Ch.16 Respiratoryemergencies Flashcards
Shortness of breath or difficulty breathing
Dyspnea
A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing obstruction of blood flow
Pulmonary embolism
The principal function of the lungs is __, which is the exchange of oxygen and carbon dioxide. To reach the lower airways, air travels through the trachea into each lung, first passing through the left and right main stem bronchus (larger airways), then on to the bronchioles (smaller airways), and finally into the alveoli. The alveoli are microscopic, thin-walled air sacs where the actual exchange of oxygen and carbon dioxide occurs
Respiration
The two processes that occur during respiration are _, the act of breathing in (inhaling), and __, the act of breathing out (exhaling)
Inspiration
Expiration
During respiration, oxygen is provided to the blood, and carbon dioxidel is removed from it. In healthy lungs, this exchange of gases takes place rapidly at the level of the alveoli (FIGURE 16-2). The alveoli lie against the pulmonary capillary vessels, and as oxygen enters the alveoli from inhalation, it passes freely through tiny passages in the alveolar wall into these capillaries through the process of__.
diffusion
Deoxygenated blood is carried from the heart (to the lungs) by the ____ and arterioles
Pulmonary arteries
Gas exchange takes place at the ___ covering the alveoli
Capillaries
Oxygenated blood is carried from the lungs (to the heart) by the ___ and venules
Pulmonary veins
Throughout the whole process of respiration, the brainstem constantly senses the level of carbon dioxide in the arterial blood. The level of carbon dioxide bathing the brainstem stimulates a healthy person to breathe. If the level of carbon dioxide drops too low, the person automatically breathes at a____. As a result, less carbon dioxide is expired, allowing carbon dioxide levels in the blood to return to normal. Although considered a waste gas, some level of carbon dioxide in the blood is necessary: In addition to stimulating breathing, it helps balance the pH level. If the level of carbon dioxide in the arterial blood rises above normal, the person breathes more rapidly and more deeply. When more fresh air is brought into the alveoli, more carbon dioxide diffuses out of the bloodstream, thereby lowering the level of carbon dioxide in the blood.
slower rate and less deeply
Signs and symptoms of
Wheezing on inspiration/expiration
Bronchospasm
Asthma
Signs and symptoms of
Flushed skin or hives (urticaria)
Generalized edema
Decreased blood pressure (hypotension)
Laryngeal edema with dyspnea
Wheezing or stridor
Anaphylaxis
Signs and symptoms of
Shortness of breath
Wheezing
Coughing
Fever
Dehydration
Tachypnea
Tachycardia
Bronchiolitis
Signs and symptoms of
Chronic cough (with sputum production)
Wheezing
Cyanosis
Tachypnea (increased breathing rate)
Bronchitis
Signs and symptoms of
Dependent (lower extremity) edema
Crackles (pulmonary edema)
Orthopnea
Paroxysmal nocturnal dyspnea
Congestive heart failure
Signs and symptoms of
Cough
Runny or stuffy nose
Sore throat
Common cold
Signs and symptoms of
Cough
Fever
dyspnea
Chest pain
Anosmia(inability to smell)
Covid-19
Signs and symptoms of
Fever
Barking cough
Stridor
Mostly seen in pediatric patients
Croup
Signs and symptoms of
Difficulty brought breathing and swallowing
Sore throat
Thick, gray buildup in throat or nose
Fever
Diphtheria
Signs and symptoms of
Barrel chest
Pursed lip breathing
Dyspnea on exertion
Cyanosis
Wheezing/decreased breath sounds
Mostly seen in older patients
Emphysema
Signs and symptoms of
Dyspnea
High fever
Stridor
Drooling
Difficulty swallowing
Severe sore throat
Tripod or sniffing position
Mostly seen in pediatric patients
Epiglottitis
Signs and symptoms of
Cough
Fever
Sore throat
Fatigue
Influenza type a (flu)
Signs and symptoms of
Coughing spells
Whooping sound
Fever
Pertussis (whooping cough)
Signs and symptoms of
Dyspnea
Chills, fever
Cough
Green, red, or rust-colored sputum
Localized wheezing or crackles
Pneumonia
Signs and symptoms of
Sudden chest pain with dyspnea
Decreased breath sounds (affected side)
Subcutaneous emphysema
Pneumothorax
Signs and symptoms of
Dyspnea
Occasionally will have sharp chest pain
Sudden onset
Tachycardia
Clear breath sounds initially
Pulmonary embolus
Signs and symptoms of
Severe shortness of breath
Diminished or absent breath sounds on one side
Decreased/altered level of consciousness
Neck vein distention
Tracheal deviation (late sign)
Hypotension; signs of shock
Tension pneumothorax
Signs and symptoms of
Cough
Wheezing
Fever
Dehydration
Respiratory syncytial virus (RSV)
Signs and symptoms of
Cough
Fever
Fatigue
Productive/bloody sputum
Tuberculosis (TB)
An acute spasm of the smaller air passages, called bronchioles, associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages
Asthma
An extreme, life-threatening, systemic allergic reaction that may include shock and respiratory failure
Anaphylaxis
Inflammation of the bronchioles that usually occurs in children younger than 2 years and is often caused by the respiratory syncytial virus
Bronchiolitis
An acute or chronic inflammation of the lung that may damage lung tissue; usually associated with cough and production of sputum and, depending on its cause, sometimes fever
Bronchitis
A disorder in which the heart loses part of its ability to effectively pump blood, usually as a result of damage to the heart muscle and usually resulting in a backup of fluid into the lungs
Congestive heart failure
Severe dyspnea experienced when lying down and relieved by sitting up
Orthopnea
Severe shortness of breath, especially at night after several hours of reclining; the person is forced to sit up to breathe
Paroxysmal nocturnal dyspnea
A viral inflammatory disease of the upper respiratory system that may cause a partial airway obstruction and is characterized by a barking cough; usually seen in children
Croup
An infectious disease in which a pseudomembrane forms, lining the pharynx; this lining can severely obstruct the passage of air into the larynx
