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CBT/OTEP 425
Respiratory Emergencies
Copyright 2008 Seattle/King County EMS
Introduction
Patients with lung and heart diseases
frequently call 9-1-1 because of breathing
difficulty
This course reviews common disorders
that can cause respiratory emergencies
and prehospital management of these
conditions.
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.
Copyright 2008 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.
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Respiratory Structures
Image credit: Copyright 2007 Seattle/King County EMS
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
Image credit: Copyright 2007 Seattle/King County EMS
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
Copyright 2008 Seattle/King County EMS
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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Airway Obstruction
• Severe
• Mild
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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
Image credit: Copyright 2007 Seattle/King County EMS
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
Copyright 2008 Seattle/King County EMS
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
Image credit: Copyright 2007 Seattle/King County EMS
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
Copyright 2008 Seattle/King County EMS
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 Ventilation
Unconscious 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
Copyright 2008 Seattle/King County EMS
Assisted Ventilation
Non-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
Copyright 2008 Seattle/King County EMS
Summary
Main structures of the respiratory system:
• Pharynx
• Bronchi
• Trachea
• Bronchioles
• Epiglottis
• Larynx
• Alveoli
• Pleura
• Diaphragm
Copyright 2008 Seattle/King County EMS
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
Copyright 2008 Seattle/King County EMS
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
Copyright 2008 Seattle/King County EMS
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
Copyright 2008 Seattle/King County EMS
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
Copyright 2008 Seattle/King County EMS
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
Copyright 2008 Seattle/King County EMS
Summary,
continued
Ventilating unconscious breathing patient:
• Consider oropharyngeal airway
• Do not over ventilate
• Keep airway open
• Maintain good seal
• Apply Sellick maneuver to reduce airflow into
stomach
Copyright 2008 Seattle/King County EMS