ems- respiratory emergencies (again)
DESCRIPTION
Ok, heres the story. I was teaching this otherwise sharp EMT-Basic class that bombed two respiratory emergency tests in a ROW! So this is the remedial lecture I inflicted on them. I don\'t know if they passed because of this fine work, or just because they were afraid of another lecture fo they failed. Hope its useful to you.TRANSCRIPT
![Page 1: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/1.jpg)
Steve Cole, Steve Cole,
Paramedic, CCEMT-Paramedic, CCEMT-PP
Respiratory Emergencies Respiratory Emergencies (again)(again)
![Page 2: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/2.jpg)
Why Again?Why Again?
Respiratory Calls are some of the most Respiratory Calls are some of the most Common calls you will see. Common calls you will see.
Respiratory care is as essential as the Respiratory care is as essential as the ABC’sABC’s
Mishandling a respiratory call can be fatal.Mishandling a respiratory call can be fatal. Mishandling a respiratory call can be fatal.Mishandling a respiratory call can be fatal. Mishandling a respiratory call can be fatal.Mishandling a respiratory call can be fatal.
![Page 3: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/3.jpg)
What we are going to discussWhat we are going to discuss
Respiratory PHYSIOLOGYRespiratory PHYSIOLOGY 5 most common respiratory problems in 5 most common respiratory problems in
adults (PEDS will come later)adults (PEDS will come later)
![Page 4: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/4.jpg)
Basic Concept: Basic Concept:
Air Goes in and OutAir Goes in and OutBlood Goes Round and RoundBlood Goes Round and Round
Any thing infringing on this is Any thing infringing on this is a a BAD THINGBAD THING!!
![Page 5: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/5.jpg)
Key ConceptsKey Concepts The primary function of the respiratory The primary function of the respiratory
system is gaseous exchange. system is gaseous exchange. – Ventilation and Oxygenation.Ventilation and Oxygenation.
Air is composed of a mixture of gases. Air is composed of a mixture of gases. Breathing is largely controlled by the Breathing is largely controlled by the
Autonomic Nervous system, in Autonomic Nervous system, in response to changes sensed in all parts response to changes sensed in all parts of the body. The biggest part of this is of the body. The biggest part of this is the “Hypoxic Drive”.the “Hypoxic Drive”.
![Page 6: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/6.jpg)
Key ConceptsKey Concepts
Diffusion of O2 from the lung to the blood is Diffusion of O2 from the lung to the blood is by the binding of O2 to the hemoglobin (Hgb) by the binding of O2 to the hemoglobin (Hgb)
This is dependant on a pressure gradient.This is dependant on a pressure gradient. This is a Passive transport system.This is a Passive transport system. It is also dependant on available surface area It is also dependant on available surface area
and distance it must travel to cross the and distance it must travel to cross the threshold.threshold.
Capillaries are where the real Oxygenation Capillaries are where the real Oxygenation and ventilation take place. and ventilation take place.
![Page 7: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/7.jpg)
Primary ConceptsPrimary Concepts All pt’s with SOB get O2. Lots of O2. All pt’s with SOB get O2. Lots of O2. Listen to ALL lungs. Listen to ALL lungs. Beware of the “silent chest”.Beware of the “silent chest”. Noisy Breathing is abnormal breathingNoisy Breathing is abnormal breathing Visible Breathing is abnormal breathing.Visible Breathing is abnormal breathing. Positional breathing is abnormal breathing.Positional breathing is abnormal breathing. Abnormal Breathing gets O2.Abnormal Breathing gets O2.
![Page 8: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/8.jpg)
VolumeVolume
Tidal VolumeTidal Volume Minute VolumeMinute Volume
– Tidal Volume X Respiratory Rate = Minute Tidal Volume X Respiratory Rate = Minute VolumeVolume
![Page 9: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/9.jpg)
Respiratory PhysiologyRespiratory Physiology
![Page 10: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/10.jpg)
What do we assess?What do we assess?