Diphtheria
A disease of the lungs in which there is extreme dilation and eventual destruction of the pulmonary alveoli with poor exchange of oxygen and carbon dioxide; it is one form of chronic obstructive pulmonary disease
Emphysema
Virus that has crossed the animal/human barrier and has infected humans, recently reaching a pandemic level with the h1n1 strain
Influenza type a (flu)
An infectious disease of the lung that damages lung tissue
Pneumonia
An accumulation of air in the pleural cavity
Pneumothorax
A blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage of blood flow
Embolus
An accumulation of air or gas in the pleural cavity that progressively increases pressure in the chest and that interferes with cardiac function, with potentially fatal results
Tension pneumothorax
A virus that causes an infection of the lungs and breathing passages; can lead to other serious illnesses that affect the lungs or heart, such as bronchiolitis and pneumonia. __ is highly contagious and spread through droplets
Respiratory syncytial virus
A chronic bacterial disease, caused by myobacterium tuberculosis, that usually affects the lungs but can also affect other organs such as the brain and kidneys; it is spread by cough and can lie dormant in a persons lungs for decades and then reactivate
Tuberculosis
The body may also produce too much carbon dioxide, either temporarily or chronically, depending on the disease or abnormality. If, for a period of years, arterial carbon dioxide levels rise to an abnormally high level and remain there, the respiratory centers in the brain, which sense the carbon dioxide level and control breathing, may work less efficiently.
The failure of these centers to respond normally to a rise in arterial levels of carbon dioxide is due to chronic __
carbon dioxide retention.
A condition characterized by a chronically high blood level of carbon dioxide in which the respiratory center no longer responds to high blood levels of carbon dioxide
Carbon dioxide retention
the brain senses the levels of carbon dioxide (based on the pH) in the blood and cerebrospinal fluid. When carbon dioxide levels become elevated, the respiratory centers in the brain adjust the rate and depth of ventilation accordingly. However, patients with chronic lung diseases have difficulty eliminating carbon dioxide through exhalation; thus, they always have higher levels of carbon dioxide. This condition potentially alters their drive for breathing. The theory is that the brain gradually accommodates high levels of carbon dioxide and then uses a backup system to control breathing based on low levels of oxygen, rather than high levels of carbon dioxide.
This condition is called__
hypoxic drive.
A condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive; seen in patients with chronic lung diseases
Hypoxic drive
__is frequently found in end-stage chronic obstructive pulmonary disease (COPD). Some experts advocate withholding high concentrations of oxygen, for extended periods of time, from patients with chronic lung diseases for fear that the increased oxygen level in the blood could depress, or completely stop, the patient’s respiratory drive. Use caution when providing high concentrations of oxygen on a long-term basis to patients with chronic lung disease, but never withhold oxygen therapy from a patient who needs it. Closely monitor patients who are experiencing respiratory distress and be prepared to assist with ventilations if needed.
Hypoxic drive
Many medical problems may cause dyspnea. Be aware that if the patient’s problem is severe and the brain is deprived of oxygen, he or she may not be alert enough to report shortness of breath. Altered mental status may be a sign that the brain is dysfunctional because of severe__, a condition in which the body’s cells and tissues do not get enough oxygen.
hypoxia
A collection of fluid between the lung and chest wall that may compress the lung
Pleural effusion
This syndrome occurs in the absence of physical problems. The respiration of a person who is experiencing hyperventilation syndrome may be as high as 40 shallow breaths/min or as low as only 20 very deep breaths/minz this syndrome is often associated with panic attacks
Hyperventilation syndrome
Collapse of the alveolar air spaces of the lungs
Atelectasis
Besides shortness of breath, a patient with___ may report the sensation of chest tightness and air hunger. Air
hunger is when a person reports the feeling of “not getting enough air” and has a strong need to breathe. Chest tightness is described as an uncomfortable feeling in the chest, and it is commonly reported by patients with asthma.
Dyspnea is also a common complaint in patients with cardiopulmonary diseases. In some cases, it may be caused by physical exertion that has been made difficult because the patient’s heart is damaged. Congestive heart failure is a troublesome cause of breathlessness because the heart is not pumping efficiently and, therefore, the body does not have adequate oxygen. Another condition commonly associated with congestive heart failure is pulmonary edema, in which the alveoli are filled with fluid.
dyspnea
Infections that impair airflow through the airways are problems of respiration.
Inadequate oxygen delivery to the tissues is a problem of__.
oxygenation
Infections may cause____ by obstructing airflow in the larger airways due to production of mucus and secretions (colds, diphtheria) or by causing swelling of soft tissues located in the larger, upper airways (epiglottitis, croup). Infections may also impair the exchange of gases between the alveoli and the capillaries (pneumonia).
dyspnea
___is caused by inflammation and swelling of the pharynx, larynx, and trachea. This disease is often secondary to an acute viral infection of the upper respiratory tract and is typically seen in children between ages 6 months and 3 vears. It is easily passed between children. Peak seasonal outbreaks of this disease occur in the late fall and during the winter.
