess lung sounds. </li></ul><ul><li>Evaluate blood pressure. </li></ul><ul><li>Patient positioning if the patient is hypotensive. </li></ul><ul><li>Ventilate the patient with BVM or other appropriate pressure device. </li></ul><ul><li>Monitor oxygen saturation (SaO 2 ). </li></ul>
    24. 24. Hyperventilation <ul><li>Rarely life-threatening; often caused by psychological stressors </li></ul><ul><li>Sometimes referred to as “behavioral breathlessness” </li></ul><ul><li>Signs and symptoms: </li></ul><ul><ul><li>Agitation/anxiety </li></ul></ul><ul><ul><li>Sudden onset of chest pain </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Dizziness </li></ul></ul><ul><ul><li>Weakness </li></ul></ul><ul><ul><li>Palpitations </li></ul></ul><ul><ul><li>Wheezing </li></ul></ul><ul><ul><li>Tetanic cramps (carpopedal spasm) </li></ul></ul><ul><ul><li>Paresthesias </li></ul></ul><ul><ul><li>Syncope </li></ul></ul>
    25. 25. Treatment of Hyperventilation <ul><li>Remove the stressor. </li></ul><ul><li>Apply a pulse oximeter. Hypoxia can cause hyperventilation, too. </li></ul><ul><li>Rebreathing into a paper bag is not recommended in the field. </li></ul><ul><li>Treat with supplemental oxygen. </li></ul><ul><li>Try to find the source of the hyperventilation. Transport to the closest appropriate facility. </li></ul>
    26. 26. Spontaneous Pneumothorax <ul><li>Collection of air or gas in the lung, causing collapse </li></ul><ul><li>Occurs in the absence of trauma </li></ul><ul><li>Primarily occurs in people without lung disease in tall, thin men between the ages of 20-40 </li></ul><ul><li>May also occur in conjunction with: </li></ul><ul><ul><li>tuberculosis. </li></ul></ul><ul><ul><li>pneumonia. </li></ul></ul><ul><ul><li>asthma. </li></ul></ul><ul><ul><li>cystic fibrosis. </li></ul></ul><ul><ul><li>lung cancer. </li></ul></ul><ul><ul><li>interstitial lung disease. </li></ul></ul>
    27. 27. Signs and Symptoms of Spontaneous Pneumothorax <ul><li>Sudden chest pain; breathing makes the pain worse </li></ul><ul><li>Shortness of breath </li></ul><ul><li>Tachypnea </li></ul><ul><li>Abnormal breathing movement </li></ul><ul><li>Coughing </li></ul>
    28. 28. Treatment of Spontaneous Pneumothorax <ul><li>Ensure adequate respiratory function and tidal volume. </li></ul><ul><li>Use pulse oximetry to monitor oxygen saturation. </li></ul><ul><li>General supportive care for stable patients. </li></ul><ul><li>Positive pressure ventilation for unstable patients. </li></ul><ul><li>Call ALS techs or transport ASAP if patient decompensates. </li></ul>
    29. 29. Knowledge Assessment <ul><li>What are the signs and symptoms of anaphylactic shock? </li></ul>
    30. 30. Learning Objective: Adjuncts of Respiratory Care <ul><li>Oxygen delivery equipment </li></ul><ul><ul><li>Come in various sizes </li></ul></ul><ul><ul><li>Must be tested every 5 years </li></ul></ul><ul><ul><li>NEVER USE ANY TYPE OF OIL NEAR O 2 EQUIPMENT </li></ul></ul><ul><li>“ D” cylinder – about 350 liters of oxygen (most commonly used by EMS providers) </li></ul><ul><li>“ E” cylinder – about 625 liters of oxygen </li></ul><ul><li>“ M” cylinder – about 3,000 liters of oxygen </li></ul>
    31. 31. Patient Care Equipment <ul><li>Nasal cannula </li></ul><ul><ul><li>Percentage of oxygen delivered is between 24 and 44 percent </li></ul></ul><ul><ul><li>Not to be used on hypoxic patients </li></ul></ul><ul><ul><li>Should be attached by inserting the prongs in the nostrils, around the ears and then under the chin; NOT in the nostrils and then back behind the head </li></ul></ul><ul><ul><li>Oxygen flow rates range between 4-6 liters per minute (LPM) but 2-3 LPM are not uncommon for patients on home oxygen via nasal cannula </li></ul></ul><ul><ul><li>Usually well tolerated by patients </li></ul></ul><ul><ul><li>Patients with inadequate tidal volume should NEVER have a nasal cannula applied for obvious reasons </li></ul></ul>
    32. 32. Non-rebreather Oxygen Mask <ul><li>Excellent 0 2 delivery tool </li></ul><ul><li>Important points: </li></ul><ul><ul><li>Should only be used in patients with adequate tidal volume. </li></ul></ul><ul><ul><li>Delivers between 80-90 percent oxygen. </li></ul></ul><ul><ul><li>Oxygen flow rates range around 12-15 LPM. </li></ul></ul><ul><ul><li>Always inflate the reservoir bag before applying to the patient by closing off the non-rebreather valve after turning on the oxygen flow. </li></ul></ul><ul><ul><li>Adjust flow rates to not allow bag deflation by more than one-third. </li></ul></ul>
    33. 33. Venturi Face Mask <ul><li>Used for long transport situations </li></ul><ul><li>Simple face mask with an adaptor </li></ul><ul><li>Adaptor accepts different color-coded inserts to control the percentage of oxygen </li></ul><ul><li>Oxygen tubing attaches to the insert </li></ul>
    34. 34. Bag Valve Mask <ul><li>“Tool of choice” in the non-breather </li></ul><ul><li>Biggest usage pitfall: improper mask size and seal </li></ul><ul><li>“E-C” method works well when a single rescuer must operate the BVM </li></ul>
    35. 35. CPAP <ul><li>Generally used by ALS techs BUT some states are now allowing EMS providers to perform CPAP under certain conditions </li></ul><ul><li>Consists of: </li></ul><ul><ul><li>mask. </li></ul></ul><ul><ul><li>hose. </li></ul></ul><ul><ul><li>pressure regulator. </li></ul></ul><ul><ul><li>PEEP. </li></ul></ul><ul><li>Indicated in CHF patients but not in other COPD patients </li></ul>
    36. 36. Pulse Oximetry Devices <ul><li>Formerly for in-hospital use </li></ul><ul><li>Noninvasively checks the percentage of 0 2 saturation in the blood on the patient’s finger </li></ul><ul><li>Normal: 95-99 percent </li></ul><ul><li>COPD patient: 88-92 percent </li></ul><ul><li>Nail polish can cause false readings </li></ul><ul><li>Use different arm for blood pressure reading </li></ul><ul><li>Disinfect the probe between patients </li></ul><ul><li>Get a “room air” reading before 0 2 administration </li></ul>
    37. 37. Oxygen Humidifiers <ul><li>Hook up between the supply and the patient. </li></ul><ul><li>Use sterile water to humidify oxygen. </li></ul><ul><li>Used primarily for long transport times. </li></ul><ul><li>Used in 0 2 administration for COPD patients </li></ul>
    38. 38. Knowledge Assessment <ul><li>What are normal SaO 2 levels? </li></ul>
    39. 39. Conclusion <ul><li>Acute respiratory distress can be challenging to treat in the field. </li></ul><ul><li>Aggressive and appropriate airway and respiratory management are critical. </li></ul><ul><li>EMS providers are encouraged to train and learn more about ARD emergencies in order to improve patient care. </li></ul>
    40. 40. End of Presentation <ul><li>Good luck with the test! </li></ul>