copyright 2008 seattle/king county ems cbt/otep 425 respiratory emergencies
TRANSCRIPT
Copyright 2008 Seattle/King County EMS
Introduction
This course reviews common This course reviews common disorders that can cause respiratory disorders that can cause respiratory
emergencies and prehospital emergencies and prehospital management of these conditions.management of these conditions.
This course reviews common This course reviews common disorders that can cause respiratory disorders that can cause respiratory
emergencies and prehospital emergencies and prehospital management of these conditions.management of these conditions.
Patients with lung and heart diseases frequently call 9-1-1 because of breathing difficulty
Copyright 2008 Seattle/King County EMS
New Terms
hypoxic drive – A condition in which the body's stimulus for taking a breath is low oxygen. Occurs in people with COPD.
metabolism – The process by which food molecules are broken down to provide material and energy for cellular function.
pH (potential of hydrogen) – A measure of the acidity or alkalinity of a solution, numerically equal to 7 for neutral solutions.
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New Terms, continued
perfusion – The movement of blood through an organ or tissue in order to supply nutrients and oxygen.
tidal volume – The volume of gas that is moved with each breath which is normally 500 ml in an adult.
ventilation – The rate at which gas enters or leaves the lungs.
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Respiratory Structures
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Copyright 2008 Seattle/King County EMS
Metabolism Produces Carbon Dioxide • Metabolism is process by which body
breaks down or "burns" stored fuel to create energy
• Cells use oxygen to transform stored glucose into energy
• A byproduct of metabolism is carbon dioxide
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pH
• Acidity measured by potential of hydrogen
• Body must maintain narrow pH range
• Respiratory system helps maintain a balanced acid level (pH) in blood
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Copyright 2008 Seattle/King County EMS
pH• If blood pH is too low (acidic), respiratory
system will attempt to fix by making lungs breathe more deeply and rapidly
• Because respiratory system helps regulate carbon dioxide excretion or retention, it is an important mechanism for regulating pH
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Hypercarbia A state of excessive carbon dioxide in the body
Hypercarbia can occur through:• Metabolic processes that form acids • Muscle exertion • Shivering
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Hypercarbia, continued
• Also can occur through decreased elimination of carbon dioxide:
• Airway obstruction • Inability to exhale fully• Depressed respiratory drive
• Affects chemistry of body causing pH imbalance
• Can be treated by BLS provider by improving ventilation
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Metabolic Problems Affect Resp.• Metabolic imbalances affect chemistry of body,
affecting pH • While not a respiratory problem, respiratory
system often tries to compensate by changing depth/rate
• Ketoacidosis • Aspirin overdose • Fever and sepsis
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Asthma • Chronic, inflammatory disease of the
airways • Allergens, infection, exercise, smoke • Muscles around bronchioles tighten• Lining of bronchioles swells• Inside of bronchioles fills with thick mucous
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Copyright 2008 Seattle/King County EMS
Asthma - Treatment
• Calm patient • Airway management • Oxygen therapy • Assist with a prescribed inhaler
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COPD• Category of diseases – asthma, emphysema,
and chronic bronchitis • Slow process of dilation and disruption of
airways and alveoli that limit ability to exhale
• Present with history of COPD, shortness of breath, fever, and increased sputum production
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COPD - Treatment
• BLS treatment for a COPD patient with respiratory distress should include oxygen therapy (high flow if needed)
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Congestive Heart Failure (CHF)• Fluid in lungs makes it difficult to get
air in • Present sitting up, short of breath,
diaphoretic, and pale or cyanotic • Meds/Hx can help differentiate from
COPD
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CHF - Treatment
• Seat upright• Administer high flow oxygen (NRM)• Consider positive pressure
ventilation with BVM if needed
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Inhalation Injuries
• Chemicals, smoke, or other substances
• Shortness of breath, coughing, hoarseness, chest pain due to bronchial irritation, and nausea
• Treat with high flow oxygen
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Pneumonia
• Fever, chills, cough, yellowish sputum, shortness of breath, general discomfort, fatigue, loss of appetite, and headache
• Treat with oxygen
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Pneumothorax
• Presence of air in pleural space• Wound allows air to enter space
between pleural tissues, leads to collapse lung
• Treat with high flow oxygen
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Copyright 2008 Seattle/King County EMS
Pulmonary Embolism• Blood clot, fat embolus, amniotic fluid embolus,
or air bubble gets loose in blood stream and travels to lungs
• Wound allows air to enter space between pleural tissues
• Lodges in major branch of pulmonary artery and lung circulation is interrupted
• Treat with high flow oxygen
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Pulmonary Embolism, continued
• Caused by immobility of lower extremities, prolonged bed rest, or recent surgery
• Signs include sudden-onset of SOB, tachypnea, chest pain worsened by breathing and coughing up blood
• Treat with high flow oxygen and rapid transport• Be gentle in moving patient
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Assessment
• Rate and depth of respirations• Together rate and depth will tell you
whether tidal volume is adequate
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Auscultation of Breath Sounds• Listen at six locations on back (medical pt.)• Listen at four locations on front • Instruct patient to take deep breath through
mouth then exhale • Listen to one or two inspiration/expiration
cycles per location • Avoid listening through clothing
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Airway Management• Head tilt/chin lift• Jaw thrust• Patient positioning• Airway adjuncts• Suction• Oxygen therapy• Assisted ventilation• Relief of foreign body airway obstruction
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Suction• Measure tip from corner of mouth to earlobe • Oxygenate patient well (if situation permits)• Insert tip into oral cavity without applying
suction• Move suction tip side–to-side• Oxygenate well after suctioning
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Assisted VentilationUnconscious breathing patient:• Consider need for oropharyngeal airway• Do not over-ventilate• Keep the airway open• Maintain a good seal• Apply Sellick maneuver to help reduce
airflow into stomach
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Assisted VentilationNon-breathing patient:• Deliver a ventilation of 1-second duration • Deliver enough volume to make chest
rise • 12 ventilations/min• 8-10 ventilations/min if an advanced
airway is in place
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Summary
Main structures of the respiratory system:
• Pharynx • Bronchi• Trachea • Bronchioles• Epiglottis • Larynx• Alveoli • Pleura• Diaphragm
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Summary, continued
• Respiratory system is an important mechanism for regulating pH in the body
• If respiration is impaired, carbon dioxide builds up in the blood (hypercarbia) and producing an acid
• BLS providers can help treat this condition by improving ventilation
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Summary, continued
• Signs of severe airway obstruction include poor air exchange and increased breathing difficulty
• COPD-related emergency may present with shortness of breath, fever, and increased sputum production
• CHF signs include acute onset of breathing difficulty, diaphoresis, and cyanosis
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Summary, continued
• Pneumothorax can cause sharp chest pain and SOB
• Signs of pulmonary embolism include sudden onset of SOB, tachypnea, chest pain worsened by breathing, coughing up blood
• Treatment for respiratory emergency can include high flow oxygen and/or assisted ventilations
• CHF patients may require positive-pressure ventilations
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Summary, continued
Auscultating the chest: • Listen at six locations on back (medical
pt.)• Listen at four locations on front • Move from bottom to top in medical pt • Instruct pt to take a deep breath
through mouth then exhale • Listen to one or two
inspiration/expiration cycles • Avoid listening through clothing
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Summary, continued
Guidelines for use of suction:• Measure tip from corner of mouth to
earlobe • Oxygenate patient well, if situation permits• Insert tip into oral cavity without applying
suction• Suction of the way out• Move suction tip side to side• Oxygenate well after suctioning