Respiratory

Emergencies
or all that wheezes is NOT
asthma
Definitions
Apnea
Dypsnea
Orthopnea
Tachypnea
Bradypnea
Hypercarbia

Acidosis
Alkalosis
Ventilation
Diffusion
Perfusion
Respiration
Anatomy
Anatomy
Physiology
Takes in oxygen
Disposes of wastes
Carbon dioxide
Excess water
O
2
+ Glucose
CO
2
+ H
2
O
The Cell
Physiology
Physiology
Inspiration
Active process
Chest cavity expands
Intrathoracic pressure falls
Air flows in until pressure
equalizes
Expiration
Passive process
Chest cavity size decreases
Intrathoracic pressure rises
Air flows out until pressure
equalizes
Physiology
Autonomic Function
Primary drive: increase in
arterial CO
2

Secondary (hypoxic) drive:
decrease in arterial O
2

Adequate Breathing
Normal rate and depth
Regular breathing pattern
Good breath sounds on both sides
of lungs
Equal chest rise and fall
Pink, warm, dry skin
Inadequate Breathing
Breathing rate < 12 or > 20*
Shallow or irregular respirations
Unequal chest expansion
Decreased or absent lung sounds
Accessory muscle usage
Pale or cyanotic skin color
Cool, clammy skin appearance
Obstructive Pathophysiology
Tongue
Foreign body obstruction
Anaphylaxis and angiodema
Facial trauma and inhalation
injuries (burns)
Epiglottitis and Croup
Aspiration





Restrictive Pathophysiology
Asthma
COPD
Emphysema
Chronic Bronchitis
Diffusion Pathophysiology
Pulmonary Edema:
Left-sided heart failure
Toxic inhalations
Near drowning
Pneumonia
Pulmonary Embolism:
Blood clots
Amniotic fluid
Fat embolism
Ventilation Pathophysiology
Trauma: rib fractures, flail chest, spinal
cord injuries
Pneumothorax, hemothorax, SCW
Diaphragmatic hernia
Pleural effusion
Morbid obesity
Neurological/muscular diseases: polio,
MD, myasthenia gravis
Control System Pathophysiology
Head trauma
CVA
Depressant drug toxicity
Narcotics
Sedative-hypnotics
Ethyl alcohol
FBAO
Obstruction may
result from head
position, tongue,
aspiration, or foreign
body.
Be prepared to treat
quickly and
aggressively.
Head-tilt/chin-lift to
open airway
Upper Airway Infections
Bronchitis
Common cold
Diphtheria
Pneumonia
Croup
Epiglottitis
Severe Acute Respiratory Syndrome
Upper Airway Infections
Signs & Symptoms
Dyspnea or respiratory distress
Seal-bark cough
Acute angiodema
Excessive salivation
Stridor
Sniff positioning

Acute Pulmonary Edema
Fluid buildup in lungs
History of CHF
High recurrence
Signs & symptoms:
Dypsnea
Frothy, pink sputum
Pedal edema, ascities
Rales, wheezes
Hypertension
.
Pedal Edema
Ascites

Bronchitis
Chronic condition similar to emphysema
Reduction in ventilation due to increased
mucus production.
Productive cough, copious sputum
Blue bloaters
Treatment goals: relief of hypoxia, reversal
of bronchoconstriction
COPD
Damaged lungs from
repeated infections or
inhalation of toxic
agents.
Signs & symptoms:
Chronic cough
Rhonchi, wheezing
SpO2 88-92%
Clubbing
Pursed lip breathing
Clubbing
Asthma
Common but serious
disease
Acute bronchiole
constriction with
increased mucus
production
Signs & symptoms:
Wheezing
Patient looks tired
Cyanosis
Pneumothorax
Spontaneous or
trauma induced
Accumulation of air in
the pleural space
Signs & symptoms:
Dypsnea
One-sided chest pain
Absent or decreased
breath sounds
Anaphylaxis
Characterized by
respiratory distress
and hypotension
Usually results from
body response to
allergen.
Airway obstruction
due to angiodema is
major concern
Pneumonia
5
th
leading cause of death in the U.S.
Infection usually caused by bacteria or
virus, rare instances fungal
Patient will present with sick appearance,
febrile, shaking, productive cough,
increased sputum.
Patient with increase respiratory
rate/effort, tachycardic,
wheezes/rales/consolidated lung sounds
Pleural Effusion
Collection of fluid
outside the lung
Caused by irritation,
infection, or cancer
Signs & symptoms:
Dypsnea
Decreased breath
sounds over effected
area
Positional comfort
Pulmonary Embolism
Blood clot that breaks
off, circulating through
venous system.
Signs & symptoms:
Dypsnea/tachypnea
Cyanosis
Acute pleuritic pain
Hemoptysis
Hypoxia
Pulmonary Embolism

Hyperventilation
Over-breathing resulting in a decrease in
the level of CO2 (alkalosis)
Signs and symptoms:
Anxiety
Tingling in hands & feet (carpal-pedal
spasms)
A sense of dypsnea despite rapid breathing
Dizziness
Numbness

ARDS
Pulmonary edema caused by fluid
accumulation in the interstitial spaces,
interfering with diffusion causing hypoxia
(fluid balance)
Underlying etiology includes sepsis,
pneumonia, inhalation injuries, emboli,
tumors
Mortality rate >70%
Supportive care at the BLS level

Patient Assessment
BSI/Scene Safety
Initial Assessment (Sick/Not Sick)
Focused Exam
Detailed Exam
Assessment
Treatment and Plan
Initial Assessment
Initial Impression:
Body position
Skin signs and color
Respiratory rate and effort
Mental status
Pulse (rate & character)
Determine Sick/Not Sick (Oxygen?)
Identify and correct immediate life
threats ABCS!
Focused Exam (S)
Signs and symptoms
Allergies (med allergies)
Medications
Past medical history
Last meal or intake
Events leading to call
Focused Exam (S)
Onset
Provocation
Quality
Radiation
Severity
Time
Listen to the patient
they will tell exactly what is
wrong!
Focused Exam (O)
Vital signs:
Skin (signs of adequate perfusion)
Level of consciousness
Respiratory rate and effort
Lung sounds (SpO2?)
Pulse rate and character
Blood pressure (bilateral?)
Pupillary reaction


Focused Exam (O)
Crackles (Rales)
CHF
Pneumonia

Rhonchi
Pneumonia
Aspiration
COPD
Sometimes Asthma

Stridor
FBAO
Croup
Anaphylaxis
Epiglottitis
Airway burn

Wheezing
Asthma
CHF
COPD
Focused Exam (O)
Based upon your clinical findings.
Observe the patient while they
are talking to you, note any
distress.
Watch for critical signs: JVD,
tracheal deviation, paradoxial
chest movement.
Detailed Exam
Complete and thorough head,
neck-to-toe exam with non critical
patients.
Elicit further information and
necessary interventions.
Key in on critical signs!
Assessment (A)
This is your best guess (or rule out) as
to what is going on with the patient.

It is based upon YOUR Subjective and
Objective findings and should help
you develop and implement a Plan.


Plan
Medics?
ABCs/Monitor vitals
Patient in position of comfort.
Oxygen via ?
Assist with medications.
Maintain body temperature.
Calm and reassure.
Minimize patient movement.
Rapid transport!

PT Management (P)
Golden Rules:

If you are thinking about giving O
2
, then give it!

If you cant tell whether a patient is breathing
adequately, then they arent!

If youre thinking about assisting a patients
breathing, you probably should be!

When a patient quits fighting it does not mean
that they are getting better!


Tools of the Trade