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Pre-Hospital > Breathing > Flashcards

Breathing Flashcards

1
Q

What are signs of respiratory distress?

A
  • Central cyanosis
  • Inability to complete full sentences
  • Use of accessory muscles
  • Reduced consiouness
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2
Q

How would you assess someone’s breathing?

A

SO TRIPPA

  • SpO2 if possible
  • Oxygen therapy - if needed
  • Tracheal position - not overly sensitive/specific sign, and difficult to see, but should still assess
  • Respiratory rate
  • Inspection
  • Palpation
  • Percussion
  • Ausculatation

https://www.youtube.com/watch?v=89QZ6tkGSaU&t=76s

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3
Q

When you are inspecting the chest, what would you look for?

A
  • Raised JVP
  • Tracheal position
  • Bruising/Wounds
  • Asymmetrical movment
  • Depth of breathing
  • Obvious flail chest
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4
Q

What are you palpating for when inspecting the chest?

A
  • Crepitus
  • Sugical Emphysema
  • Tenderness
  • Rib fractures
  • Blood
  • Paradoxical chest movement
  • Chest expansion
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5
Q

What is surgical emphysema suggestive of until proven otherwise?

A

Pneumothorax until proven otherwise

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6
Q

What might a hyperresonant chest indicate on percussion?

A

Pneumothorax

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7
Q

What might dullness on percussion indicate?

A

Pleural effusion

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8
Q

What might bronchial breathing indicate on auscultation?

A

Consolidation

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9
Q

What might absent breath sounds indicate on auscultation?

A

Pneumothorax

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10
Q

What are indications for oxygen therapy?

A
  • Correct hypoxaemia
  • Prevent hypoxaemia in those who are unwell
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11
Q

How does oxygen therapy work?

A

The concentration of oxygen given is normally higher than that of air, and so is transferred across the alveoli, saturating haemoglobin at a faster rate. This is important when haemoglobin is travelling past the alveoli at higher velocities, or gas transfer is reduced

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12
Q

What is hypoxia?

A

Inadequate supply of oxygen to the body’s tissues

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13
Q

What is hypoxaemia?

A

Low oxygen concentration in the blood

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14
Q

What are the primary organs affected by lack of oxygen?

A
  • Kidneys
  • Heart
  • Brain
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15
Q

Why is oxygen therapy important?

A

If the amount of oxygen circulating around the body dramatically falls, even for a short space of time, the effects of tissue hypoxia set in

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16
Q

At what arterial oxygen concentration does impaired consciousness occur?

A

<80% saturations

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17
Q

How is oxygen normally delivered in a pre-hospital setting?

A

Mask with oxygen reservoir - 10-15 L/min

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18
Q

What are the effects of hyperoxia?

A
  • Increased vascular resistance and BP
  • Decreased cardiac output -> decreased tissue perfusion
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19
Q

What methods can be used to manage breathing?

A
  • Mouth to mouth +/- face shield
  • Pocket mask
  • Bag-valve-mask
  • Bag + SGA/ET tube
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20
Q

What percentage oxygen is delivered by mouth to mask ventilation?

A

16-17%

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21
Q

What is a bag-valve mask?

A

A self-inflating bag that can be attached to a face mask. When the bag is squeezed the air inside the bag is delivered to the lungs. The use of a pressure or one-way valve allows the expired gases to be removed. If the bag is attached to an oxygen supply the amount of oxygen inspired can be increased from that of normal air (21%) to around 45%

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22
Q

When is BVM contraindicated?

A

Completely obstructedd airway

23
Q

What rate should breaths be delivered using a BVM in a non-cardiac arrest situation?

A

10-12 per minute

24
Q

What ratio of breaths to chest compressions is used in an adult?

A

30 compressions:2 breaths

25
Q

How would you assess the effectiveness of ventilation?

A
  • Chest rising
  • Good seal
  • Check placement of adjuncts
  • Check there is no gastric extension
26
Q

What factors could cause difficulty when trying to ventilate someone using a BVM?

A
  • Presenace of a beard
  • No teeth
  • Obesity
  • Obstruction
  • >55 years old
  • History of snoring
  • COPD
27
Q

What rate should oxygen be set at when being connected to a BVM?

A

10L/min

28
Q

What are the main life-threatening breathing problems?

A
  • Airway obstruction
  • Tension pneumothorax
  • Open pneumothorax
  • Massive haemothorax
  • Flail chest
  • Cardiac tamponade
29
Q

What symptoms might someone have if they are having a tension pneumothorax in a pre-hospital setting?

A

Commonly following fall/RTC

  • Breathless
  • Sharp pleuritic chest pain
30
Q

What might you find on examination in someone with a tension pneumothorax in a pre-hospital setting?

A
  • Decreased chest expansion
  • Hyper-expanded chest
  • Hyper-resonant
  • Absent breath sounds over affected area
  • Haemodynamic instability - Hypotension, shock
31
Q

What do you need to be aware of when assessing the trachea in a pre-hosptial setting?

A

Not specific or sensitive - determine if someone has a tension pneumothorax with signs of pneumothorax + circulatory shock

32
Q

How would you manage a tension pneumothorax?