Presence or absence?Presence or absence? Rate Rate QualityQuality
![Page 11: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/11.jpg)
Respiratory RateRespiratory Rate
Decreased by:Decreased by:– Depressant DrugsDepressant Drugs– SleepSleep
Increased by:Increased by:– FeverFever– FearFear– ExertionExertion
![Page 12: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/12.jpg)
Respiratory QualityRespiratory Quality Irregular: Neuro Insult.Irregular: Neuro Insult. Shallow: Shallow:
– Respiratory DepressantsRespiratory Depressants– CNS DepressantsCNS Depressants– Neuro InsultNeuro Insult
Deep: Deep: – Hyperglycemia with Acidosis (DKA): “Kussmal Hyperglycemia with Acidosis (DKA): “Kussmal
RespirationsRespirations– Electrolyte ImbalancesElectrolyte Imbalances– Neuro InsultNeuro Insult
![Page 13: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/13.jpg)
Adult Lung VolumesAdult Lung Volumes
5,500 to 6,000mL at end inspiration.5,500 to 6,000mL at end inspiration. Normal tidal volume: 500mLNormal tidal volume: 500mL Dead space air: 150mLDead space air: 150mL Alveolar Air: 350mLAlveolar Air: 350mL
![Page 14: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/14.jpg)
Key components of an intact Key components of an intact respiratory systemrespiratory system
An appropriate Drive to BreathAn appropriate Drive to Breath Airway and respiratory tractAirway and respiratory tract Mechanical BellowsMechanical Bellows A diffusion friendly place for gas exchange to A diffusion friendly place for gas exchange to
happen.happen. An O2 friendly RBC with hgb.An O2 friendly RBC with hgb. An intact circulatory system to carry the gasses An intact circulatory system to carry the gasses
and waste through out the body. and waste through out the body. – Must have enough of a pressure to promote diffusion. Must have enough of a pressure to promote diffusion.
An intact capillary bed An intact capillary bed
![Page 15: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/15.jpg)
Drive to breathDrive to breath Controlled by the CNS through information Controlled by the CNS through information
gathered from receptors in the body.gathered from receptors in the body. Located in the pons region of the brainstemLocated in the pons region of the brainstem Detects increases in CO2 or decreases in pH Detects increases in CO2 or decreases in pH
and informs the brain to increase the and informs the brain to increase the respiratory rate.respiratory rate.
Increased respiratory rate reduces CO2 and Increased respiratory rate reduces CO2 and will increase pH.will increase pH.
Other things can effect our drive to breathOther things can effect our drive to breath
![Page 16: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/16.jpg)
““Hypoxic Drive”Hypoxic Drive”
Develops in some patients with Chronic Develops in some patients with Chronic Lung DiseaseLung Disease
Pons region of brain becomes sensitized to Pons region of brain becomes sensitized to constant increased CO2 stateconstant increased CO2 state
Regulation is now based on O2 level in Regulation is now based on O2 level in bloodblood
Increased oxygen level states may tell the Increased oxygen level states may tell the brain to stop breathingbrain to stop breathing
![Page 17: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/17.jpg)
Dr. Slovis’s top 5 effects on Dr. Slovis’s top 5 effects on respiratory drive.respiratory drive.
CVACVA Trauma to the brainTrauma to the brain DrugsDrugs TumorTumor Electrolyte ImbalancesElectrolyte Imbalances
![Page 18: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/18.jpg)
The Airway and Respiratory The Airway and Respiratory tracttract
From the tip of the From the tip of the mouth mouth
To the “Functional To the “Functional Unit of the Lungs”Unit of the Lungs”– AlveoliAlveoli
Functions by negative Functions by negative pressure inspiration.pressure inspiration.
““The means of getting The means of getting cargo to the loading cargo to the loading docks.”docks.”
![Page 19: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/19.jpg)
The Mechanical BellowsThe Mechanical Bellows The muscles of the ribs The muscles of the ribs
expand the size of the expand the size of the chest, creating a (relative) chest, creating a (relative) negative pressure.negative pressure.
Air (with O2) moves in to Air (with O2) moves in to fill the void. fill the void.
Commonly thought of as Commonly thought of as Oxygenation.Oxygenation.
Actual oxygenation takes Actual oxygenation takes place at the cellular level.place at the cellular level.
Special Thanks to Charlie Miller for this Graphic.
![Page 20: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/20.jpg)
The Mechanical BellowsThe Mechanical Bellows The intercostals muscles The intercostals muscles
relax, allowing the chest relax, allowing the chest to return to its neutral to return to its neutral position, expelling air out position, expelling air out of the lungs (and CO2 of the lungs (and CO2 with it.)with it.)
Commonly thought of as Commonly thought of as VentilationVentilation..