The disease starts with a cold, cough, and a low-grade fever that develops over a few days. The hallmark signs of____ are stridor and a seal-bark cough, which signal a narrowing of the air passage of the trachea that may progress to significant obstruction.
___is rarely seen in adults because their breathing passages are larger and can accommodate the inflammation and mucus production without producing symptoms. The airways of adults are wider, and the supporting tissue is firmer than in children.
___often responds well to the administration of humidified oxygen. Note that bronchodilators are not indicated
for__ and can worsen a patient’s symptoms.
Croup
____is a life-threatening inflammatory disease of the__, the small flap of tissue at the back of the throat that protects the larynx and trachea during swallowing. Bacterial infection is the most common cause (FIGURE 16-5). In the past,___ was most often seen in infants and children. In some cases, it occurs in adults. The development of a childhood vaccine against Haemophilus influenzae has dramatically decreased the incidence of this disease. In preschool and school-age children especially, the___ can swell to two to three times its normal size. This puts the airway at risk of complete obstruction. The condition usually develops in otherwise healthy children, and symptoms are sudden in onset. Children with this infection look ill, report a very sore throat, and have a high fever.
They will often be found in the tripod position and drooling. Stridor is a late sign in the development of airway Treat children with suspected____ gently and try not to do anything that will cause them to cry. Keep them in a position of comfort, and give them high-flow oxygen. Do not put anything in their mouths, as this could trigger a complete airway obstruction.
Deterioration can occur quickly in adults with acute__. You should be concerned if your adult patient presents with stridor or any other sign of airway obstruction without an obvious mechanical cause. Focus your patient management on maintaining a patent (adequate) airway, and provide prompt transport to the emergency department (ED).
Epiglottitis
___is a common cause of illness in young children. It causes an infection in the lungs and breathing passages, and can lead to other serious illnesses such as bronchiolitis and pneumonia, as well as serious heart and lung problems in premature infants and in children who have depressed immune systems.
__is highly contagious and can be spread through droplets when the patient coughs or sneezes. The virus can also survive on surfaces, including hands and clothing. Therefore, the infection tends to spread rapidly through schools and child care centers.
When you assess a child with suspected___, look for signs of dehydration. Infants with___ often refuse liquids.
Treat airway and breathing problems as appropriate. Humidified oxygen is helpful if available.
Respiratory syncytial virus (RSV)
___is a respiratory illness that often occurs due to RSV infection and results in severe inflammation of the bronchioles. Bronchioles, the tiny airways that lead from the larger airways (bronchi) to the alveoli in the lungs, become inflamed, swell, and fill with mucus. This condition occurs most frequently in newborns and toddlers, especially boys, whose airways can easily become blocked. Infections are common during the winter and spring. Young children who require hospitalization for___ are at increased risk for developing childhood asthma.
The treatment for a child suffering from____ is mainly supportive. Although many of these patients do well, there is still a risk for significant respiratory compromise. You should provide appropriate oxygen therapy and allow the patient to remain in a position of comfort. Suction thick mucus from the nostrils if present. Reassess frequently for signs of worsening respiratory distress. Be prepared to provide airway management and positive-pressure ventilation should the patient develop respiratory failure.
Bronchiolitis
According to the World Health Organization,___ is a significant cause of morbidity worldwide.___ is a general term that refers to an infection of the lungs. The infection collects in the surrounding normal lung tissues, impairing the lung’s ability to exchange oxygen and carbon dioxide.
___is often a secondary infection, meaning it begins after an upper respiratory tract infection such as a cold or sore throat. It can be caused by a virus or bacterium, or by a chemical injury after an accidental ingestion or al direct lung injury from a submersion incident. Interventions such as intubation and tracheostomy can increase the risk of developing pneumonia.____ commonly affects people who are chronically and terminally ill. Factors that predispose patients to___ include the following:
• Institutional residence (nursing home or long-term care facilities)
• Recent hospitalization
• Chronic disease processes (such as renal failure requiring dialysis)
• Immune system compromise (patient receiving chemotherapy or diseases such as HIV)
• History of COPD
Symptoms of___ vary, depending on the age of the person and the cause of the illness. Children often present with unusually rapid or labored breathing or breathing characterized by grunting or wheezing sounds. In severe cases where oxygen exchange at the alveoli is markedly impaired, the lips and fingernails may be blue or gray. If the___ is in the lower part of the lungs near the abdomen, there may be fever, abdominal pain, and vomiting rather than dyspnea.
Bacterial___ results in severe symptoms more quickly, including high fevers, which put the child at risk for
febrile seizures. A viral__ presents more gradually and is less severe.
Other signs and symptoms include dry skin, decreased skin turgor, exertional dyspnea, a productive cough, chest discomfort or pain that varies with inspiration and expiration, headache, nausea and vomiting, musculoskeletal pain, weight loss, and confusion. The patient may be febrile, tachycardic, or even hypotensive. Assessment of the lungs may reveal diminished breath sounds, along with the presence of wheezing, crackles, or rhonchi. You will need to evaluate the patient’s history for possible risk factors. If possible, assess temperature to determine the presence of fever. Pulse oximetry readings, if available, may be low.
pneumonia
_____is an airborne bacterial infection that primarily affects children younger than 6 years. It is highly contagious and is passed through droplet infection.
