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ATS - respiratory compromise
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Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 2
3.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • The respiratory system in any patient can become compromised with: – Little warning – No warning • Injury and illness can both compromise respiration Slide 3
4.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 1. Inadequate Breathing 2. Assessing Inadequate Breathing 3. Respiratory Distress Medications 4. Respiratory Distress & Failure Slide 4
5.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 5
6.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • A patient with respiratory difficulty can present with breathing that is: – Adequate – Inadequate • Your ability to rapid assess and provide immediate intervention will be critical in providing life-saving care Slide 6
7.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Inadequate breathing is breathing that is not sufficient to support life due to a lack of oxygen or an excess of carbon dioxide • If untreated, it will lead to death Slide 7
8.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • The rate of breathing may be outside the normal range of 12-20 bpm for an adult • Breathing that is either very slow or very rapid can limit the effective amount of air entering or leaving the lungs Slide 8
9.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • The rhythm of breathing may be irregular • Regularity can be difficult to assess, as it can be difficult to see or hear the respirations – Talking can cause respirations to be irregular Slide 9
10.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • A patient could exhibit a regular rate even though the effort to breathe is inadequate Slide 10
11.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • The quality of breathing, or the effectiveness of the effort to move adequate air in and out of the lungs, will deviate from normal • Breath sounds may be: – Present – Decreased – Absent Slide 11
12.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Respiratory effort may: – Normal – Excessively deep – Shallow – Absent • Chest expansion may be: – Normal – Minimal – Unequal Slide 12
13.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • A patient that has inadequate breathing is experiencing respiratory compromise • Respiratory compromise: – Develop slowly over time – Can come on suddenly • Any compromise to the respiratory system is an emergency that requires immediate, corrective action: – Be alert for respiratory compromise in every patient Slide 13
14.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Respiratory compromise can involve an impairment of the airway, respiration or ventilation • If the airway is impaired, movement of oxygenated air into and out of the lungs is blocked Slide 14
15.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Possible causes of airway blockage can include: – A foreign body obstruction – Blockage from the tongue – Fluids such as blood, secretions or emesis • The airway can also be impaired by swelling or trauma to the neck Slide 15
16.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Respiration is the exchange of the gases oxygen and carbon dioxide between the bloodstream and outside air • If respiration is impaired, air is breathed in, but it either lacks adequate oxygen or the body is unable to use the oxygen contained in it Slide 16
17.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Possible causes of impaired respiration: – Trauma – Infection in the lungs – Narrowing of the airway caused by illness – Poor circulation – Excess fluid in the lungs or between the lungs an blood vessels – A low-oxygen environment – Poison gas Slide 17
18.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Ventilation is the effectiveness of the mechanical process by which air is moved in and out of the lungs • Ventilation is impaired if an insufficient volume of air is moving into and out of the lungs, or the rate of breathing, depth of breathing or both are not adequate Slide 18
19.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Possible causes of impaired ventilation can include: – An altered level of consciousness – Injury to the chest – Poisoning – Overdose – Disease Slide 19
20.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Trauma injuries can cause severe damage that can quickly compromise the respiratory system • Some injuries are obvious when they involve the chest • Expect respiratory compromise in any trauma case Slide 20
21.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Common medical causes of respiratory compromise can include: – Respiratory infections – Diseases Slide 21
22.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • In the case of respiratory infections, the ability of the respiratory system to function properly can be severely limited • It is not necessary that you determine the exact medical cause of the breathing difficulty: – Be aware of some common illnesses Slide 22
23.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Pneumonia and other chronic conditions, such as chronic obstructive pulmonary disease (COPD) can cause respiratory compromise • COPD includes serious conditions such as: – Emphysema – Chronic bronchitis Slide 23
24.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Asthma is a life- threatening disease that presents with episodic flares • Can be triggered by: – Allergies – Pollutants – Infections – Strenuous exercise – Emotional stress Slide 24
25.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Asthma patients are typically able to inhale, but constricted bronchioles and overproduction of mucus causes stale air to be trapped in the lungs • Forceful exhalation produces a characteristic wheezing sound Slide 25
26.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Pediatric patients can have respiratory compromise due to: – Asthma – Allergies – Drowning – Choking – Illness • In children, respiratory arrest is the most likely cause of cardiac arrest that is not due to trauma Slide 26
27.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Croup is a viral illness often seen in pediatric patients • Croup causes inflammation of the larynx, trachea and bronchi that results in swelling of the upper airway Slide 27
28.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 28