Actual ventilation takes Actual ventilation takes place at the cellular level. place at the cellular level.
Special Thanks to Charlie Miller for this Graphic.
![Page 21: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/21.jpg)
The Mechanical BellowsThe Mechanical Bellows
Example of a Example of a Compromised BellowsCompromised Bellows
Positional AsphyxiaPositional Asphyxia
Special Thanks to Charlie Miller for this Graphic.
![Page 22: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/22.jpg)
A diffusion friendly place for gas A diffusion friendly place for gas exchange to happen.exchange to happen.
Diffusion is a passive process. Diffusion is a passive process. Intact capillary bed. Intact capillary bed. Jimmie Edwards Fart Theory.Jimmie Edwards Fart Theory. Things that effect diffusion:Things that effect diffusion:
– Thickness of Membrane the gas has to crossThickness of Membrane the gas has to cross– Surface Area to diffuse acrossSurface Area to diffuse across– Partial Pressure differences in Gas on each side.Partial Pressure differences in Gas on each side.– Physiologic PEEPPhysiologic PEEP
![Page 23: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/23.jpg)
DiffusionDiffusion
![Page 24: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/24.jpg)
An O2 friendly RBC with hgb.An O2 friendly RBC with hgb.
Hemoglobin is an Iron Based compound Hemoglobin is an Iron Based compound essentialessential to the transport of O2. to the transport of O2. – AnemiaAnemia– Cyanide PoisoningCyanide Poisoning– CO PoisoningCO Poisoning
![Page 25: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/25.jpg)
An intact circulatory system An intact circulatory system
Blood LossBlood Loss ShockShock
– Pump ProblemPump Problem– Volume ProblemVolume Problem
» Fluid issueFluid issue» O2 carrying issueO2 carrying issue
– Vessel ProblemVessel Problem
![Page 26: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/26.jpg)
Must have enough of a pressure Must have enough of a pressure to promote diffusion.to promote diffusion.
Conditions like Hypotension cause Conditions like Hypotension cause secondary hypoxia by promoting low secondary hypoxia by promoting low perfusion.perfusion.
![Page 27: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/27.jpg)
Assessing the pt with Respiratory Assessing the pt with Respiratory Distress.Distress.
![Page 28: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/28.jpg)
First ImpressionsFirst Impressions
Air HungryAir Hungry Nasal FlaringNasal Flaring TripodingTripoding Rocking with Rocking with
respirationsrespirations Pursed Lip Pursed Lip
BreathingBreathing Barrel or Sparrow Barrel or Sparrow
ChestChest Home O2Home O2
![Page 29: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/29.jpg)
Skin SignsSkin Signs
CyanosisCyanosis– Nail BedsNail Beds– LipsLips– EarsEars
MottlingMottling– ChestChest– Lower ExtLower Ext– AbdAbd
![Page 30: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/30.jpg)
Noisy breathing is obstructed Noisy breathing is obstructed breathingbreathing
Snoring: obstruction by tongueSnoring: obstruction by tongue Gurgling: Funky Junk in upper airwayGurgling: Funky Junk in upper airway Grunting: Physiologic PEEPGrunting: Physiologic PEEP Stridor: harsh, high pitched sound on Stridor: harsh, high pitched sound on
inhalation: inhalation: – Laryngeal edemaLaryngeal edema– EpiglotitisEpiglotitis– FBAOFBAO
![Page 31: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/31.jpg)
Speech DyspneaSpeech Dyspnea
Inability to speak more than a few sylables Inability to speak more than a few sylables in a sentence between breaths.in a sentence between breaths.
![Page 32: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/32.jpg)
Breath SoundsBreath Sounds
Listening by Listening by comparisoncomparison
Listening anteriorListening anterior Listening posteriorListening posterior FremitusFremitus
![Page 33: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/33.jpg)
![Page 34: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/34.jpg)
![Page 35: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/35.jpg)
Abnormal breath soundsAbnormal breath sounds
Rales (crackles): fine bubbling sound of Rales (crackles): fine bubbling sound of fluid in alveoli (“Rice Krispies”: snap, fluid in alveoli (“Rice Krispies”: snap, crackle and pop) Alveoli popping open.crackle and pop) Alveoli popping open.