A patient with____ will be feverish and exhibit a “whoop” sound on inspiration after a coughing attack.
Symptoms are generally similar to colds, but coughing spells can last for more than 1 minute, during which the child may turn red or purple. This may frighten the parents or caregivers into calling 9-1-1.
Some infants and younger children with___ should be treated in a hospital because they are at greater risk for complications such as pneumonia, which occurs mostly in children younger than 1 year. In infants younger than 6 months,____ can be life threatening.
Children with___ may vomit or not want to eat or drink. Watch for signs of dehydration. You may have to
suction thick secretions to clear the airway. Give oxygen by the most appropriate means.
___can also occur in adults either because they were not vaccinated as children, or more commonly because the vaccine did not confer lifelong immunity. When it does occur, it can cause a severe upper respiratory infection. which can lead to pneumonia in geriatric patients or people with compromised immune systems. The infection can cause coughing spells that last for weeks and can be so severe that patients find it hard to breathe, eat, or sleep. In the worst cases of infection, particularly in geriatric patients, coughing can lead to cracked ribs. For patients who are already weak from other chronic conditions,___ can lead to hospitalization. According to the CDC, the disease has become a serious issue and physicians are becoming more aggressive about immunizing adults with the___ vaccine
Pertussis (whooping cough)
___is an animal respiratory disease that has mutated to infect humans. In 2009, the H1N1 strain of___ became pandemic (an outbreak that occurred on a global scale). Like seasonal flu, it may make chronic medical conditions worse. All strains of___ are transmitted by direct contact with nasal secretions and aerosolized droplets from coughing and sneezing by infected people. __viruses cause fever, cough, sore throat, muscle aches, headache, and fatigue and may lead to pneumonia or dehydration.
Influenza type A
___is a respiratory disease caused by the virus SARS-CoV-2. The virus is a coronavirus, similar to the one that causes the common cold. It is believed to have initially been native to bats and transferred to humans by contact in an open-livestock meat market in Wuhan, China, in 2019. Because the virus is extremely contagious, it spread rapidly across the entire world, creating a severe pandemic that resulted in hundreds of thousands of deaths worldwide. The virus preferentially affects the elderly, patients living in close quarters with one another, and those with weakened immune systems, but it has also sickened and even killed many people who were otherwise young and healthy.
___is transmitted by aerosol droplets, through airborne particles generated by sneezing or coughing, and by direct contact. The virus can survive on surfaces for several days. Symptoms include high fever, cough, chest pain during inspiration, vomiting and diarrhea, and anosmia (inability to smell). Respiratory deterioration in these patients can be dramatic and rapid
COVID-19
___is a bacterial infection caused by Mycobacterium__.__ spreads by cough and is dangerous because many strains are resistant to antibiotics.___ most commonly affects the lungs but can also be found in almost any organ of the body, particularly the kidneys, spine, and lining of the brain and spinal cord (meninges). In some cases,__ can remain dormant (inactive) for years without causing symptoms or being infectious to other people.
However, when the person is in a state of weakened immunity,___ can become active again. The patient may not even be aware he or she has the disease.
Patients with active___ involving the lungs will report fever, coughing, fatigue, night sweats, and weight loss. If the lung infection becomes severe, the patient will experience shortness of breath, coughing, productive sputum, bloody sputum, and chest pain.
___has a higher prevalence among people who live in close contact, such as prison inmates, nursing home residents, and people in homeless shelters.__ is also found in people who abuse intravenous drugs or alcohol and people whose immune systems are compromised by an infection such as HIV. Anyone who comes into close contact with people who have active__ or is in contact with people from countries that have a high prevalence of__ is at risk for contracting the disease. As an EMT, you are also at risk.
If you suspect your patient may have active__, you need to wear (at a minimum) your gloves, eye protection, and an N-95 respirator. These respirators are fit-tested to the individual to ensure no contaminated air can pass through.
Also place a surgical mask or oxygen mask on the patient.
Tuberculosis (TB)
Sometimes, the heart muscle is so injured after a heart attack or other illness that it cannot circulate blood properly. In these cases, the left side of the heart cannot remove blood from the lung as fast as the right side delivers it. As a result, fluid builds up within the alveoli and in the lung tissue between the alveoli and the pulmonary capillaries. This accumulation of fluid is referred to as__, and it is usually a result of congestive heart failure. By physically separating the alveoli from the pulmonary capillary vessels, the edema interferes with the exchange of carbon dioxide and oxygen (FIGURE 16-6). High blood pressure and low cardiac output often trigger this flash (sudden) pulmonary edema. These patients are among the most sick, frightened, and worrisome patients you will encounter.
They are literally drowning in their own fluid. The patient usually experiences dyspnea with rapid, shallow respirations.
In the most severe cases, you will see frothy pink sputum at the nose and mouth.
pulmonary edema
Patient risk factors for___ include hypertension and a history of coronary artery disease
and/or atrial fibrillation, a condition in which the atria no longer contract, but instead quiver.