29.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • A patient with respiratory difficulty can present with breathing that is either adequate or inadequate • Your ability to rapid assess and provide immediate intervention is critical Slide 29
30.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Signs and symptoms for inadequate breathing can vary greatly depending on the respiratory condition that is causing the problem Slide 30
31.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • A common sign of respiratory distress is “tripoding” – The patient may stand or sit with hands on the knees, shoulders arched upward and head forward • Tripoding allows for unrestricted movement of the muscles used in respiration and straightens the airway to reduce resistance to airflow Slide 31
32.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Common signs and symptoms of respiratory conditions associated with inadequate breathing can include • Restlessness: – Low levels of oxygen to the brain • Respiratory distress, or an increase in the work of breathing Slide 32
33.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Dyspnea • Abnormal breathing sounds • Changes in respiratory rate or rhythm • Abdominal breathing • Accessory muscle use during breathing Slide 33
34.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Increased pulse rate • Altered mental status • Skin color changes • An inability to speak Slide 34
35.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Use a modified OPQRST mnemonic to gather patient information • Keep the questioning short: – Patient may be in too much distress to answer a lot of questions Slide 35
36.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Ask what the patient was doing at the time of onset: – Did anything triggered it ? – Was gradual or sudden? • Inquire and observe whether changing position makes breathing better or more difficult Slide 36
37.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Ask if the patient has more difficulty breathing in or breathing out • Have patient indicate whether the discomfort radiates to any other part of his body • Have him describe the severity of his breathing difficulty on a scale of 1 to 10, with 10 being the most severe Slide 37
38.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Ask: – When the breathing difficulty began – How long it lasts – If it has been a recurring problem • Patients with pneumonia: – Ask whether he has been coughing and if it is productive Slide 38
39.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Auscultate the patient’s chest to assess breath sounds as he inhales and exhales • Listen to the anterior upper lobe just below the second rib at the midclavicular line: – Listen to the lower lobe just below the 4th rib Slide 39
40.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 40 • Listen to the posterior upper lobe at the midscapular line: – Listen laterally to the midscapular line for the lower lobe • At the mid-axillary line, listen to the upper lobe
41.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Listening to the lungs in multiple locations can help you: – Localize – Identify the patient’s problem – Detect changes over time Slide 41
42.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • The quality of breathing is evaluated by breath sounds • The depth of breathing effort as noted by: – Chest expansion and contraction – Symmetry of the chest movement Slide 42
43.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Respiratory effort may be: – Normal – Excessively vigorous – Shallow or absent • Listen for whether breath sounds are: – Present – Decreased – Absent • If present, they may be: – Normal – Abnormally noisy – Diminished Slide 43
44.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Absent or diminished breath sounds suggest: – The presence of air, blood or fluid outside the lung and in the chest cavity – An obstruction of a bronchus – A problem with the lung tissue such as fluid, infection or a mass Slide 44
45.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Compare both sides of the chest • Chest expansion may be: – Normal – Unequal • Typically, diminished or absent breath sounds on only one side indicates the presence of: – An injury – Collapse lung – Surrounding air or fluid between the lung and the inner chest wall Slide 45
46.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Note any abnormal sounds you hear • Common abnormal breath sounds include: – Stridor – Wheezing – Rhonchi – Rales • Practice listening to breath sounds: – Will help you recognize the difference between normal and abnormal breathing Slide 46
47.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Stridor is a high-pitched sound – Is typically be heard on inspiration, often without a stethoscope • Stridor indicates the presence of a partial obstruction of the upper airway caused by an object, swelling or spasm Slide 47
48.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 •Causes of Stridor include: – Infection – Allergic reactions – Burns Slide 48
49.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Wheezing is a high- pitched musical sound • Typically heard on expiration: – In severe cases it is heard on inhalation • Wheezing indicates narrowing of the bronchioles Slide 49
50.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Wheezing can be heard with many conditions • It is typical in conditions such as: – Asthma – Emphysema – Chronic bronchitis Slide 50
51.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Rales, sometimes called crackles: – Fine crackling or bubbling sound on inhalation • Crackles indicate that there is fluid in and around the alveoli: – Common in patients with pneumonia or heart failure with congestion Slide 51
52.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Rhonchi are low-pitched snoring or rattling sounds: – Indicates an obstruction of the larger airway structures • Heard in patients with: – Pneumonia – Emphysema – Bronchitis • Because rhonchi are caused by thick secretions of mucus, the quality of the sound changes if the patient coughs Slide 52
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Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Rhonchi are caused by thick secretions of mucus: – The quality of the sound changes if the patient coughs Slide 53