Rhonchi: fluid in larger airways, obstructing Rhonchi: fluid in larger airways, obstructing object in the bronchusobject in the bronchus
Wheezes: high pitched whistling, air Wheezes: high pitched whistling, air through narrowed airwaysthrough narrowed airways
SILENCE IS BAD NEWSSILENCE IS BAD NEWS
![Page 36: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/36.jpg)
Causes of respiratory Causes of respiratory abnormalitiesabnormalities
Brain damage: trauma, drugs, strokeBrain damage: trauma, drugs, stroke Spinal cord damage: trauma, polioSpinal cord damage: trauma, polio Upper airways: tongue, swelling, foreign Upper airways: tongue, swelling, foreign
body, traumabody, trauma Lower airways: asthma, chronic bronchitisLower airways: asthma, chronic bronchitis Alveoli: atelectasis, obstruction Alveoli: atelectasis, obstruction Impaired pulmonary circulation: embolismImpaired pulmonary circulation: embolism
![Page 37: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/37.jpg)
Signs/symptoms of distressSigns/symptoms of distress
DyspneaDyspnea Restlessness/anxietyRestlessness/anxiety Tachypnea/BradypneaTachypnea/Bradypnea Cyanosis (core)Cyanosis (core) Abnormal soundsAbnormal sounds RetractionsRetractions Diminished ability to speakDiminished ability to speak
![Page 38: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/38.jpg)
More S/SMore S/S Retractions and/or use of accessory musclesRetractions and/or use of accessory muscles Abdominal breathingAbdominal breathing Nasal flaringNasal flaring Productive coughProductive cough
– Color?Color? Irregular breathing Irregular breathing Tripod positionTripod position Pursed-lip breathingPursed-lip breathing
![Page 39: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/39.jpg)
Take another look ….What do you see?
![Page 40: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/40.jpg)
Hows this?
Pursed Lips
Sparrow Chest
Tripoding
Retractions
Abd retractions
Kewl Haircut
O2
![Page 41: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/41.jpg)
Inadequate Breathing: Infants and Inadequate Breathing: Infants and ChildrenChildren
Retractions
Nasal Flaring
See-Saw Breathing
Diaphragmatic Breathing
![Page 42: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/42.jpg)
BREAK?BREAK?
![Page 43: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/43.jpg)
The Usual SuspectsThe Usual Suspects
Photo by Linda R. Chen - © 1995 Gramercy Pictures.
![Page 44: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/44.jpg)
Top 6 you need to know Top 6 you need to know
COPD/Reactive Airway DisordersCOPD/Reactive Airway Disorders– EmphysemaEmphysema– AsthmaAsthma– BronchitisBronchitis
PneumoniaPneumonia CHFCHF Pulmonary EmboliPulmonary Emboli Hyperventilation DisordersHyperventilation Disorders PneumothoraxPneumothorax
![Page 45: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/45.jpg)
COPDCOPD
![Page 46: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/46.jpg)
Causes of Chronic Obstructive Causes of Chronic Obstructive Pulmonary Disease (COPD)Pulmonary Disease (COPD)
Cigarette smokingCigarette smoking
Environmental pollution Environmental pollution Previous pulmonary infectionsPrevious pulmonary infections Chronic asthmaChronic asthma
![Page 47: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/47.jpg)
Common Traits of COPD’ersCommon Traits of COPD’ers– ““pink puffer”pink puffer”– ““air trapping”air trapping”– destruction of alveoli, destruction of alveoli,
loss of elasticityloss of elasticity– barrel chest/Sparrow barrel chest/Sparrow
ChestChest– use of accessory use of accessory
musclesmuscles– noisy breath sounds: noisy breath sounds:
wheezing prolonged wheezing prolonged and increasing on and increasing on exhalationexhalation
![Page 48: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/48.jpg)
Air TrappingAir Trapping
Due to loss of elasticity in the alveoli, these Due to loss of elasticity in the alveoli, these pt’s trap air. pt’s trap air.
They need over double the exhalation They need over double the exhalation period period
This means inhibited gas exchange and This means inhibited gas exchange and possibly……possibly……
They can develop a spontaneous They can develop a spontaneous pneumothorax.. pneumothorax..
![Page 49: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/49.jpg)
EMPHYSEMAEMPHYSEMA
In Emphysema the chronic damage to the lungs In Emphysema the chronic damage to the lungs interferes with gas exchange.interferes with gas exchange.
