© 2011 Seattle / King County EMS CBT425-EMT11: Respiratory Emergencies

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<ul><li> Slide 1 </li> <li> 2011 Seattle / King County EMS CBT425-EMT11: Respiratory Emergencies </li> <li> Slide 2 </li> <li> 2011 Seattle / King County EMS Introduction Patients with lung &amp; heart diseases frequently call 9-1-1 due to breathing difficulty This course reviews common disorders that can cause respiratory emergencies &amp; prehospital management of these conditions </li> <li> Slide 3 </li> <li> 2011 Seattle / King County EMS Objectives 1.Identify the anatomic structures of the respiratory system 2.Demonstrate an understanding of the physiology of the respiratory system and its relationship to BLS treatment 3.Identify signs and symptoms of respiratory emergencies 4.Identify treatment of respiratory emergencies 5.Distinguish between normal and abnormal breath sounds 6.Identify correct technique for auscultation of breath sounds 7.Identify correct BVM technique and suctioning technique </li> <li> Slide 4 </li> <li> 2011 Seattle / King County EMS Terms chronic obstructive pulmonary disease (COPD) - A category of diseases characterized by a slow process of dilation and disruption of pulmonary alveoli. dyspnea - A term for shortness of breath or breathing difficulty. embolus - A blood clot or other substance that has formed in a blood vessel or the heart, that breaks off and travels to another blood vessel, where it may cause blockage. flail chest - A condition in which three or more ribs are fractured in two or more places such that a section of the chest wall is detached from the rest of the chest wall. </li> <li> Slide 5 </li> <li> 2011 Seattle / King County EMS Terms, continued gag reflex - A protective contraction of the muscles of the throat caused especially by stimulation of the pharynx that prevents food and liquids from entering the airway. hypoxia - A condition in which the body's cells and tissue do not have enough oxygen. pleuritic chest pain - A sharp, stabbing pain in the chest that is worsened by a deep breath; often caused by inflammation or irritation of the pleura. pneumothorax - Condition where air enters the pleural space and is trapped during expiration. It can occur without trauma as in a spontaneous pneumothorax. </li> <li> Slide 6 </li> <li> 2011 Seattle / King County EMS Terms, continued pulmonary edema - A buildup of fluid in the lungs, usually as a result of congestive heart failure. rales - Crackling, rattling breath sounds signaling fluid in the air spaces of the lungs. rhonchi - Coarse breath sounds heard in patients with mucus in the airways. stridor - A harsh, high-pitched inspiratory sound often heard in acute laryngeal (upper airway) obstruction. </li> <li> Slide 7 </li> <li> 2011 Seattle / King County EMS Terms continued tension pneumothorax - A life-threatening condition in which air enters the pleural space and the pressure inside the lung cavity progressively increases and compresses the lung. It may displace the mediastinum and other structures toward the opposite side. traumatic asphyxia - Condition characterized by distended neck veins, cyanosis in face and neck and bleeding in the sclera of the eye that is caused by severe compression of the chest. wheeze - A high-pitched, whistling breath sound, characteristically heard on expiration in patients with asthma or COPD. </li> <li> Slide 8 </li> <li> 2011 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, increasing with increasing alkalinity and decreasing with increasing acidity. The pH scale ranges from 0 to 14. Numbers from 7 and below represent increasing acidity. </li> <li> Slide 9 </li> <li> 2011 Seattle / King County EMS 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. Generally it is described in terms of good or poor ventilation. Bluish or dusky skin can indicate poor ventilation. </li> <li> Slide 10 </li> <li> 2011 Seattle / King County EMS Respiratory Structures Airway protection &amp; oxygen administration are perhaps the most important BLS skills you have Important to know structures of respiratory system Understand basic physiology affected by BLS treatment Learning Activity for Functions of Respiratory Structures http://www.emsonline.net/resp2011/functions.asp Learning Activity for Functions of Respiratory Structures http://www.emsonline.net/resp2011/functions.asp </li> <li> Slide 11 </li> <li> 2011 Seattle / King County EMS PHYSIOLOGY </li> <li> Slide 12 </li> <li> 2011 Seattle / King County EMS Metabolism Produces Carbon Dioxide Process by which body breaks down or "burns" stored fuel to create energy Cells use oxygen to transform stored glucose into energy Think of glucose as "fuel" &amp; oxygen as "match" that releases energy Byproduct of metabolism is carbon dioxide (CO2) </li> <li> Slide 13 </li> <li> 2011 Seattle / King County EMS Metabolism Carbon