Respiratory_Emergencies for older adults_fall06Pic.ppt

Respiratory Emerge
Respiratory Emerge
ncies
ncies
Chapter 8
Chapter 8

Topic Overview
Topic Overview
 Anatomy and Physiology
Anatomy and Physiology
 Adequate and Inadequate breathing
Adequate and Inadequate breathing
 Airway positioning
Airway positioning
 Head/tilt-Chin/lift
Head/tilt-Chin/lift
 Jaw Thrust
Jaw Thrust

Topic Overview
Topic Overview
 Techniques of Artificial Ventilation.
Techniques of Artificial Ventilation.
 Rescue Breathing (adult, child, infant)
Rescue Breathing (adult, child, infant)
 Mouth-to-Mask, Bag-Valve Mask, Mouth-
Mouth-to-Mask, Bag-Valve Mask, Mouth-
to-mouth, Mouth-to-nose, Mouth-to-stoma
to-mouth, Mouth-to-nose, Mouth-to-stoma
rescue breathing.
rescue breathing.
 Foreign Body Airway Obstruction
Foreign Body Airway Obstruction
 Conscious (adult, child, infant)
Conscious (adult, child, infant)
 Unconscious (adult, child, infant)
Unconscious (adult, child, infant)

Respiratory Emergencies
 Respiratory Anatomy
Respiratory Anatomy
 You are responsible for this information
You are responsible for this information
 Respiratory Physiology
Respiratory Physiology
 You are responsible for this information
You are responsible for this information

 Introduction
Introduction
 Oxygen
Oxygen
 Essential component
Essential component
 Inadequate perfusion can have irreversible
Inadequate perfusion can have irreversible
effects from organ failure, loss of brain function to
effects from organ failure, loss of brain function to
death.
death.
 Any and all Patient Care Situations You
Any and all Patient Care Situations You
Must
Must
 Evaluate, establish and maintain a patent airway
Evaluate, establish and maintain a patent airway

 Adequate Respirations
Adequate Respirations
 Inhalation of oxygen and exhalation of
Inhalation of oxygen and exhalation of
CO
CO2
2
 Rate and depth are adequate
Rate and depth are adequate
 Adult - Normal range 12-20 breaths/minute
Adult - Normal range 12-20 breaths/minute
 Child – Normal range 15-30 breaths/minute
Child – Normal range 15-30 breaths/minute
 Infant – Normal range 25-50 breaths/minute
Infant – Normal range 25-50 breaths/minute
 No abnormal breath sounds
No abnormal breath sounds
 Air moves freely
Air moves freely
 Skin color normal
Skin color normal

 Inadequate Respirations
Inadequate Respirations
 Respiratory failure
Respiratory failure
 Reduction of breathing to the point where
Reduction of breathing to the point where
oxygen intake in insufficient to support life.
oxygen intake in insufficient to support life.
 Respiratory Arrest
Respiratory Arrest
 Breathing stops completely
Breathing stops completely

 Inadequate Breathing
Inadequate Breathing
 Signs of breathing but inadequate to support
Signs of breathing but inadequate to support
life
life
 Rate of breathing or depth of breathing or both
Rate of breathing or depth of breathing or both
fall outside normal ranges.
fall outside normal ranges.
 Shallow ventilations
Shallow ventilations
 Diminished or absent breath sounds
Diminished or absent breath sounds
 Decreased minute volume
Decreased minute volume

 Inadequate Breathing
Inadequate Breathing
 General Signs and Symptoms
General Signs and Symptoms
 Nasal Flaring
Nasal Flaring
 Grunting
Grunting
 Retractions between the ribs, above the clavicles and
Retractions between the ribs, above the clavicles and
above the sternum
above the sternum
 Increased Pulse Rate
Increased Pulse Rate
 Decreased Pulse Rate (infants and children)
Decreased Pulse Rate (infants and children)
 Changes in the rate
Changes in the rate
 Changes in the rhythm
Changes in the rhythm

 Skin Color
Skin Color
 Central Cyanosis (Lips and Mouth)
Central Cyanosis (Lips and Mouth)
 Peripheral Cyanosis (fingers, toes, tip of nose)
Peripheral Cyanosis (fingers, toes, tip of nose)
 Gray skin color
Gray skin color
 Diaphoresis
Diaphoresis
 Restlessness, anxiety, irritability, drowsiness
Restlessness, anxiety, irritability, drowsiness
 Coughing up sputum
Coughing up sputum
 Clubbing
Clubbing