A secondary point of exacerbation is the irritation A secondary point of exacerbation is the irritation of the broncheols, making them constrict and of the broncheols, making them constrict and spasm. Since the alveoli are damaged, this spasm. Since the alveoli are damaged, this causes them to collapse easily.causes them to collapse easily.
![Page 50: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/50.jpg)
Chronic BronchitisChronic Bronchitis
““The English Disease”The English Disease” Chronic irritation cause increases mucus Chronic irritation cause increases mucus
production as a defense mechanism. production as a defense mechanism. This in turn decreases surface area for gas This in turn decreases surface area for gas
exchange. exchange. The phlegm also irritates the bronchioles, The phlegm also irritates the bronchioles,
causing bronchio-constriction and spasm.causing bronchio-constriction and spasm.
![Page 51: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/51.jpg)
ASTHMA: causes….ASTHMA: causes….
Reactive airway event caused by Reactive airway event caused by bronchospasm, reversiblebronchospasm, reversible
Extrinsic: environmental, allergic trigger, Extrinsic: environmental, allergic trigger, temperaturetemperature
Intrinsic: exertion/ stress, illness Intrinsic: exertion/ stress, illness Inflammatory reaction Inflammatory reaction
![Page 52: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/52.jpg)
Acute asthmatic attack:Acute asthmatic attack:
Bronchospasm: rapid onset, can be relieved Bronchospasm: rapid onset, can be relieved by medicationsby medications
Swelling of mucous membranes in Swelling of mucous membranes in bronchial walls (inflammatory response)bronchial walls (inflammatory response)
Mucus plugging of bronchiMucus plugging of bronchi
![Page 53: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/53.jpg)
Signs and SymptomsSigns and Symptoms Usually patient has history of asthma, may Usually patient has history of asthma, may
have prescription for medshave prescription for meds ““Noisy” breath sounds (increased on Noisy” breath sounds (increased on
exhalation)exhalation)– BEWARE A SILENT CHESTBEWARE A SILENT CHEST
Accessory muscle useAccessory muscle use Tachycardia and tachypneaTachycardia and tachypnea Pulsus paradoxus (decrease in systolic BP Pulsus paradoxus (decrease in systolic BP
with inhalation)with inhalation) ExhaustionExhaustion
![Page 54: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/54.jpg)
Status AsthmaticusStatus Asthmaticus
Prolonged asthma attack that is not broken Prolonged asthma attack that is not broken by normal treatmentsby normal treatments
Requires aggressive treatment and Requires aggressive treatment and transportationtransportation
A SILENT CHEST IS BAD!A SILENT CHEST IS BAD!
![Page 55: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/55.jpg)
TreatmentTreatment
ReassureReassure High flow humidified High flow humidified
oxygenoxygen Assist with medication Assist with medication
(per protocol)(per protocol) Position of comfortPosition of comfort Insure adequate Insure adequate
ventilationventilation BronchoDilatorsBronchoDilators
![Page 56: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/56.jpg)
BronchodilatorsBronchodilators Beta II agonistBeta II agonist
– Stimulate receptor sites causing bronchiole relaxationStimulate receptor sites causing bronchiole relaxation– First Line.First Line.– AlbuterolAlbuterol
Parasympatholytic Parasympatholytic – Inhibit Parasympathetic broncheoconstrictionInhibit Parasympathetic broncheoconstriction– Second line.Use only onceSecond line.Use only once– AtroventAtrovent
May improve air passage around mucous plugsMay improve air passage around mucous plugs Many side effectsMany side effects
![Page 57: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/57.jpg)
Metered Dose InhalerMetered Dose Inhaler
EMT’s may “assist” a patient with a EMT’s may “assist” a patient with a PRESCRIBEDPRESCRIBED MDI in: MDI in:– Respiratory DistressRespiratory Distress– Allergic reactions with wheezingAllergic reactions with wheezing
![Page 58: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/58.jpg)
BASIC USE OF AN MDIBASIC USE OF AN MDI
![Page 59: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/59.jpg)
Remember to Obtain orders from medical Remember to Obtain orders from medical direction.direction.