___(which can lead to pulmonary edema) is often cited as one of the most common causes of hospital admission in the United States. It is not uncommon for a patient to have repeated bouts. In most cases, patients have a long-standing history of chronic congestive heart failure that can be kept under control with medication. However, an acute onset may occur if the patient stops taking the medication, eats food that is too salty, or has a stressful illness, a new heart attack, or an abnormal heart rhythm.
congestive heart failure
However, not all patients with___ have heart disease. Poisonings from inhaling large amounts of smoke or toxic chemical fumes can produce_, as can traumatic injuries of the chest and exposure to high altitudes. In these cases, fluid collects in the alveoli and lung tissue in response to damage to the tissues of the lung or the bronchi.
pulmonary edema
Signs and symptoms of__ include difficulty breathing with exertion because the heart cannot keep up with the body’s need for oxygen. Patients may also report a sudden attack of respiratory distress that wakes them at night when they are in a reclining position. This is caused by fluid accumulation in the lungs. Patients also report coughing, feeling suffocated, cold sweats, and tachycardia.
In your primary assessment, you might find the patient has cool, diaphoretic, cyanotic skin and you will hear adventitious breath sounds such as crackles or wheezing. The patient’s pulse will be tachycardic. The patient may have hypertension early, followed by deterioration to hypotension as a late finding.
congestive heart failure
Abnormal breath sounds such as wheezing, stridor, rhonchi, and crackles
Adventitious breath sounds
___, according to the World Health Organization, is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. According to the US Department of Health and Human Services,___ has been diagnosed in approximately 16 million people, and millions more people have___ and do not know it. According to the CDC, it is the fourth leading cause of death in the United States.___ is an umbrella term used to describe several lung diseases, including emphysema and chronic bronchitis, an ongoing irritation of the trachea and bronchi.
Chronic obstructive pulmonary disease (COPD)
COPD may be a result of direct lung and airway damage from repeated infections or inhalation of toxic gases and particles, but most often it results from cigarette smoking. Although it is well known that cigarettes are a direct cause of lung cancer, their role in the development of COPD is far more significant and less publicized.
Tobacco smoke is a bronchial irritant and can create chronic__. With__, excess mucus is constantly produced, obstructing small airways and alveoli. Protective cells and lung mechanisms that remove foreign particles are destroyed, further weakening the airways. Chronic oxygenation problems can also lead to right-side heart failure and fluid retention, such as edema in the legs.
Pneumonia develops easily when the air passages are persistently obstructed. Ultimately, repeated episodes of irritation and pneumonia cause scarring in the lungs and some dilation of the obstructed alveoli, leading to COPD
bronchitis
Irritation of the major lung passageways from long-term exposure to infectious disease or irritants such as smoke
Chronic bronchitis
The most common form of COPD is__.___ is a loss of the elastic material in the lungs that occurs when the alveolar air spaces are chronically stretched due to inflamed airways and obstruction of airflow out of the lungs. Smoking can also directly destroy the elasticity of the lung tissue. Normally, the lungs act like spongy balloons that are inflated; once they are inflated, they will naturally recoil because of their elastic nature, expelling gas rapidly.
However, when they are constantly obstructed or when the elasticity is diminished, air is no longer expelled rapidly, and the walls of the alveoli eventually fall apart, leaving large holes in the lung that resemble large air pockets or
cavities.
Most patients with COPD have elements of both chronic bronchitis and___. Some patients will have more elements of one condition than the other; few patients will have only___ or bronchitis. Therefore, most patients with COPD will chronically produce sputum, have a chronic cough, and have difficulty expelling air from their lungs, with long expiration phases and wheezing. Patients may present with adventitious breath sounds such as crackles, rhonchi, and wheezes, or may have severely diminished breath sounds due to poor air movement.
emphysema
Be aware that the signs and symptoms of COPD and congestive heart failure significantly overlap. Many patients suffer from both diseases, and it is often difficult to determine which disease is causing the patient’s shortness of breath; often these patients are treated for both diseases after arrival to the hospital. Lung sounds (discussed later in the chapter) are one way to help you tell the difference. Patients with___ caused most often by congestive heart failure will often have wet lung sounds (crackles), and patients with COPD will often have dry lung sounds (wheezes). However, do not assume all patients with COPD have wheezes and all congestive heart failure patients have crackles.
pulmonary edema
__is an acute spasm of the bronchioles associated with excessive mucus production and with swelling of the mucous lining of the respiratory passages (FIGURE 16-8). According to the CDC, approximately 25 million Americans have_.___ affects people of all ages, but the highest prevalence rate is seen in children ages 5 to 17 years.__ produces a characteristic wheezing as the patient attempts to exhale through partially obstructed air passages; wheezing is indicative of a partial lower airway obstruction. These same air passages open easily during inspiration. The wheezing may be so loud that you can hear it without a stethoscope. In other cases, the airways are so blocked that no air movement is heard. In severe cases, the actual work of exhaling is tiring, and cyanosis and/or respiratory arrest may quickly develop. Cyanosis is the result of poor oxygenation of the blood as it passes through the capillaries around the alveoli. It can be seen first in the lips and mucous membranes.
Asthma
___, or allergic rhinitis, causes coldlike symptoms, including a runny nose, sneezing, congestion, and sinus pressure. The symptoms are caused by an allergic response, usually to outdoor airborne allergens such as pollen or sometimes indoor allergens such as dust mites and pet dander. For many people, hay fever is at its worst in the spring and summer, but others may have hay fever symptoms year-round. People do not generally call 9-1-1 or request an ambulance for simple___ symptoms, but__ is included in this discussion of allergic conditions because it affects so many people. People with___ tend to be atopic, meaning that they are more likely to have other allergies, and they may also have a higher incidence of severe reactions, including anaphylaxis.