dioxide produced by cells &amp; carried by circulatory system to lungs where it is expired If respirations impaired Carbon dioxide builds up in blood Excess carbon dioxide combines with water in blood to produce acid </li> <li> Slide 14 </li> <li> 2011 Seattle / King County EMS pH Acidity in solution such as blood measured by potential of Hydrogen Body must maintain relatively narrow pH range (neither too acidic nor too basic) Respiratory system helps maintain balanced acid level or pH in blood </li> <li> Slide 15 </li> <li> 2011 Seattle / King County EMS The pH Balancing Act Respiratory system mirror for other changes that happen in the body Blood pH becomes too low (acidic) Respiratory system will attempt to fix by making lungs breathe more deeply &amp; rapidly Excreting more carbon dioxide Homeostasis body attempts to maintain balance </li> <li> Slide 16 </li> <li> 2011 Seattle / King County EMS Hypercarbia Excessive carbon dioxide in the body Results in acidosis as carbon dioxide causes chemical reaction producing carbonic acid Hypercarbia can occur through: Metabolic processes that form acids Muscle exertion Shivering Occurs through decreased elimination of carbon dioxide, for example with: Airway obstruction Inability to exhale fully (e.g., asthma or emphysema) Depressed respiratory drive (e.g., overdose of sedative drugs) </li> <li> Slide 17 </li> <li> 2011 Seattle / King County EMS Hypoxic Drive Amount of carbon dioxide in blood is primary stimulus for breathing Secondary stimulus is hypoxia Decrease in oxygen Occurs in small percentage of COPD patients Expirations so inefficient their bodies become accustomed to higher than normal levels of carbon dioxide Decrease in oxygen, rather than increase in carbon dioxide, provides primary stimulus for taking breath </li> <li> Slide 18 </li> <li> 2011 Seattle / King County EMS Respiratory Drive Act of breathing autonomic &amp; involuntary function controlled by centers in brain sensitive to blood levels of oxygen &amp; carbon dioxide Bodys response to increased carbon dioxide in blood is to "blow off carbon dioxide by increasing rate &amp; depth of respirations </li> <li> Slide 19 </li> <li> 2011 Seattle / King County EMS Metabolic Problems Metabolic imbalances affect chemistry of body affecting pH &amp; other measures of body chemistry Not a respiratory problem, respiratory system often tries to compensate by changing depth and/or rate of respirations </li> <li> Slide 20 </li> <li> 2011 Seattle / King County EMS Metabolic Problems Ketoacidosis inefficient metabolism of sugars in a diabetic causes body to turn to other fuel sources for energy (fat &amp; muscle) Byproducts acids called ketoacids Presence of ketoacids &amp; related compounds in blood will cause lower pH Respiratory system responds by increasing depth and/or rate of respirations Aspirin overdose an acid (the chemical name is acetylsalicylic acid) Taken in large quantities, person becomes acidotic Body compensates by increasing depth and/or rate of respirations </li> <li> Slide 21 </li> <li> 2011 Seattle / King County EMS Metabolic Problems Fever increases metabolic rate, causing production of more carbon dioxide which leads to more acid in blood Tissue perfusion fails (as it can in sepsis) Excess metabolic acids accumulate causing metabolic acidosis with a low pH Body responds by increasing depth and/or rate of respirations Hyperventilating breathing deeply &amp; rapidly Efficient way of ridding body of carbon dioxide which in turn may alter the bodys equilibrium Causes alkalosis (meaning very "basic") Symptoms of respiratory alkalosis may include faintness &amp; tingling in the extremities </li> <li> Slide 22 </li> <li> 2011 Seattle / King County EMS CLINICAL SYNDROMES </li> <li> Slide 23 </li> <li> 2011 Seattle / King County EMS Airway Obstruction EMS providers should intervene if choking victim has signs of severe airway obstruction Poor air exchange or increased breathing difficulty (indicated by silent cough) cyanosis or inability to speak or breathe Mild obstruction &amp; victim coughing forcefully Do not interfere with efforts to relieve obstruction Attempt to relieve obstruction only if it becomes severe Use a finger sweep only if you can see solid material obstructing airway of unresponsive patient </li> <li> Slide 24 </li> <li> 2011 Seattle / King County EMS Asthma Chronic, inflammatory disease of airways Asthma attacks induced by different factors: Allergens Infections Exercise Smoke During asthma attack: Muscles around bronchioles tighten Lining of inside bronchioles swells Inside of bronchioles fills with thick mucous Severely restricts expiration of air from lungs </li> <li> Slide 25 </li> <li> Slide 26 </li> <li> 2011 Seattle / King County EMS Asthma Patients often describe history of asthma Have prescription for metered-dose inhaler BLS treatment considerations include: