1、Respiratory Emergencies,Provena Regional EMS,What we know,Air is good Pink is good Blue is bad Air goes in Air goes out,Ventilation is,Movement of air in and out,Upper Airway,In through nose Warms Humidifies FiltersPast epiglottisInto trachea Anterior to esophagus,Sellicks Maneuver,Pressure on carti
2、lage Pushes trachea more posterior for visualization of vocal cords in intubation Compresses esophagus to inhibit vomiting,Bronchi Branch off trachea Bronchioles 33 divisions to alveoli No air exchange until alveoli Dead air space Must ventilate with 500 cc of inspired air to get to alveoli,Alveoli,
3、Elastic muscles around bronchioles can cause spasm Network of capillaries around alveoli for gas exchange,Exchange of oxygen and carbon dioxide,Ventilation,Mechanics of Breathing,Inspiration chest expands creates vacuum air rushes in Expiration chest contracts creates pressure air rushes out,Diffusi
4、on process of moving oxygen into blood and carbon dioxide out,Diffusion is movement of particles (gas) from an area of high concentration to an area of low concentration,Hemoglobin,98% of inspired oxygen attached to the protein, hemoglobin in RBCalveoli cells,Hypoxia low oxygen to cells,Causes of hy
5、poxia Hypoxic hypoxia not enough oxygen Anemic hypoxia not enough hemoglobin Stagnant hypoxia not enough perfusion shock Histotoxic hypoxia unable to download Cyanide poisoning,Causes of Respiratory Emergencies,Failure of: Ventilation: air in/ air out Diffusion: movement of gases Perfusion: movement
6、 of bloodRelieved by: epinephrine based medications (such as Beta 2 agonist albuterol, terbutaline)Compounded by: Inflammation/mucus production,Assessment,Scene size up Scene safety Environment What in and around the patient suggests that this is a respiratory emergency?,General Impression of Patien
7、t,Position Color Mental Status Ability to Speak Respiratory Effort,Is this patient in distress?,Look for pursed lip breathing or prolonged expiration,Tripod position suggests distress, resting weight on knees helps with chest expansion,Slow labored breathing is a sign of respiratory failure,Cyanosis
8、 blue discoloration suggests hypoxia,Initial Assessment,Airway open,no noises Breathing 12-20 times per minute Circulation warm, pink, dry, strong pulses Disability mental status clear Vital Signs,Focused History,SAMPLE OPQRST How long has this been going on? Start gradual or abrupt Better or worse
9、with position Cough Productive of sputum Color of sputum white? Yellow? Red? green? brown?,Additional Symptoms,Chest pain Fever/chills Wheezing Smoking history Trauma,Medications Currently Taking,Antibiotics Oxygen Steroids Emphysema Asthma Inhalers/nebulizers Emphysema Asthma Cardiac drugs,Respirat
10、ory Emergencies,For each, consider Cause/Pathology Signs and symptoms Management,Upper Airway Obstruction,Due to Foreign bodies food, toys Tongue Swelling Underlying Problem VENTILATION Assessment/Associated Symptoms Airway movement Ability to speak Dyspnea Hypoxia Sounds snoring, stridor Oxygen sat
11、uration will be low,Upper Airway Obstruction,Management BLS Heimlich maneuver ALS Foreign Body Magill Forceps Allergic Reaction epi-pen and ALS protocol Epiglottitis rapid transport Croup humidified oxygen Sleep apnea Prescribed CPAP,Emphysema,Destruction of alveolar walls Underlying Problem: Diffus
12、ion Assessment/Associated Symptoms Dyspnea with exertion History of exposure Barrel chest Prolonged expiratory phase Pursed lip breathing Thin and emaciated Pink puffer (extra hemoglobin to make up for poor oxygen pick up),Management,Wont call till there is a problem Secure airway Correct hypoxia Re
13、spiratory drive from low oxygen not high CO2 IV access (dehydration) Albuterol for Bronchodilation if wheezing,Chronic Bronchitis,Increased mucus production Decreased alveolar ventilation Underlying Problem: VENTILATION AND INFLAMMATION Assessment/Associated Symptoms History of long term exposure to
14、 toxins Frequent respiratory infections Heavy sputum production Obese and cyanotic (blue bloater),Management,Secure airway Correct hypoxia IV access (dehydration) Albuterol Bronchodilation if wheezing,Asthma,Lower airway obstruction Bronchospasm Edema Mucus Caused by Irritants Respiratory infection
15、Emotional distress,Asthma,Underlying Problem: VENTILATION AND INFLAMMATION Assessment/Associated Symptoms Non productive cough Wheezing Speech dyspnea one word sentences Use of accessory muscles Status Asthmaticus not responding to treatment,Breath sounds? IF BRONCHOLES TOTALLY OCCLUDED NO BREATH SO
16、UNDS AT ALL -SILENCE IS BAD, BAD, BAD,Management,Secure airway Correct hypoxia IV access (dehydration) Bronchodilation Beta 2 agonist Inhaled, nebulized and/or subcutaneous Albuterol, terbutaline,Pneumonia,Infection of the lungs Alveoli and interstitial spaces fill with fluid Includes Severe Acute R