Hay fever
___, is a severe allergic reaction characterized by airway swelling and dilation of blood vessels all over the body, which may significantly lower blood pressure (FIGURE 16-9).___ may be associated with widespread hives (urticaria), itching, signs of shock, and signs and symptoms similar to asthma. The airway may swell so much that breathing problems can progress to total airway obstruction in a matter of minutes. Most___ reactions occur within 30 minutes of exposure to the allergen, which can be anything from food (such as peanuts) to medication (such as penicillin). For some patients, the episode of___ may be their first; therefore, they may not know what caused the reaction. In other cases, the patient may be aware of what substance he or she is sensitive to but is unaware that an exposure has octurred, such as eating food that was not supposed to contain nuts.
In most cases, epinephrine (adrenalin) is the treatment of choice. Patients may have their own prescribed automatic epinephrine injector, or EpiPen. Oxygen and antihistamines are also useful. As always, medical direction should guide appropriate therapy.
Anaphylaxis, or anaphylactic shock
___is a partial or complete accumulation of air in the pleural space.___ is most often caused by trauma, but it can also be caused by some medical conditions. In these cases, the condition is called a spontaneous pneumothorax____.
Normally, the vacuum pressure in the pleural space keeps the lung inflated. When the surface of the lung is disrupted, however, air escapes into the pleural cavity and results in a loss of negative vacuum pressure. The natural elasticity of the lung tissue causes the lung to collapse. The accumulation of air in the pleural space may be mild or severe
Pneumothorax
Spontaneous____ may occur in patients with certain chronic lung infections or in young people born with weak areas of the lung. Patients with emphysema and asthma are at high risk for spontaneous___ when a weakened portion of lung ruptures, often during severe coughing. Tall, thin young men are also more susceptible than the rest of the population to development of spontaneous___, particularly while performing strenuous activities, such as heavy lifting.
A patient with a spontaneous___ has dyspnea and might report pleuritic chest pain, a sharp, stabbing pain on one side that is worse during inspiration and expiration or with certain movement of the chest wall. By listening to the chest with a stethoscope, you can sometimes detect that breath sounds are absent or decreased on the affected side. However, altered breath sounds are very difficult to detect in a patient with severe emphysema.
Spontaneous____ may be the cause of sudden dyspnea in a patient with underlying emphysema. A spontaneous____ has the potential to evolve into a life-threatening___. Continually reassess for anxiety, increased dyspnea, hypotension, absent or severely decreased breath sounds on one side, the presence of jugular vein distention, and cyanosis.
pneumothorax
Sharp stabbing pain in the chest that is worsened by a deep breath or other chest wall movement; often caused by inflammation or irritation of the pleura
Pleuritic chest pain
A high pitched, whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of the lower airways; occurs in asthma and bronchiolitis
Wheezing
Patients with__ wheeze because of bronchial constriction and present with shortness of breath. Their breathing
gets progressively worse, and they have the most trouble breathing on exertion. Patients with___ have chronic coughing and thick sputum. They are usually long-term smokers with a thin, barrel chest appearance. Their medications would include home oxygen, bronchodilators, and corticosteroids.
Patients with__ often have a slower onset of symptoms because their disease is worsened by infection and other stressors. Patients with congestive heart failure experience a fluid overload in the lung, which may develop quickly from a failing pump.
As you try to discern between__ and congestive heart failure, keep an open mind so that you do not miss
iportant differences. The best advice is to treat the patient, not the lung sounds.
COPD
A patient with a spontaneous pneumothorax has dyspnea and might report__, a sharp, stabbing pain on one side that is worse during inspiration and expiration or with certain movement of the chest wall. By listening to the chest with a stethoscope, you can sometimes detect that breath sounds are absent or decreased on the affected side. However, altered breath sounds are very difficult to detect in a patient with severe emphysema.
Spontaneous pneumothorax may be the cause of sudden dyspnea in a patient with underlying emphysema. A spontaneous pneumothorax has the potential to evolve into a life-threatening pneumothorax. Continually reassess for anxiety, increased dyspnea, hypotension, absent or severely decreased breath sounds on one side, the presence of jugular vein distention, and cyanosis.
pleuritic chest pain
A___ is a collection of fluid outside the lung on one or both sides of the chest. It compresses the lung or lungs and causes dyspnea (FIGURE 16-11). This fluid may collect in large volumes in response to any form of irritation such as infection, congestive heart failure, or cancer. Although it can build up gradually, over days or even weeks, patients often report that their dyspnea came on suddenly.___ may also contribute to shortness of breath in a patient with lung cancer.
pleural effusion
When you listen with a stethoscope to the chest of a patient with dyspnea resulting from__, you will hear decreased breath sounds over the region of the chest where fluid has moved the lung away from the chest wall.