A

Immediate needle thoracostomy

  • 14-16G IV cannula -> second IC space, MC line over top third of rib to avoid NV bundle
33
Q

What are complcations what can arise from a needle thorracostomy used to relieve a tension pneumothorax?

A
  • Haemorrhage
  • Lung injury
  • Air emboli
  • Pneumothorax recurrence
  • Damage to local structures - NV bundles, Great vessels
34
Q

How can you reduce the risk of complications from needle thoracostomy to decompress a tension pneumothorax?

A

Insert needle into triagle of safety at 4th-5th intercostal space MA line:

  • Line perpendicular to the floor from the nipple
  • Line following the border of pectoralis major
  • Line anterior to the md axillary line
35
Q

Why might a needle thoracostomy in the triangle of safety fail?

A
  • Cannula is insufficient length to pass through chest wall (e.g. obsese patients)
  • Air can leak from lung faster than it can come out cannula - preventing re-expansion
  • Tissue/blood can block the lumen
  • Cannula malposition
  • Cannula can become kinked due to high pressure
36
Q

What is a safe alternative to needle thoracostomy?

A

https://www.youtube.com/watch?v=3ES8x2PQhqA

Simple/finger thoracostomy

37
Q

How would you perform a simple/finger thoracostomy?

A
  1. Incision made through the skin + subcut tissue
  2. Feel for the top of the 4th/5th rib, and insert Kelly forceps
  3. Anterior axillary line in the 4th/5th intercostal space - used to puncture the chest wall, they are then spread and withdrawn
  4. Finger is inserted and moved around to confirm that you are into the thorax and to clear any adhesions.

https://www.youtube.com/watch?v=3ES8x2PQhqA

38
Q

What is an open pneumothorax?

A

Where air enters the pleural cavity through a defect in the chest wall causing lung collapse. This forms when a hole in the chest wall is greater than 0.75 times the diameter of the trachea. Air is then inspired through the opening rather than trachea (path of least resistance)

39
Q

What are signs that someone has an open pneumothorax?

A

Usually penetrating chest trauma (e.g. stab wound):

  • Hole in the chest - seen sucking/bubbling
  • Tachypnoea
  • Increased resp. effort
  • Decreased chest expansion on affected side
  • Decreased breath sounds
  • Hyperresonant
40
Q

How would you manage an open pneumothorax?

A
  • 100% oxygen via facemask
  • Occlusive dressing over wound
    • Asherman chest seal
    • If asherman not available - Dressing with taped down 3 sides, one open
  • Insert chest drain when possible
41
Q

What is the definition of a massive haemothorax?

A

Pleural aspirate contains haematocrit value of at least 50% of the haematocrit of peripheral blood.

42
Q

What are causes of a massive haemothorax?

A

Blunt force or penetrating trauma

43
Q

What are clinical signs of a massive haemothorax?

A

MOI - thoracic trauma

  • Crepitus
  • Rib fracture
  • Tracheal deviation
  • Reduced chest expansion
  • Dull to percussion
  • Reduced breath sounds
44
Q

What potential investigation could you do in an emergency vehicle to assess a suspected haemothorax?

A

Focussed assessment sonography in trauma (FAST) scan - able to detect as little as 20 mL fluid

45
Q

How would you manage a massive haemothorax?

A
  • Large calibre tube thoracostomy
  • CXR to confirm positioning
46
Q

What is the pathophysiology of a haemothorax?

A

Movements of the pulmonary system cause defibrination where partial clots form. During active bleeding the bodily mechanisms cause large clots to form, which attach to the lung reducing pulmonary movements.

This is problematic for the cardiorespiratory system and therefore it is essential the blood from a haemothorax is removed as quickly as possible

47
Q

What is a flail chest?

A

When a segment of rib cage (usually 2 or more broken ribs in two or more places) is separated from the rest of the chest wall, usually as a result of blunt force chest trauma. The ribs affected can no longer move with the rest of the chest wall during normal ventilation.

48
Q

What are clinical signs of a flail chest?

A
  • Paradoxical movement of the chest - affected area draws in
  • Bruising
  • Chest pain
  • Tachycardia
  • Tachypnoa
  • Difficulty breathing

https://www.youtube.com/watch?time_continue=3&v=uJHfX1RFkF0

49
Q

How would you manage a flail chest in a pre-hospital setting?

A
  • Analgesia
  • Placement of hand on segment - provides splintage
50
Q

What is cardiac tamponade?

A

Cardiac Tamponade is an acute pericardial effusion that puts pressure on the heart. Blood accumulates in the sac (pericardium) surrounding the heart decreasing cardiac output and therefore reducing the amount of blood the rest of the body receives.

51
Q

What are causes of cardiac tamponade?

A
  • Dissecting thoracic aneurysm
  • Acute myocardial infarction
  • Pericarditis
  • Penetrating cardiac injury
52
Q

What are the most common physical symptoms of cardiac tamponade?

A

Dyspnoa

53
Q

What a clinical signs of cardiac tamponade?

A
  • Tachycardia
  • Becks triad - hypotension, increased JVP, muffled heart sounds
54
Q

How would you manage cardiac tamponade in someone in a pre-hospital setting?

A

Definitive treatment - pericardiocentesis:

  • Standard critical care management until able to do pericardiocentesiss

Pre-Hospital (15 decks)

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