17、espiratory Syndrome (SARS) and tuberculosisUnderlying Problem: DIFFUSION,Assessment/Associated Symptoms Looks ill Fever and chills Productive cough Chest pain with respiration,Management,BSI wear a mask Secure airway Correct hypoxia IV access (dehydration) If wheezing - Bronchodilation Beta 2 Agonis
18、t - albuterol,Costochondritis,Viral chest wall pain Inflammation of muscle walls and cartilage of chestUnderlying problem: VENTILATION AND INFLAMMATION,Assessment/Associated Symptoms Sudden onset No trauma Pain on deep inhalation Pain on palpation May have fever or history of cold,Management,Correct
19、 hypoxia Symptom relief Anti-inflammatory medications Ibuprofen,Toxic Inhalation,Inhalation of Super heated air Chemicals Combustion products Steam Lower airway edema Bronchospasm Underlying Problem: VENTILATION, INFLAMMATION, DIFFUSION,Assessment/Associated Symptoms Nature of inhalant Burns to face
20、, nose, mouth Strider,Management,Rescuer safety Remove from further exposure Secure airway may need intubation Correct hypoxia IV access Rapid transport Correct wheezing with beta 2 agonist- albuterol,Carbon Monoxide Poisoning,Inhalation of gas that binds with hemoglobin Underlying Problem: CELLULAR
21、 HYPOXIA Assessment/Associated Symptoms Headache Irritability Errors in judgment Confusion Vomiting Flu symptoms Pink color,Management,Rescuer safety Remove from source Secure airway High flow oxygen Hyperbaric chamber,Pulmonary Emboli,Blood clot (or other emboli) in pulmonary circulation blocking b
22、lood flow Ventilation perfusion mis-match Underlying problem: PERFUSION, DIFFUSION,Assessment/Associated Symptoms: Sudden onset acute chest pain Sudden onset acute dyspnea Tachypnea fast breathing Tachycardia fast heart rate Recent history of being inactive,Management,Secure Airway Correct hypoxia I
23、V Access,Spontaneous Pneumothorax,Sudden loss of pleural seal Underlying Problem: DIFFUSION,Assessment/Associated Symptoms Non traumatic Sudden onset dyspnea No pain on palpation May develop tension and JVD Breath sounds absent on 1 side,Management,Secure airway Correct hypoxia Watch for tension pne
24、umothorax IV access,Hyperventilation,Increased minute volume Underlying problem: too much oxygen and not enough carbon dioxide (ACID/BASE DISRUPTION) Assessment/Associated Symptoms Tachypnea Numbness and tingling of fingers, toes, mouth(Carpopedal spasms),Breath sounds are present on both sides Oxyg
25、en Saturation is greater than 94% on room air,Management,Secure airway Correct respiratory rate slow down Oxygen by mask as 6 liters IV access,Central Nervous System Dysfunction - Brain,Head trauma, stroke, brain tumor, insulin shock, drug toxicity Underlying Problem: VENTILATIONAssessment/Associate
26、d Symptomsslow shallow breathingdecreased tidal volume and minute volumecyanosis,Management,Secure airway Correct hypoxia May need to assist ventilations IV access Treat underlying cause if able,Central Nervous System Dysfunction Spinal Cord,Trauma, polio, multiple sclerosis, myasthenia gravis, ALS
27、Underlying problem: VentilationAssessment/Associated Symptoms: Slow shallow respirations Poor use of chest muscles Decreased tidal volume and minute volume,Management,Secure airway Correct hypoxia May need to assist ventilations IV access,Respiratory Failure,Inability of the to meet the basic demand
28、s for tissue oxygenationUnderlying Problem: VENTILATION, PERFUSION, DIFFUSION,Assessment/Associated Symptoms: Gradual onset ofInadequate oxygen productionInadequate CO2 removalTachycardia and Tachypnea Followed in end stages byBrady cardia and BradypneaCyanosisPoor chest wall movementProfound acidos
29、is,Management,Open airway and mechanically ventilate IV access and correct hypovolemia Work to correct underlying problem,Review,Answer the following questions as a group. If doing this CE individually, please e-mail your answers to: shelley.peelmanprovena.org Use “Nov 2008 CE” in subject box. You w
30、ill receive an e-mail confirmation. Print this confirmation for your records, and document the CE in your PREMSS CE record book.,What do you know? Question 1,You are in a restaurant when a middle-aged man at the next table begins to act strangely while eating steak. He appears to be in acute distres
31、s but is completely silent. His eyes are open wide and he is staggering about. As you approach him, he slumps into your arms unconscious. What has possibly happened to this man? A. Acute asthma attack B. Emphysema C. Foreign body airway obstruction D. Hyperventilation,Question 1 part B,How do you wa
32、nt to manage the patient in question 1? A. call 911 and apply oxygen B. call 911 and attempt BLS maneuvers to remove a Foreign Body C. call 911 and administer an epi-pen D. Begin CPR,Question 2,You are called to attend a 56-year old man whose chief complaint is dyspnea. He states that he has a chron
33、ic cough that has gotten worse over the last few days. The sputum he is coughing up has changed in color from white to yellow/green. The man is heavy set and has a cyanotic color. He has loud wheezes and gurgling in his chest. His vitals are BP 150/90, Pulse 110 and respirations 28. Oxygen saturatio
