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Overview
Anatomy Review Physiology Review Normal Breathing Respiratory Distress Causes of Shortness of Breath
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Anatomy Review
Respiratory system is made up of:– Airways– Lungs– Blood vessels
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Anatomy Review
Upper airway– Passage of air:
• Nose and mouth• Pharynx• Trachea
– Differences in pediatric patients
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Anatomy Review
Respiratory tree– Trachea– Bronchi– Bronchioles– Alveoli
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Anatomy Review
Respiratory tree– Capillaries: gas exchange
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Anatomy Review
Musculature– Multiple muscles involved in ventilation– Ventilation is the movement of air into and
out of the lungs– Ventilation is unconscious
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Anatomy Review
Musculature– Diaphragm
• A large muscle in the chest • Controlled by nerves from the cervical spinal cord
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Anatomy Review
Musculature– Chest wall muscles
• Help raise the chest• Called the accessory muscles of respiration
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Physiology Review
Respiratory drive– Normal person’s respiratory rate is determined
by the carbon dioxide level– The higher the level, the more stimulation
to breathe– COPD patients
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Physiology Review
Ventilation– Inhalation
• Diaphragm contracts and moves downward• Air is pulled into the chest
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Physiology Review
Ventilation– Exhalation
• Diaphragm relaxes• Passive
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Physiology Review
Respiration Ventilation
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Physiology Review
Respiration– Pulmonary respiration
• Diffusion• Gas exchange• Passive process
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Physiology Review
Respiration– Cellular respiration
• Process which allows the exchange of gases in the periphery
• Uses the same process of diffusion
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Normal Breathing
Breathing normally takes minimal effort The brain sets the breathing rate
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Normal Breathing
Patient appearance– Respiratory difficulty is often
obvious upon looking at the patient• Normal breathing• Respiratory difficulty• Patient may be tired from the effort of
breathing
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Normal Breathing
Lung sounds– Wheezing– Rhonchi– Crackles
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Normal Breathing
Rates and patterns– Normal: 12–20– Pediatric: 15–30– Infants: 25–50
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Normal Breathing
Vital signs– Normal breathing should be reflected in normal
heart rate and blood pressure
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Normal Breathing
Mucous membrane color– Adequate gas exchange—pink– Inadequate gas exchange—bluish– Cyanosis
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Respiratory Distress
Classic signs and symptoms The EMT must recognize them
and act quickly
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Respiratory Distress
Signs and symptoms– Patient may describe own difficulty breathing– Other signs:
• Increased respiratory rate• Increased heart rate• Cyanosis
– Progression of symptoms
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Respiratory Distress
Assessment– Initial assessment
• Very brief• Correct any threats to breathing
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Respiratory Distress
Assessment– Focused history and physical examination
• Done after life threats have been managed• Gather relevant history
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Respiratory Distress
Assessment– Focused history and physical examination
• Responsive patient– Ask about the illness and any remedies tried
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Respiratory Distress
Assessment– Focused history and physical examination
• Responsive patient– Assess lung sounds– Look for JVD– Note skin color– Assess vital signs
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Respiratory Distress
Assessment– Focused history and physical examination
• Unresponsive patient– Complete a rapid physical examination– Obtain vital signs– Obtain history from any family or bystanders
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Respiratory Distress
Assessment– Focused history and physical examination
• Rapid physical examination– After the initial assessment– Look for cause of breathing difficulty
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Respiratory Distress
Assessment– Focused history and physical examination
• Vital signs– The next priority– Pulse oximetry
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Respiratory Distress
Assessment– Focused history and physical examination
• History from others– When patient is unresponsive
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Stop and Review
How would you determine if a patient was having difficulty breathing?
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Respiratory Distress
Management– Oxygen
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Respiratory Distress
Management– Spontaneously breathing patient
• Non-rebreather mask• Nasal cannula
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Respiratory Distress
Management– Assisting ventilations
• Bag valve mask
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Respiratory Distress
Management– Intubation
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Respiratory Distress
Management– Positioning
• Sitting up• Whatever is most comfortable
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Respiratory Distress
Prescribed medications– Patient may need help – Contact medical control
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Respiratory Distress
Prescribed medications– Bronchodilator inhalers
• Inhaled directly into the airways• Help relieve the spasm
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Respiratory Distress
Transport– Initiate quickly for patients in respiratory distress– Obtain a quick history
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Respiratory Distress
Transport– Destination decisions– Advanced life support
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Respiratory Distress
Ongoing assessment Reassessment
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Airway– Foreign body obstruction
• Blocks oxygen from the body• Heimlich maneuver
Causes of Shortness of Breath
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Airway– Epiglottitis
• May occlude the airway• More common in pediatric patients
Causes of Shortness of Breath
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Airway– Epiglottitis
• Signs and symptoms– Child will be frightened– Fever, cough, difficulty breathing– Drooling
Causes of Shortness of Breath
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Airway– Epiglottitis
• Management– Keep patient calm– Do not examine mouth or throat– Notify receiving hospital– Use a BVM, if necessary
Causes of Shortness of Breath
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Airway– Croup
• Viral infection• Not as aggressive as epiglottitis
Causes of Shortness of Breath
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Airway– Croup
• Signs and symptoms– May accompany upper respiratory infection – Bark-like cough
Causes of Shortness of Breath
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Airway– Croup
• Management– Keep patient calm– Cool humidified oxygen– Notify hospital
Causes of Shortness of Breath
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Breathing– Bronchospasm– Asthma
Causes of Shortness of Breath
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Breathing– Asthma
• Signs and symptoms– Distress– Elevated respiratory rate– Wheezing
Causes of Shortness of Breath
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Asthma
Watch this animation showing the effects of asthma on the airway
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Causes of Shortness of Breath
Breathing– Asthma
• Management– ABCs– Assist with inhaler– High-flow oxygen– Transport to hospital
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Breathing– Chronic obstructive pulmonary disease
• Emphysema and chronic bronchitis make up a majority of this group
• Combination of bronchospasm and inflammation
Causes of Shortness of Breath
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Breathing– Chronic obstructive pulmonary disease
• Signs and symptoms– Exacerbated by respiratory infection– Shortness of breath– Hypoxic drive
Causes of Shortness of Breath
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Breathing– Chronic obstructive pulmonary disease
• Management– ABCs– High-flow oxygen– Assist with medications– Transport to the hospital
Causes of Shortness of Breath
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Breathing– Respiratory infections– Signs and symptoms– Management
Causes of Shortness of Breath
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Breathing– Chronic lung diseases
• Administer oxygen
Causes of Shortness of Breath
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Circulation– Pulmonary embolus
• Signs and symptoms• Management
Causes of Shortness of Breath
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Causes of Shortness of Breath
Circulation– Pulmonary edema
• Fluid in the lungs• Signs and symptoms• Management