![Page 60: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/60.jpg)
Remember the 5 R’sRemember the 5 R’s
![Page 61: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/61.jpg)
Remember the 5 R’sRemember the 5 R’s
RIGHT PATIENTRIGHT PATIENT RIGHT MEDICATIONRIGHT MEDICATION RIGHT DOSERIGHT DOSE RIGHT ROUTERIGHT ROUTE RIGHT SITUATION/TIMERIGHT SITUATION/TIME
![Page 62: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/62.jpg)
Shake vigorouslyShake vigorously
![Page 63: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/63.jpg)
Depress hand-held inhaler asDepress hand-held inhaler aspatient inhales deeply.patient inhales deeply.
![Page 64: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/64.jpg)
Instruct patient to hold/blow out Instruct patient to hold/blow out breath.breath.
![Page 65: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/65.jpg)
Allow patient to breathe. Allow patient to breathe. Repeat dose if ordered.Repeat dose if ordered.
![Page 66: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/66.jpg)
Spacer DeviceSpacer Device
![Page 67: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/67.jpg)
REMEMBER:REMEMBER:ALL THAT WHEEZES IS ALL THAT WHEEZES IS
NOT ASTHMA…..NOT ASTHMA…..AND NOT ALL ASTHMA AND NOT ALL ASTHMA
WHEEZES!WHEEZES!
![Page 68: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/68.jpg)
All that wheezes is not asthma:All that wheezes is not asthma:
Other causes:Other causes:– acute left heart failure (“cardiac asthma”)acute left heart failure (“cardiac asthma”)– smoke inhalationsmoke inhalation– chronic bronchitischronic bronchitis– acute pulmonary embolismacute pulmonary embolism
May be localized: suspect an obstructionMay be localized: suspect an obstruction
![Page 69: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/69.jpg)
The Oxygen Myth and COPDThe Oxygen Myth and COPD
People used to think that if you gave a People used to think that if you gave a COPD’er too much O2, they would stop COPD’er too much O2, they would stop breathing…..breathing…..
This is major BS..purely theoretical at best.This is major BS..purely theoretical at best. In short:In short: If their SOB, they gets lots of O2If their SOB, they gets lots of O2
– ““High Flow” 10-15 LPM NRBHigh Flow” 10-15 LPM NRB
![Page 70: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/70.jpg)
NEVER WITHHOLD OXYGEN NEVER WITHHOLD OXYGEN FROM A PATIENT WHO FROM A PATIENT WHO
NEEDS IT!NEEDS IT!
![Page 71: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/71.jpg)
Signs and SymptomsSigns and Symptoms
Something has changed from normalSomething has changed from normal Marked respiratory distressMarked respiratory distress Diaphoresis, cyanosis Diaphoresis, cyanosis Agitation and confusion (hypoxemia), Agitation and confusion (hypoxemia),
lethargy (hypercarbia)lethargy (hypercarbia) Tachypnea, tachycardia, irregular heart beatTachypnea, tachycardia, irregular heart beat
![Page 72: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/72.jpg)
TreatmentTreatment
Ventilate appropriatelyVentilate appropriately Expect low pulse oximetry: don’t try to Expect low pulse oximetry: don’t try to
raise to “normal” Base on Mental Status raise to “normal” Base on Mental Status and subjective statements. Try at least and subjective statements. Try at least above 85-90%above 85-90%
Position of comfort (upright, tripod)Position of comfort (upright, tripod) Rapid transportRapid transport Monitor ventilationsMonitor ventilations
![Page 73: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/73.jpg)
Pulmonary EdemaPulmonary Edema
Definition: Definition: accumulation of fluid in alveoli, accumulation of fluid in alveoli, chronic or acutechronic or acute
Primary Cause is Cardiac (CHF)Primary Cause is Cardiac (CHF) Other Causes:Other Causes:
– exposure to toxic substancesexposure to toxic substances– damaged tissuedamaged tissue– Actively Dying (ARDS)Actively Dying (ARDS)
![Page 74: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/74.jpg)
Signs and SymptomsSigns and Symptoms
AnxietyAnxiety tachypnea/tachycardiatachypnea/tachycardia dyspnea, hemoptysisdyspnea, hemoptysis abnormal breath sounds (moist, wheezes)abnormal breath sounds (moist, wheezes) JVDJVD Elevated blood pressureElevated blood pressure orthopnea/paroxysmal nocturnal dyspneaorthopnea/paroxysmal nocturnal dyspnea
![Page 75: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/75.jpg)
Treatment:Treatment:
ReassureReassure High flow oxygen (positive pressure)High flow oxygen (positive pressure) NTG (Medical Control Only)NTG (Medical Control Only) Position of comfortPosition of comfort Rapid transportRapid transport
![Page 76: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/76.jpg)