34、n on room air is 88%. What is wrong with this man? A. Acute foreign body airway obstruction B. Allergic reaction to the environment C. Asthma D. Chronic bronchitis with an acute infection,Question 2 part B,How do you want to manage the patient in question 2? A. apply oxygen B. attempt BLS maneuvers
35、to remove a Foreign Body C. administer an epi-pen D. begin CPR,Question 3,You are called to help a 24 year old woman with difficulty breathing. She is sitting up when you find her, bending forward and fighting to breathe. Her chest is not moving much and only faint wheezing can be heard when you lis
36、ten to her chest. She is so short of breath that she cannot talk. She takes inhalers daily. What is wrong with this patient? A. Acute asthma attack B. Airway obstruction from a Foreign body C. Hyperventilation syndrome D. Pneumonia,Question 3 part B,How do you want to manage the patient in question
37、3? A. apply oxygen B. attempt BLS maneuvers to remove aForeign Body C. administer an epi-pen D. apply oxygen and assist the patient with taking her inhaler or (advanced providers) administer albuterol,Question 4,You are called to a restaurant to attend a patient in respiratory distress. Speaking hoa
38、rsely, he tells you that he was eating shrimp cocktail and that his throat feels swollen. He tells you that he has been allergic to lobster in the past. You notice that he has swelling of his lips and hives on his face. His respiratory distress is increasing and his respirations are wheezing and sha
39、llow. What is wrong with this patient? A. Acute asthma attack B. Acute allergic reaction C. Acute foreign body airway obstruction D. Chronic bronchitis,Question 4 part B,How do you want to manage the patient in question 4? A. apply oxygen B. attempt BLS maneuvers to remove a Foreign Body C. apply ox
40、ygen and administer an epi-pen D. begin CPR,Question 5,A 60 year old woman has been unable to walk since surgery. She has been either in bed or in a chair for several weeks. She only walks to the bathroom and back. Suddenly she feels extremely short of breath and has developed sharp chest pain . You
41、 find her anxious with labored respirations. Her vitals are BP 100/60, pulse 120, respirations 28, oxygen saturation 90% on room air. What is most likely wrong with this woman? A. Acute asthma attack B. Pulmonary emboli C. Acute myocardial infarction D. Acute allergic reaction,Question 5 part B,How
42、do you want to manage the patient in question 5? A. apply oxygen and transport immediately B. apply oxygen and administer albuterol by nebulizer C. apply oxygen and administer an epi-pen D. begin CPR and prepare to defibrillate,Question 6,You are called to a large party for a man who is short of bre
43、ath. You find a thin 19 year old man who is breathing 40 times a minute. His respirations are not wheezing and his skin is pink, warm and dry. He is very anxious and complaining of tightness in his chest. His fingers are painful and cramped. What is wrong with this patient?A. Acute asthma attack B.
44、Acute myocardial infarction C. Hyperventilation syndrome D. Foreign body airway obstruction,Question 6 part B,How do you want to manage the patient in question 6? A. apply oxygen by mask at 6 liters and attempt to slow breathing B. attempt BLS maneuvers to remove a Foreign Body C. apply oxygen and a
45、dminister an epi-pen D. begin CPR and prepare to defibrillate,Question 7,You respond to a house fire to assist a 30 year old woman. She has facial burns with singed eyebrows and nasal hairs. Her voice is very hoarse and she has soot in her sputum. What two airway emergencies are going on with this l
46、ady?A. Toxic inhalation and chronic bronchitis B. Acute asthma attack and airway burns C. Foreign body obstruction and chronic bronchitis D. Toxic inhalation and airway burns,Question 7 part B,How do you want to manage the patient in question 7? A. apply oxygen, if Advanced provider prepare to intub
47、ate B. attempt BLS maneuvers to remove a Foreign Body C. apply oxygen and administer an epi-pen D. begin CPR and prepare to defibrillate,Question 8,Most respiratory emergencies are due to a failure of: A. Perfusion B. Ventilation C. Diffusion of gases D. All of the above,Question 9,Respiratory emerg
48、encies are frequently complicated by: A. Inflammation B. Mucus production C. History of toxic exposure such as cigarette smoke D. All of the above,Question 10,Hypoxia, low oxygen delivery to the cells can be caused by:A. Hypoxic hypoxia insufficient oxygen B. Anemic hypoxia insufficient red blood ce
49、lls C. Stagnant hypoxia shock D. Histotoxic hypoxia oxygen unable to download at the cell E. All of the above,Happy Thanksgiving, and thanks to you all for all your hard work.Provena Regional EMS Staff,Answers,1. C Part B. B 2. D Part B. A 3. A Part B. D 4. B Part B. C 5. B Part B. A 6. C Part B. A 7. D Part B. A 8. D 9. D 10. E,