Calming the patient Airway management Oxygen therapy Assisting with a prescribed inhaler Asthma attack muscles around airways tighten, making airway openings narrower so less air can flow through Inflammation increases and airways become more swollen and narrow Cells in airways also produce more mucus than normal Extra mucus also narrows the airways. </li> <li> Slide 27 </li> <li> 2011 Seattle / King County EMS COPD Chronic obstructive pulmonary disease (COPD) Category of diseases that includes: Asthma Emphysema Chronic bronchitis Slow process of dilation &amp; disruption of airways &amp; alveoli Includes several related irreversible conditions that limit ability to exhale </li> <li> Slide 28 </li> <li> 2011 Seattle / King County EMS </li> <li> Slide 29 </li> <li> COPD Patients present with shortness of breath, fever and increased sputum production Medical history can include: Upper-respiratory infection Chronic bronchitis Emphysema History of smoking Working in hazardous environment (e.g., coal smoke, asbestos) Common medications include: Prednisone Proventil Ventolin Atrovent Azmacort BLS treatment for a COPD patient with respiratory distress should include high flow oxygen. </li> <li> Slide 30 </li> <li> 2011 Seattle / King County EMS Emphysema Very small airways that join alveoli are damaged &amp; walls lose elasticity Chronic irritation of small airways causes inflammation &amp; swelling reducing diameter of air passages Irritation causes bronchospasms &amp; further decreases the lumen On inspiration, expansion of lungs holds airways open On exhalation, lungs relax &amp; airways narrow, trapping air </li> <li> Slide 31 </li> <li> 2011 Seattle / King County EMS Chronic Bronchitis Characterized by structural changes in airways of the lungs Enlargement of mucous glands cause coughing &amp; production of sputum Causes shortness of breath Often accompanied by infection, mucus production &amp; coughing </li> <li> Slide 32 </li> <li> 2011 Seattle / King County EMS Congestive Heart Failure During acute exacerbation patient will present: Sitting up Short of breath Diaphoretic Pale Cyanotic in color Breath sounds can include rales or wheezes Medical history can include: Increased salt ingestion Respiratory infection Non-compliance with medications Angina Symptoms of acute coronary syndrome </li> <li> Slide 33 </li> <li> 2011 Seattle / King County EMS Congestive Heart Failure Result of too much fluid in lungs making it difficult to get air inas opposed to COPD patient who has trouble getting air out Occurs when ventricles weakened by myocardial infarction, underlying coronary artery disease, hypertension or valve disease Impairs hearts ability to contract &amp; empty during systole Blood backs up in lungs &amp; tissues of body Increased pressure in left ventricle transmitted to lung capillaries Fluid forced into alveoli Interrupts gas exchange &amp; results in shortness of breath Increased pressure in right ventricle causes fluid to back up into bodys tissues Leading primarily to swelling in lower extremities Do not suffer from purely left- or purely right-ventricle heart failure Rather present with combination of symptoms </li> <li> Slide 34 </li> <li> 2011 Seattle / King County EMS CHF Symptoms </li> <li> Slide 35 </li> <li> 2011 Seattle / King County EMS Congestive Heart Failure Common medications include: ACE inhibitors Furosemide (Lasix) HCTZ (hydrochlorthiazide) Beta-blockers Angiotensin II receptor blockers Digoxin (Lanoxin) Medications can help differentiate this patient's symptoms from those of someone with COPD </li> <li> Slide 36 </li> <li> 2011 Seattle / King County EMS Congestive Heart Failure When treating CHF: Seat the patient upright Administer high flow oxygen Consider positive pressure ventilation with a BVM if the patient is experiencing severe respiratory difficulty </li> <li> Slide 37 </li> <li> 2011 Seattle / King County EMS Inhalation Injuries Breathing of chemicals, smoke or other substances Common chief complaints include: Shortness of breath Coughing Hoarseness Chest pain due to bronchial irritation Nausea Individuals with decreased respiratory reserve (e.g., history of COPD or CHF) are likely to experience an exacerbation of the disease </li> <li> Slide 38 </li> <li> 2011 Seattle / King County EMS Inhalation Injuries Patient in respiratory distress: Treat immediately with high flow oxygen Assist breathing with a BVM if the respiratory effort is insufficient Indicated by a slow rate &amp; poor air exchange </li> <li> Slide 39 </li> <li> 2011 Seattle / King County EMS Pneumonia Symptoms include: Fever Chills Cough (often with yellowish sputum) Shortness of breath General discomfort Fatigue Loss of appetite Headache Can be chest pain associated with breathing (usually sharp and stabbing in nature) and worsened by coughing...</li></ul>

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