 Noisy breathing
Noisy breathing
 Crackles (rales)
Crackles (rales)
 Fine, wet, crackling sounds. Air passing through
Fine, wet, crackling sounds. Air passing through
fluid
fluid
 Rhonchi
Rhonchi
 Coarse, rattling sounds, air passing through mucus
Coarse, rattling sounds, air passing through mucus
 Wheezes
Wheezes
 High-pitched, musical sounds of narrowed airways
High-pitched, musical sounds of narrowed airways

 Stridor
Stridor
 Harsh sounding respirations indicating narrowing or
Harsh sounding respirations indicating narrowing or
obstruction
obstruction
 Pleural friction rub
Pleural friction rub
 Continuous low-pitched, rubbing sound
Continuous low-pitched, rubbing sound
 Inability to speak full sentences
Inability to speak full sentences
 Use of accessory muscles to breathe
Use of accessory muscles to breathe
 Gasping for air
Gasping for air

 Altered mental status
Altered mental status
 Breathing through pursed lips
Breathing through pursed lips
 Tripod position
Tripod position
 Unusual anatomy (barrel chest)
Unusual anatomy (barrel chest)
 Unusually Slow
Unusually Slow
 less than 8 bpm in adults or less than 10bpm
less than 8 bpm in adults or less than 10bpm
for children
for children

 Infants and Children
Infants and Children
 Can be a very serious problem
Can be a very serious problem
 Statistically respiratory conditions are the leading
Statistically respiratory conditions are the leading
killer of infants and children
killer of infants and children
 Airway is smaller thus more easily obstructed
Airway is smaller thus more easily obstructed
 The tongue is proportionately larger and take up more
The tongue is proportionately larger and take up more
space in the mouth
space in the mouth
 Trachea is smaller, softer and more flexible in
Trachea is smaller, softer and more flexible in
 More dependant on the diaphragm for respirations.
More dependant on the diaphragm for respirations.
exhibit a seesaw breathing pattern
exhibit a seesaw breathing pattern

 Breathing Difficulty Patient Care
Breathing Difficulty Patient Care
 Assessment
Assessment
 Oxygen
Oxygen
 If breathing adequately – nonrebreather at 12-15
If breathing adequately – nonrebreather at 12-15
liters per minute.
liters per minute.
 Inadequate breathing – BVM or resuscitation
Inadequate breathing – BVM or resuscitation
mask with supplement oxygen.
mask with supplement oxygen.
 Positoning
Positoning
 Sitting up
Sitting up
 Prescribed inhaler
Prescribed inhaler

 Most Commonly Encountered
Most Commonly Encountered
Problems
Problems
 COPD
COPD
 Emphysema
Emphysema
 Chronic Bronchitis
Chronic Bronchitis
 Asthma
Asthma
 Hyperventilation
Hyperventilation
 Anaphylaxis (also covered under shock)
Anaphylaxis (also covered under shock)

 COPD
COPD
 Chronic Bronchitis
Chronic Bronchitis
 Excessive mucus in the airways
Excessive mucus in the airways
 Cilia in bronchioles damaged or destroyed
Cilia in bronchioles damaged or destroyed
 Patient typically overweight and cyanotic
Patient typically overweight and cyanotic
 “
“blue bloater”
blue bloater”

 Emphysema
Emphysema
 Destroys alveoli
Destroys alveoli
 Decreased ability to exchange oxygen and
Decreased ability to exchange oxygen and
wastes
wastes
 Lungs lose elasticity and excessive mucus is
Lungs lose elasticity and excessive mucus is
formed
formed
 Patient becomes barrel-chested over time
Patient becomes barrel-chested over time
 Typically thin, uses pursed lip breathing and have
Typically thin, uses pursed lip breathing and have
pink or reddish skin
pink or reddish skin
 “
“pink puffer”
pink puffer”

 COPD
COPD
 Hypoxic Drive
Hypoxic Drive
 Respirations regulated by the level of oxygen in
Respirations regulated by the level of oxygen in
the body (they have developed a tolerance to
the body (they have developed a tolerance to
higher than normal levels of CO
higher than normal levels of CO2
2)
)
 Only a SMALL percentage of COPD patients use
Only a SMALL percentage of COPD patients use
hypoxic drive
hypoxic drive
 High flow O
High flow O2
2 for extended periods of time, could
for extended periods of time, could
result in decreased respiratory function - RARE
result in decreased respiratory function - RARE

