This document provides an overview of respiratory emergencies for emergency medical responders. It describes the anatomy and physiology of the respiratory system and signs of adequate versus inadequate breathing. It then details the primary, secondary, and reassessment phases for responding to a respiratory emergency including assessing the scene, airway, breathing, circulation, and vital signs. Specific conditions are covered such as upper airway infections, pulmonary edema, COPD, asthma, pneumothorax, pleural effusion, airway obstruction, pulmonary embolism, and hyperventilation. For each, the document outlines management steps like positioning, oxygen administration, ventilation support, and prompt transport.

1. 8
Respiratory
Emergencies
Anas Bahnassi PhD

2. Anas Bahnassi PhD CDM CDE
2

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. 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. 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. 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. Inadequate breathing:
o Pale or blue skin.
o Cool clammy skin.
o Occasional gasp.

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. 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. 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. 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. 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. 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. Respiratory Emergencies:
Primary Assessment:
Transport Decision:
Airway or
Breathing
Problem?
Lifethreat?
Internal
Bleeding?
Anas Bahnassi PhD CDM CDE
14

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Clinical Pharmacy VI:
First Aid
Anas Bahnassi PhD CDM CDE
abahnassi@gmail.com
http://www.twitter.com/abpharm
http://www.facebook.com/pharmaprof
http://www.linkedin.com/in/abahnassi