PneumoniaPneumonia
Definition: Definition: infection of respiratory infection of respiratory tree, may result in systemic sepsistree, may result in systemic sepsis
Types:Types:– bacterial 90%bacterial 90%– viral (from influenza)viral (from influenza)– mycoplasmal/fungalmycoplasmal/fungal– aspirationaspiration
![Page 77: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/77.jpg)
Signs and symptomsSigns and symptoms
Patient looks sick/dehydratedPatient looks sick/dehydrated Illness over several daysIllness over several days FeverFever DehydrationDehydration Productive cough Productive cough tachypnea/ tachycardiatachypnea/ tachycardia Rales and rhonchiRales and rhonchi
![Page 78: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/78.jpg)
Treatment:Treatment:
Oxygen and transportOxygen and transport
![Page 79: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/79.jpg)
Pulmonary EmbolismPulmonary Embolism
Definition:Definition:sudden blocking of pulmonary sudden blocking of pulmonary artery by clot artery by clot
Causes: Causes: – blood clots in legsblood clots in legs– prolonged immobilizationprolonged immobilization– birth control pillsbirth control pills
![Page 80: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/80.jpg)
Signs and symptoms:Signs and symptoms:
Sudden onset of severe, unexplained Sudden onset of severe, unexplained dyspneadyspnea
other s/s may or may not be presentother s/s may or may not be present chest pain made worse on coughingchest pain made worse on coughing Tachycardia/tachypneaTachycardia/tachypnea JVDJVD
![Page 81: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/81.jpg)
TreatmentTreatment
RecognitionRecognition OxygenOxygen HospitalizationHospitalization Suspect PE when there is acute onset of Suspect PE when there is acute onset of
tachycardia or dyspnea of unknown origintachycardia or dyspnea of unknown origin
![Page 82: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/82.jpg)
HyperventilationHyperventilation
Definition: Definition: rapid, deep respirations causing rapid, deep respirations causing imbalance of CO2 in body often caused by imbalance of CO2 in body often caused by emotions or stressemotions or stress
May be hard to recognizeMay be hard to recognize There may be other causes of patternThere may be other causes of pattern
![Page 83: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/83.jpg)
Signs and symptomsSigns and symptoms
Elevated respiratory rate or increased depthElevated respiratory rate or increased depth chest painchest pain tingling or numbness around mouth, hands, tingling or numbness around mouth, hands,
feetfeet Carpopedal spasmCarpopedal spasm
![Page 84: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/84.jpg)
Treatment:Treatment:
Do NOT use a paper bagDo NOT use a paper bag Try to calm and reassureTry to calm and reassure Remove patient from environment that may Remove patient from environment that may
be causing problembe causing problem Transport if problem can’t be resolvedTransport if problem can’t be resolved
![Page 85: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/85.jpg)
Spontaneous PneumothoraxSpontaneous Pneumothorax
Definition: Definition: sudden leak of air into pleural sudden leak of air into pleural space; may have no apparent causespace; may have no apparent cause
Frequently young, tall, thin malesFrequently young, tall, thin males May have previous historyMay have previous history
![Page 86: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/86.jpg)
Signs/ symptomsSigns/ symptoms
Sudden, sharp chest painSudden, sharp chest pain Sudden dyspneaSudden dyspnea Diminished breath soundsDiminished breath sounds Pleuritic chest painPleuritic chest pain
![Page 87: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/87.jpg)
TreatmentTreatment
Oxygen and transportOxygen and transport
![Page 88: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/88.jpg)
Other problems:Other problems:
Pickwickian syndrome: patient is VERY Pickwickian syndrome: patient is VERY obese, related to sleep apneaobese, related to sleep apnea
Cystic fibrosisCystic fibrosis Legionnaires (type of pneumonia)Legionnaires (type of pneumonia)
![Page 89: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/89.jpg)
Getting a good history will be one of Getting a good history will be one of the most important ways to the most important ways to differentiate between respiratory differentiate between respiratory conditionsconditions
Look for underlying conditionsLook for underlying conditions
![Page 90: EMS- Respiratory Emergencies (Again)](https://reader034.vdocument.in/reader034/viewer/2022051107/53f881e58d7f7253318b4687/html5/thumbnails/90.jpg)
Questions?Questions?