 Asthma
Asthma
 Bronchioles spasm during exhalation
Bronchioles spasm during exhalation
 Air trapping during exhalation
Air trapping during exhalation
 Forceful exhalation producing classic
Forceful exhalation producing classic
wheezing sound
wheezing sound
 Hyper production of thick mucus
Hyper production of thick mucus
 Affects both young and old
Affects both young and old

 Status Asthmatics
Status Asthmatics
 Severe prolonged asthma attack that cannot be
Severe prolonged asthma attack that cannot be
broken despite repeated dosages of epinephrine
broken despite repeated dosages of epinephrine
 Activate EMS rapidly
Activate EMS rapidly
 THESE PATIENTS OFTEN DIE
THESE PATIENTS OFTEN DIE

 Hyperventilation Syndrome
Hyperventilation Syndrome
 Rapid breathing (Tachypnea)
Rapid breathing (Tachypnea)
 Dyspnea
Dyspnea
 Chest pain
Chest pain
 Numbness or tingling in the fingers, toes
Numbness or tingling in the fingers, toes
and around lips.
and around lips.
 Carpal/Pedal spasms
Carpal/Pedal spasms
 Dry mouth
Dry mouth
 Lightheadedness
Lightheadedness

 Emotional stress, some medications and
Emotional stress, some medications and
trauma can cause hyperventilation syndrome
trauma can cause hyperventilation syndrome
 Treatment
Treatment
 Calm patient
Calm patient
 Oxygen
Oxygen
 End Result
End Result

 Anaphylaxis
Anaphylaxis
 Severe Allergic Reaction
Severe Allergic Reaction
 A life-threatening problem which requires
A life-threatening problem which requires
immediate attention
immediate attention
 Covered in detail under shock
Covered in detail under shock

 General Care for Respiratory
General Care for Respiratory
Emergencies
Emergencies
 Summon more advanced medical personnel
Summon more advanced medical personnel
 Place patient in a sitting position
Place patient in a sitting position
 Provide Oxygen if available
Provide Oxygen if available
 Maintain body temperature
Maintain body temperature
 Help with meds
Help with meds
 Monitor vital signs, LOC and initial assessment
Monitor vital signs, LOC and initial assessment

 NEVER DENY OXYGEN TO
NEVER DENY OXYGEN TO
ANY PATIENT WHO NEEDS IT!
ANY PATIENT WHO NEEDS IT!

 Additional Problems
Additional Problems
 Pneumothorax or Hemothorax
Pneumothorax or Hemothorax
 Lung on affected side collapses
Lung on affected side collapses
 If untreated, a Tension Pneumothorax is created whereby
If untreated, a Tension Pneumothorax is created whereby
the mediastinum is shifted over and other lung is affected
the mediastinum is shifted over and other lung is affected
 Sudden dyspnea, chest pain, tachypnea,
Sudden dyspnea, chest pain, tachypnea,
diminished breath sounds on one side,
diminished breath sounds on one side,
subcutaneous emphysema, progressing to
subcutaneous emphysema, progressing to
tracheal deviation
tracheal deviation
 If due to trauma, sucking chest wound may be
If due to trauma, sucking chest wound may be
present
present

 Pulmonary Edema
Pulmonary Edema
 Causes
Causes
 Congestive heart failure
Congestive heart failure
 Inhaled substances
Inhaled substances
 Narcotic overdose
Narcotic overdose
 High altitudes
High altitudes
 Compression injuries
Compression injuries
 Rapid shallow breathing, crackles, JVD, pink
Rapid shallow breathing, crackles, JVD, pink
frothy sputum
frothy sputum

 Toxic Inhalation
Toxic Inhalation
 If the patient has been exposed to a
If the patient has been exposed to a
hazardous chemical or substance
hazardous chemical or substance
 You should not deal with this patient until
You should not deal with this patient until
after decontamination has taken place.
after decontamination has taken place.
 The symptoms you see will depend on what
The symptoms you see will depend on what
substance the patient has been exposed to
substance the patient has been exposed to