These patients frequently feel better if they are sitting upright. Nothing will completely relieve their symptoms, however, except removal of the fluid, which must be done by a physician in the hospital.
pleural effusion
A collection of fluid between the lung and chest wall that may compress the lung
Pleural effusion
An___ is anything in the circulatory system that moves from its point of origin to a distant site and lodges there, obstructing subsequent blood flow in that area. Beyond the point of obstruction, circulation can be significantly decreased or completely blocked, which can result in a life-threatening condition. Emboli can be fragments of blood clots in an artery or vein that break off and travel through the bloodstream, or foreign bodies that enter the circulation, such as a bubble of air.
embolus
A___ is a blood clot formed in a vein, usually in the legs or pelvis, that breaks off and circulates through the venous system. The embolus can also come from the right atrium in a patient with atrial fibrillation. The clot moves through the right side of the heart and into the pulmonary artery, where it becomes lodged, significantly decreasing or blocking blood flow (FIGURE 16-13). Even though the lung itself can continue the process of inhalation and exhalation, no exchange of oxygen or carbon dioxide takes place in the areas of blocked blood flow because there is no effective circulation. In this circumstance, oxygen levels in the bloodstream may drop enough to cause cyanosis.
The severity of cyanosis and dyspnea is directly related to the size of the embolism and the amount of tissue affected.
pulmonary embolism
A blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage of blood flow
Embolus
A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing obstruction of blood flow
Pulmonary embolism
___may occur as a result of damage to the lining of vessels, a tendency for blood to clot unusually fast, or, most often, slow blood flow in a lower extremity. Slow blood flow in the legs is usually caused by long-term bed rest, which can lead to the collapse of veins. Pregnancy, active cancer, and bed rest are other risk factors. Recent surgery in the legs or pelvis of any type increases the risk of__. Although uncommon,___ may also occur in active, healthy people in the absence of any other known risk factors.
Although they are fairly common,___ are difficult to diagnose. According to the US Department of Health and Human Services, 100,000 cases of ___occur each year in the United States. Symptoms and signs of___ include the following:
Pulmonary emboli
Hyperventilation is defined as rapid breathing to the point that the level of arterial carbon dioxide falls below normal.
This may be an indicator of a life-threatening illness. For example, a patient with diabetes who has a high blood glucose level, a patient who has taken an overdose of aspirin, or a patient with a severe infection is likely to hyperventilate. In these cases, rapid, deep breathing is the body’s attempt to stay alive. The body is trying to compensate for__, the buildup of excess acid in the blood or body tissues that results from the primary illness.
Because carbon dioxide, mixed with water in the bloodstream, can add to the blood’s acidity, lowering the level of carbon dioxide helps to compensate for the other acids.
acidosis
Similarly, in an otherwise healthy person, blood acidity can be diminished by excessive breathing because it blows off too much carbon dioxide. The result is a relative lack of acids. The resulting condition,__, is the buildup of excess base (lack of acids) in the body fluids
alkalosis
Alkalosis is the cause of many of the symptoms associated with__, including anxiety, dizziness, numbness, tingling of the hands and feet, and painful spasms of the hands and/or feet (carpopedal spasms).
Patients often feel as if they cannot catch their breath despite the rapid breathing. Although hyperventilation can be a response to illness and a buildup of acids,___ is not caused by these conditions. Instead, this syndrome occurs in the absence of other physical problems. It commonly occurs when a person is experiencing psychological stress and affects some 10% of the population at one time or another. The respirations of an individual who is experiencing___ may be as high as 40 shallow breaths/min or as low as 20 deep breaths/min.
The decision whether hyperventilation is being caused by a life-threatening illness or a panic attack should not be made outside the hospital. Initially, you can verbally instruct the patient to slow his or her breathing; however, if that does not work, give supplemental oxygen and provide transport to the hospital where physicians will determine the cause of the hyperventilation.
hyperventilation syndrome
Rapid or deep breathing that lowers the blood carbon dioxide level below normal; may lead to increased intrathoracic pressure, decreased venous return, and hypotension when associated with bag-mask device use
Hyperventilation
The buildup of excess acids in the blood or body tissues that can result from a primary illness
Acidosis
The buildup of excess base (lack of acids) in the body fluids
Alkalosis
This syndrome occurs in the absence of physical problems. The respiration of a person who is experiencing hyperventilation syndrome may be as high as 40 shallow breaths/min or as low as only 20 very deep breaths/min. This syndrome is often associated with panic attacks
Hyperventilation syndrome
Toxic gases can also affect people outside the industrial setting. One common type of exposure is___, a coloriess, odorless, tasteless, and highly poisonous gas known as “the silent killer.”___ is the leading cause or nondrug accidental poisoning deaths in the United States, according to the CDC. People who survive carbon monoxide poisoning can have permanent brain damage.
carbon monoxide
__is produced by fuel-burning household appliances such as gas water heaters, space heaters, grills, and generators; it is also present in smoke from fire or cigarettes. The onset of cold weather commonly leads to an increase in___ poisonings as people turn on heaters for the first time. The combined effects of incomplete combustion and a poorly ventilated building can cause a buildup of carbon monoxide. Another common source of___ poisoning is motor vehicle exhaust. Some people will attempt suicide by running the engine inside a closed garage and inhaling the fumes.
People who are exposed to___ may think they have the flu. They initially report headache, dizziness, fatigue, and nausea and vomiting. They may report dyspnea on exertion and chest pain and display nervous system symptoms such as impaired judgment, confusion, or even hallucinations. The worst exposures may result in syncope or seizure.___ has a much stronger bond with hemoglobin than does oxygen; therefore, oxygen is not being delivered to the tissues of the body. This can lead to cellular death and organ failure if uncorrected.