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Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Whenever the respiratory system is compromised, expect the patient to be experiencing some degree of inadequate oxygenation • Just because your patient is breathing does not mean that she is receiving adequate oxygen to sustain life • You must determine the adequacy of the oxygen and act accordingly Slide 54
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Emergency Medical Technician 8
– Respiratory Compromise © 2014 • A patient with adequate oxygenation will: – Exhibit a mental status considered normal for the patient – May or may not have a skin color that appears normal for her Slide 55
56.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • A patient with inadequate oxygenation will: – Have a mental status considered abnormal or altered – His skin color may or may not appear normal with possible cyanosis, pallor or mottling • Inadequate breathing can lead to hypoxemia Slide 56
57.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Hypoxemia can cause hypoxia: – The cells of the body lack sufficient oxygen – Cells function abnormally or die – Can cause organ failure and, eventually, death Slide 57
58.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • When you take the patient’s vital signs, you may see anomalies in: – Heart rate – Breathing rate – Blood pressure • The blood pressure may drop as a result of pressure inside the chest Slide 58
59.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • If the needle drops more than 10 mmHg on inhalation when obtaining systolic pressure, pulsus paradoxus is indicated: – A severe respiratory condition • This caused by pressure in the chest decreasing the volume of blood returning to the heart: – The pulse strength returns on exhalation Slide 59
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Emergency Medical Technician 8
– Respiratory Compromise © 2014 • The heart rate may be either increased or decreased • Bradycardia - a slow heart rate indicates: – Poor oxygenation – Respiratory failure – Possible impending cardiac arrest Slide 60
61.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Expect the breathing rate to be increased: – A decrease indicates severe hypoxia and will require immediate ventilation • Closely monitor the patient’s respiratory rate and tidal volume for adequacy Slide 61
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Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Get a baseline reading for comparison later • Check the pulse oximeter and make sure it correlates with the palpated pulse or a cardiac monitor: – This will help you more accurately identify changes in the patient’s oxygen saturation level Slide 62
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Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 63
64.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Bronchodilators used to treat acute and chronic respiratory conditions: – These act quickly – Help to open the airways • Medications are delivered via: – A metered-dose inhaler – Small-volume nebulizer • If your patient has a prescription, you may be able to assist with administering the medication Slide 64
65.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Contact medical direction for permission and guidance before assisting any patient with medication • An order from medical direction may be either: – On-line by direct communication – Off-line through established protocols or standing orders Slide 65
66.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Check the 5 rights of medication administration • Confirm the following: – Right patient – Right medication – Right route of administration – Right dose – Right time Slide 66
67.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Inspect the medication to make sure it is prescribed for the patient you are assisting • Confirm that it is the correct medication to be administered under the circumstances • Make sure you understand how to correctly administer the medication • Inhalers and nebulizers are administered through the route of inhalation Slide 67
68.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Follow the manufacturer’s direction and the guidance of medical control in administering the proper dose • Overmedicating can harm the patient • Ask whether the patient used the medication before you arrived: – If so, how much was used? Slide 68
69.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Assess whether this is the right time during your course of treatment to administer the medication Slide 69
70.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Using a metered-dose inhaler (MDI) make sure the inhaler is at room temperature or warmer • Shake it vigorously for at least 30 seconds • Attach a spacer to the device if one is available: – This holds aerosolized medication in a chamber so it can be inhaled more directly into the lungs Slide 70
71.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • The patient should be alert enough to use the inhaler • Calm him so that administration will be successful • Direct the patient to exhale deeply and place his lips around the mouthpiece Slide 71
72.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Remove the patient’s oxygen source • Have patient immediately press down on the inhaler as he inhales deeply • In order to be effective, the medication must be mixed with inhaled air so that it directly contacts lung tissue Slide 72
73.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 73 • After completing the full inhalation, direct the patient to hold his breath as long as possible • Place the patient back on oxygen
74.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 74 • To administer medication: – Prepare the nebulizer by opening chamber – Put the required amount of medication prescribed to the patient in the device according to the manufacturer’s directions – Reassemble the chamber
75.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 75 – Attach the chamber to a delivery device: Inhalation tube Face mask – Attach an oxygen line to the device and set the flow for 6-8 lpm – Direct the patient to put lips around the mouthpiece and inhale deeply
76.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 – Have patient hold breath for 2 -3 seconds before exhaling – Continue to assist the patient with nebulizer until all the medication in the chamber is used Slide 76
