Chapter 15: Respiratory Emergencies Flashcards
Structures of the respiratory system
Diaphragm, muscles of the chest wall, accessory muscles, and nerves from brain/spinal cord to those muscles.
Upper airway structures
Nose, mouth, jaw, oral cavity, pharynx and larynx
Epiglottis
Flap of tissue that protects the larynx
Respiration
Exchange of oxygen and carbon dioxide
Function of brain stem in respiration
Senses level of CO2 in arterial blood and can adjust respiration rate. Rate will increase with increased carbon dioxide
Hypoxic Drive
Patients who have difficulty exhaling to eliminate CO2, so they breathe based on low levels of oxygen. Often occurs with COPD.
Symptoms of Inadequate Breathing
- Altered mental status associated with shallow or rapid breathing.
- Anxiety or restlessness (adult) or sleepiness (child)
- Skin is cyanotic or clammy
- Fast or slow rr, tripod position, abnormal breath sounds
Disorders of the lungs cause which situations? (5)
- Gas exchange between alveoli and pulmonary circulation is obstructed by fluid in the lung, infection, or atherosclerosis.
- Alveoli are damaged and can’t carry out gas exchange
- Blood flow to the lungs is obstructed by blood clots
- Pleural space is filled with air or excess fluid, so the lungs can’t expand.
- Air passages are obstructed by muscle spasm, mucus, or weakened airway walls.
What causes a high respiratory rate without dyspnea?
Pain
Croup
- Inflammation and swelling of pharynx, larynx, and trachea in pediatric patients often secondary to viral infection of upper respiratory tract.
- Sx: cough (barking), cold, fever, stridor
- Do not give bronchodilators, give humidified oxygen
Epiglottitis
- Swelling of epiglottis commonly caused by a bacterial infection
- Sx: severe sore throat, high fever, drooling, stridor, can cause airway obstruction
- Give high flow oxygen, don’t put anything in mouth.
Respiratory Syncytial Virus
- Infection in lungs or breathing passages that can cause other illnesses or complications
- Give humidified oxygen, watch for dehydration
Bronchiolitis
- Inflammation of bronchioles often due to RSV
2. Give oxygen, possibly positive pressure ventilation, watch for respiratory failure.
Pneumonia
- Infection of the lungs that impairs gas exchange, often secondary to a URI
- Fever, abdominal pain, vomiting, chest discomfort and pain, rapid breathing and wheezing in children.
- Give supplemental oxygen, support airway.
Pertussis
- Contagious bacterial infection in pediatric patients
- Prolonged coughing attacks, fever, whoop sound when inhaling after coughing.
- Watch for dehydration, use suction, give oxygen.
Influenza Type A
Fever, cough, fatigue, night sweats, weight loss
Tuberculosis
- Bacterial infection, most often affects lungs.
2. Fever, cough, night sweats, weight loss
Pulmonary edema
- Heart can’t remove blood from the lungs quickly enough, fluid builds up in alveoli and lung tissue, usually caused by CHF.
- Dyspnea, rapid respirations, frothy pink sputum.
Congestive Heart Failure symptoms
Cool and diaphoretic skin, tachycardia, abnormal breath sounds
COPD
- Dilation and disruption of airways and alveoli, includes chronic bronchitis and emphysema
- cb- excess mucus, protective lung mechanisms are destroyed which causes heart failure and edema
- emphysema- lungs are less elastic, walls of alveoli fall apart and create holes
COPD vs CHF
- Symptoms can overlap, and patients can have both
- COPD causes dry lung sounds (wheezes), which CHF can cause wet lung sounds (rhonchi, crackles).
- CHF causes elevated bp and pedal edema
- COPD causes chest tightness, constant fatigue, accessory muscle use, abnormal breath sounds, digital clubbing, exhaling through pursed lips, barrel chest
Cardiac asthma
Wheezing caused by left sided heart failure.
Asthma
Spasm of bronchioles, excessive mucus production, swelling of respiratory passages, wheezing with exhalation.
Hay fever
Runny nose, sneezing, congestion, sinus pressure
Anaphylactic Reactions
Airway swelling, dilation of blood vessels, hives, itching, dyspnea/wheezing, signs of shock. Give oxygen and epinephrine.
Spontaneous Pneumothorax
- Partial or complete accumulation of air in pleural space, can be caused by trauma or other conditions.
- Can be caused by lung infections, asthma, emphysema, weak areas of lung. Surface of lung is disrupted, air escapes, and lung collapses.
- sx; dyspnea, pleuritic chest pain (stabbing, one side), absent breath sounds.
Pleural Effusion
- Collection of fluid outside the lungs, compresses the lungs and causes dyspnea.
- Caused by irritation, infection, CHF, cancer
- Sx: Dyspnea, decreased breath sounds, relieved by sitting upright.
Pulmonary Embolism
- venous blood clot from legs or pelvis, goes through heart and lodges in pulmonary artery.
- Sx: dyspnea, tachycardia, tachypnea,chest pain, hemoptysis
Embolus
Anything that moves from its point of origin and obstructs blood flow.
Hyperventilation
Overbreathing causing carbon dioxide to fall below normal. Caused by infection, high blood glucose, or panic attack.
Carbon monoxide poisoning
- Caused by heaters, grills, and generators. Oxygen is not delivered to tissues because CO binds with hemoglobin.
- Sx: headache, dizziness, fatigue, nausea, syncope, seizure, AMS
- Remove from area, give oxygen, manage airway.
Patient Assessment- Scene size up
Consider contagious respiratory infections or toxic substances.
Patient Assessment- Primary Assessment
- Ensure airway is open, use head tilt chin lift
- Breathing- is air going in, is chest rising and falling with each breath, is RR adequate, skin color, retractions
- Use oxygen or insert airway if necessary.
- Slow or fast pulse can indicate respiratory problem, irregular can indicate cardiac
- Shock- pay attention to skin color, temp, condition
- Have the patient sit up, take lung sounds
Snoring lung sounds
Partial upper airway obstruction (oropharynx)
Wheezing
Constriction or inflammation in the bronchus, usually on exhalation. Can indicate asthma or COPD.
Crackles/ rales
Air trying to pass through fluid in the alveoli, typically on inspiration. Can indicate asthma or COPD.
Rhonchi
Low pitched rattling sounds from secretions or mucus in the airway. Indicates pneumonia, bronchitis, or aspiration.
Stridor
High pitched sound on inspiration- indicates obstruction of upper airway.
Patient Assessment- History Taking
- What medications or devices are used for breathing issues?
- For chronic conditions, determine triggers, recent infections, normal conditions, what is different now.
- Use SAMPLE and PASTE (Progression, Associated chest pain, Sputum, Talking tiredness, Exercise tolerance
Patient Assessment- Secondary Assessment
Assess for COPD vs CHF
Metered Dose Inhaler
- Administers albuterol, metaproterenol, terbutaline
- Indications- sob sx
- Contraindications- pt is unable to coordinate inhalation, pt has not been prescribed an MVI/ SVN, pt has already had the max dose
- Side effects- increased pulse, nervousness, tremors, pt will often begin coughing
Albuterol action
Relaxes muscles that surround air passages, allowing them to dilate.
How to dose with albuterol
Get permission from medical control, ask pt to hold breath for as long as possible.