Carbon monoxide
You need to determine whether your patient’s breath sounds are normal (____ or ___) or decreased, absent, or abnormal (______). With your stethoscope, check breath sounds on the right and left sides of the chest, and compare each side (FIGURE 16-15). When listening on the patient’s back, place the stethoscope head between and below the scapulae, not over them, or you will have an inaccurate assessment.
vesicular breath sounds, bronchial breath sounds
adventitious breath sounds
Normal breath sounds made by air moving in and out of the alveoli
Vesicular breath sounds
Normal breath sounds made by air moving through the bronchi
Bronchial breath sounds
Abnormal breath sounds such as wheezing, stridor, rhonchi, and crackles
Adventitious breath sounds
Breath sound :
Asthma
Copd
Chf/pulmonary edema
Pneumonia
Bronchitis
Anaphylaxis
Wheezes
Breath sound :
Copd
Pneumonia
Bronchitis
Rhonchi
Breath sound :
Chf/pulmanory edema
Pneumonia
Crackles
Breath sound :
Croup
Epiglittits
Stridor
Breath sound :
Asthma
Copd
Pneumonia
Hemothorax
Pneumothorax
Atelectasis
Decreased or absent breath sounds
Snoring sounds are indicative of a partial upper airway obstruction, usually in the oropharynx.___ indicates constriction and/or inflammation in the bronchus.___ is generally heard on exhalation as a high-pitched, almost musical or whistling sound. This sound is commonly heard in patients with asthma and sometimes in patients with copd
Wheezing
__are the sounds of air trying to pass through fluid in the alveoli. It is a crackling or bubbling sound typically heard on inspiration. High-pitched sounds are called fine crackles, and low-pitched sounds are called coarse crackles. These sounds are often a result of congestive heart failure or pulmonary edema.
Crackles (formerly called rales)
___are low-pitched rattling sounds caused by secretions or mucus in the larger airway.___ are sometimes referred to as junky lung sounds and can be heard with infections such as pneumonia and bronchitis or in cases of aspiration.
Rhonchi
___is the high-pitched sound heard on inspiration as air tries to pass through an obstruction in the upper airway. This sound indicates a partial obstruction of the trachea and occurs in patients with anatomic or foreign body airway obstruction.
Stridor
A miniature spray canister used to direct medications through the mouth and into the lungs
Metered dose inhaler
A respiratory device that holds liquid medicine that is turned into a fine mist. The patient inhales the medication into the airways and lungs as a treatment for conditions such as asthma
Small-volume nebulizer
__is a noninvasive means of providing ventilatory support for patients experiencing respiratory distress associated with obstructive pulmonary disease (such as emphysema) and acute pulmonary. edema.__ increases pressure in the lungs, opens collapsed alveoli, pushes more oxygen across the alveolar membrane, and forces interstitial fluid back into the pulmonary circulation. See Chapter 11, Airway Management, for a complete discussion and Skill Drill 11-10 for instructions on using_.__ systems use oxygen to deliver the positive ventilatory pressure to the patient. Many patients show dramatic improvement with the use of_.__ can be used for patients who have moderate to severe respiratory distress from an underlying disease, such as pulmonary edema or obstructive pulmonary disease (including emphysema), are alert and able to follow commands, have tachypnea, or have a pulse oximetry reading of less than 90%. One potential contraindication to the use of___ is low blood pressure. Because of the increased pressure inside the chest, blood flow returning to the heart is diminished, further decreasing blood pressure.
___is also not used in patients in respiratory arrest or who have signs and symptoms of a pneumothorax or chest trauma, a tracheostomy, a decreased level of consciousness, inability to follow commands, or active gastrointestinal bleeding.
If you are authorized to apply___ for acute pulmonary edema according to your local protocols, do so. Call for ALS support or provide prompt transport to the nearest appropriate ED. Continue to reassess patients using___ for signs of deterioration and/or respiratory failure.
Continuous positive airway pressure (CPAP)
A method of ventilation used primarily in the treatment of critically ill patients with respiratory distress; can prevent the need for endotracheal intubation
CPAP
A prolonged asthma attack that is unrelieved may progress into a condition known as__. The patient is
likely to be frightened, frantically trying to breathe, and using all the accessory muscles.___ is a true emergency. Give oxygen and promptly transport to the ED
status asthmaticus
__is a genetic disorder that affects the lungs and digestive system.___ disrupts the normal function of cells that make up the sweat glands in the skin and that also line the lungs and the digestive and reproductive systems. The disease predisposes the child to repeated lung infections.
The disease process in___ disrupts the essential balance of salt and water necessary to maintain a normal coating of fluid and mucus inside the lungs and other organs. The end result is that the mucus becomes thick, sticky, and hard to move.
The mucus holds germs, causing the lungs to become infected
In__, the child’s symptoms range from sinus congestion to wheezing and asthmalike complaints. A chronic cough that produces thick, heavy, discolored mucus may develop in the child. As lung function decreases, so does the ability to breathe effectively. The child often has dyspnea; this generally results in the parents or caregivers calling EMS. Treat the child with suction and oxygen using age-appropriate adjuncts.
__often causes death in childhood because of chronic pneumonia secondary to the thick, pathologic mucus in the airway. It also causes malabsorption of nutrients in the intestines. Because of advances in treatment, the life expectancy for patients with__ becomes better each year. Adults with__ are predisposed to other medical conditions, including arthritis, osteoporosis, diabetes, and liver problems.
Cystic fibrosis (CF)