77.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • After administering any medication, document the drug, dose, route and time of administration • Reassess the patient for any changes • Check vital signs and be alert for side effects of the medication Slide 77
78.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Bronchodilators increase in the heart rate known as tachycardia • May also be accompanied by: – Tremors – Nervousness • Expect tachycardia to decrease as the medication wears off Slide 78
79.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 79 • Check the adequacy of oxygen being delivered using a pulse oximeter • Document any improvement or deterioration • If no improvement: – Contact medical direction before administering another dose of medication
80.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 80
81.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Any time respiration is compromised, immediate action must be taken: – To ensure adequate ventilation – Provide supplemental oxygen if needed • Every patient with breathing difficulty is considered a priority patient Slide 81
82.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 82 • Two common respiratory conditions you can expect to encounter: – Respiratory distress – Respiratory failure
83.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Respiratory distress occurs when a patient must work harder to: – Move air into the lungs – Out of the lungs – Both • Respiratory distress is an early sign of respiratory compromise and can progress in severity • Be aware that a patient can have adequate ventilation but still be in respiratory distress Slide 83
84.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • You must recognize and treat respiratory distress as early as possible: – Helps prevent respiratory failure • The signs and symptoms of respiratory distress can include: – Increased rate and depth of breathing – Unusual breathing sounds, – Normal to pale skin color Slide 84
85.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 85 • Immediately provide oxygen according to protocols: – 15 lpm often suggested via NRB: Nasal cannula can be used if NRB is not tolerated • Use of supplemental oxygen will often restore oxygen levels
86.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 86 • Obtain baseline vitals • Determine if patient has a prescribed MDI: – If so, contact medical control • Allow patient remain in a position of comfort • Perform a secondary assessment
87.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • A patient who is NOT breathing adequately will require manually assisted ventilations, use: – A pocket face mask – Bag mask device – Other ventilation equipment Slide 87
88.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Prepare for transport • Continue to monitor vital signs: – Note any changes • Reassure the patient to help reduce stress Slide 88
89.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Respiratory distress can lead to respiratory failure • Respiratory failure leads to respiratory arrest • Respiratory arrest leads to cardiac arrest Slide 89
90.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Respiratory failure occurs when the respiratory rate or volume is reduced to the point where the patient does not take in enough oxygen to support life or retains too much carbon dioxide • Common causes include: – Asthma – Hyperventilation – Chronic bronchitis – Emphysema Slide 90
91.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • The signs and symptoms of respiratory failure are: – Altered mental status – Cyanosis – An inadequate rate and depth of breathing Slide 91
92.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Assess responsiveness • Hold your ear next to the nose and mouth, listen for: – Breathing – Rhythm – Rate – Depth – Effort Slide 92
93.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • If the airway is not patent, you must immediately open and maintain it • For an unresponsive medical patient, use the head-tilt, chin-lift technique: – Check again for breathing and be prepared to suction if necessary Slide 93
94.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • If patient is an unresponsive trauma patient: – Open and maintain the airway using the modified jaw-thrust technique – Maintaining manual cervical stabilization Slide 94
95.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Immediately provide positive pressure ventilation to force air into the lungs: – Always follow local protocols • Use a pocket mask or a bag valve device and attach it firmly to the patient’s face to obtain a firm, leak free seal Slide 95
96.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 96 • Attach an oxygen supply line to the mask or bag and adjust the regulator to a high-flow rate • Deliver ventilations by gently squeezing the bag with each inhalation for one second until you just see the chest rise
97.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Watch for the chest to rise and fall with each ventilation • Adjust the rate of ventilations to achieve an optimal rate of 10-12 ventilations per minute for an adult, as noted by the chest rise Slide 97
98.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • For very slow breathing: – Add ventilations in between the patient’s own breaths – Obtain an appropriate rate with adequate volume • For rapid breathing, refer to your local protocols to determine whether adjustments to the rate and volume are permitted Slide 98
99.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 99 • Continually reassess for airway patency: – Make adjustments as needed • Oximetry readings will help you assess oxygenation levels • Prepare and transport the patient
100.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 100
101.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Inadequate Breathing • Assessing Inadequate Breathing • Respiratory Distress Medications • Respiratory Distress & Failure Slide 101
102.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 • Any time a patient experiences a respiratory emergency, you must be able to recognize the condition indicated by the signs and symptoms and act immediately • Any patient can develop a respiratory emergency with little or no warning • Knowing what to look for and how to respond will be crucial Slide 102
103.
Emergency Medical Technician 8
– Respiratory Compromise © 2014 Slide 103
Editor's Notes
PHOTO CHANGE? Pictures showing each one
Pushing and pulling can also put you at risk for injury.
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