 Carbon Monoxide Inhalation
Carbon Monoxide Inhalation
 Odorless, colorless, tasteless
Odorless, colorless, tasteless
 Binds 200 times faster to hemoglobin than O
Binds 200 times faster to hemoglobin than O2
2
 Signs and Symptoms
Signs and Symptoms
 Headache
Headache
 Seizures
Seizures
 Vomiting
Vomiting
 Chest pain
Chest pain
 Confusion
Confusion
 Initially cyanosis / near death cherry red lips and nail beds
Initially cyanosis / near death cherry red lips and nail beds

 Carbon Monoxide Inhalation
Carbon Monoxide Inhalation
 Treatment
Treatment
 Activation of EMS
Activation of EMS
 High flow oxygen
High flow oxygen
 Hyperbaric oxygen therapy
Hyperbaric oxygen therapy

 Pickwickian Syndrome
Pickwickian Syndrome
 Very obese patient
Very obese patient
 Periods of apnea and somnolence (extreme
Periods of apnea and somnolence (extreme
drowsiness)
drowsiness)
 Complaints of headache, inappropriate dozing,
Complaints of headache, inappropriate dozing,
cyanosis, muscle twitching
cyanosis, muscle twitching
 Treatment is supportive, assist ventilations as
Treatment is supportive, assist ventilations as
needed
needed

 Injury
Injury
 Electrocution
Electrocution
 Poisoning
Poisoning
 Drowning or near-drowning
Drowning or near-drowning
 Infectious Diseases
Infectious Diseases
 Influenza
Influenza
 Tuberculosis
Tuberculosis

 Dysfunction of the Spinal Cord, Nerves, or
Dysfunction of the Spinal Cord, Nerves, or
Respiratory Muscles
Respiratory Muscles
 Several disease processes can effect spinal cord,
Several disease processes can effect spinal cord,
nerves, and or respiratory muscles
nerves, and or respiratory muscles
 Spinal cord trauma
Spinal cord trauma
 Polio
Polio
 Myasthenia gravis
Myasthenia gravis
 Often times this group of patients require assisted
Often times this group of patients require assisted
breathing
breathing
 Establish an open airway
Establish an open airway
 Provide respiratory support
Provide respiratory support
 High flow oxygen
High flow oxygen

 General Care
General Care
 Primary Goal
Primary Goal
 Establish and maintain an adequate airway
Establish and maintain an adequate airway
 Provide supplemental oxygen
Provide supplemental oxygen
 Assist with ventilations
Assist with ventilations
 Place patient in a sitting position
Place patient in a sitting position
 Maintain body temperature
Maintain body temperature
 Help with meds
Help with meds
 Summon more advanced medical personnel
Summon more advanced medical personnel
 Monitor vital signs, LOC and initial
Monitor vital signs, LOC and initial
assessment
assessment

It is not enough to
It is not enough to
simply make sure the
simply make sure the
patient is breathing.
patient is breathing.
The patient must be
The patient must be
breathing adequately.
breathing adequately.

Never Deny any
Never Deny any
Patient Oxygen Who
Patient Oxygen Who
Needs It!
Needs It!

 Basic Airway Management
Basic Airway Management
 Heimlich Maneuver
Heimlich Maneuver
 Chest Thrusts
Chest Thrusts
 Infant Airway Obstruction
Infant Airway Obstruction
 Manual Airway
Manual Airway
 Head-tilt/Chin-lift
Head-tilt/Chin-lift
 Jaw-Thrust Maneuver
Jaw-Thrust Maneuver
 Application of a cervical collar
Application of a cervical collar

 Sellick’s Maneuver (Cricoid Pressure)
Sellick’s Maneuver (Cricoid Pressure)
 Apply slight pressure using the thumb and index
Apply slight pressure using the thumb and index
finger to the lateral and anterior aspects of the
finger to the lateral and anterior aspects of the
cricoid cartilage.
cricoid cartilage.

 Special Considerations in Rescue
Special Considerations in Rescue
Breathing
Breathing
 Air in the stomach
Air in the stomach
 Vomiting
Vomiting
 Mouth-to-nose breathing
Mouth-to-nose breathing
 Mouth-to-stoma breathing
Mouth-to-stoma breathing
 Victims with dentures
Victims with dentures
 Suspected spinal injuries
Suspected spinal injuries

Respiratory_Emergencies for older adults_fall06Pic.ppt

More Related Content

Similar to Respiratory_Emergencies for older adults_fall06Pic.ppt

Recently uploaded

Respiratory_Emergencies for older adults_fall06Pic.ppt