Chapter 17 Respiratory Emergencies Flashcards
The adequate rate for artificial ventilation is
10-12/min breath for adult
15-30/min for children
25-50/min infants
Inadequate breathing may be?
- Above or below normal Respiratory Rates
- Irregular Rhythm
- Inadequate or unequal chest expansion
- Diminished, Abnormal, unequal, or absent Breath sounds
- Labored (increased respiratory effort), use of accessory muscles
- shallow Depth
inspirations (inhalation)
an active process in which the intercostal muscles and the diaphragm contract, expanding the size of the chest cavity and causing air to flow into the lungs
expiration (exhalation)
a passive process in which the intercostal muscles and the diaphragm relax, causing the chest cavity to decrease in size and forcing air from the lungs
What three things are looked at when determining a patients breathing?
Rate, Rhythm, Quality
Physical Exam on Respiratory system
- Observing
- AMS, restlessness, anxiety
- unusual anatomy (barrel chest) - Patient Position
- Tripod position
- sniffing position - Work of breathing
- Retractions - use of accessory muscles to breathe
- flared nostrils - pursed lips
- one word dyspnea, two word dyspnea - Skin color
- Cyanosis = low O2 in body, pale, flushed - Pedal edema
- sacral edema
- Noisy breathing
- SpO2 less than 94%
Auscultating
- Lung sounds - Vitals
Wheezes
- high pitched sounds
- indicates narrowing of passages
- Common in Asthma, COPD, emphysema, and chronic bronchitis
- mostly heard on exhalation
Crackles
fine crackling or bubbling sounds heard on inhalation
- caused by fluid in alveoli
Rhonchi
lower pitched sound resembles snoring or rattling
- caused by secretions in larger airways
- seen with pneumonia, or bronchitis
- generally louder then crackles
Stridor
high pitched sound heard on inhalation
- indicates upper airway obstruction
- in trachea or larynx
- may be severe closing of airway
CPAP
Continuous Positive Airway Pressure
- blows O2 or air into the mask at relatively low pressures
- prevents alveoli from collapsing at the end of exhalation
- pushes fluid out of alveoli and lungs
- Common uses include: pulmonary edema, drownings
Patient must be breathing on his own to use CPAP
CPAP Contraindications
Two classes:
anatomic physiologic
- include mental status so depressed patient cannot protect airway
- spontaneous RR
- inability to sit up
- hypotension
- Constant positive pressure causes less blood to return to the heart, so CO decreases and also BP
Pathologic contraindications:
- nausea and vomiting
- penetrating chest trauma
- may cause Pneumothorax by causing weak area in lung to rupture
- shock
- upper GI Bleed
- Recent gastric surgery
COPD
Chronic Obstructive Pulmonary Disease
- Emphysema, chronic bronchitis and black lung are some COPD diseases
- COPD patients often develop hypoxic drive to trigger respirations
- Patients need for oxygen outweighs any risk involved in administration
- if patient has Heart attack, stroke, develops shock or respiratory distress A HIGHER CONCENTRATION OF O2 WILL BE ADMINISTERED
- If patient stops breathing use artificial ventilation and contact medical direction
Chronic Bronchitis
the Bronchiole lining becomes inflamed and excess mucus is formed
- the Cilia (short-microscopic-hairlike-vibrating structure in respiratory system) has been damaged or destroyed cilium
Emphysema
In this disease walls of alveoli break down, greatly reducing the surface area for respiratory exchange
- allows CO2 to be trapped in lungs
Asthma
Chronic episodic exacerbations and flares (effects patient in irregular intervals
- differ from chronic bronchitis or emphysema (COPD) because doesn’t produce a hypoxic drive
- Can be life threatening
- When attack happens bronchioles that lead to alveoli become narrowed because of contractions of muscles
- then there is an overproduction of Thick Mucus
- Combined can practically close down and severely restrict airways
- Airflow restricted mainly in one direction
- During exhalation air becomes trapped in lungs requiring patient to FORCEFULLY exhale air
- Creating the Wheezing associated w/asthma
Pulmonary Edema
Patients with Congestive Heart Failure may experience difficulty breathing because fluid that accumulates in the lungs.
- the Abnormal accumulation of fluid in the alveoli of the lungs
- Typically occurs because the left side of the heart has been damaged (often by myocardial infarction)
- Theres only one layer of cells lining alveolus and one layer of cells covering adjoining capillaries, when pressure builds up it is relatively easy for fluid to cross this thin barrier and accumulate in the alveoli (resulting in Dyspnea)
- Patient will also show PEDAL EDEMA because when one side of heart doesn’t work good the other starts to wear out
- Other symptoms include: anxiety, pale, sweaty, tachycardia, hypertension, Tachypnea and labored, low SpO2, Gurgling sound or Crackling
Treatment
- High O2 by mask or BVM
- Keep patient legs hanging or below chest - putting legs higher may result in more fluid pushed in an already overloaded system
- CPAP may be useful in this situation
many people today are living normal lives because of strict diet mods (low sodium) - modern pharmacology - and in some cases the use of advanced electronic pace makers
Pneumonia
is an infection of one or both lungs caused by bacteria, virus, or fungi
- Causes inflammation
- people with COPD or respiratory problems are at higher risk of getting pneumonia
Symptoms
- coughing up mucus (green, yellow, blood), fever, chest pain, and severe chills
- SOB
- Chest pains - Sharp and pleuritic , worse on inhalation
- headache
- diaphoretic
- Crackles in chest (usually on one side of chest)
- fatigue and confusion
Treatment
- Antibiotics
- may use CPAP
- Use of O2 by nonrebreather or nasal canola
Spontaneous Pneumothorax
When lung collapses without injury or any other obvious cause
- is usually a result of rupture of a bleb (small section of lung that is weak) letting air escape and fill chest
Symptoms
- Sharp, pleuritic chest pain and SOB
- Tachycardia, Tachypnea, and Low SpO2
- Cyanosis
Treatment
- Administer O2
- Do not use CPAP (contraindication)
- Most patient will need to have a small catheter/large plastic chest tube inserted between ribs into pleural space (Not in scope of practice)
Pulmonary Embolism
When a clot, air, or fat goes through artery to lungs and gets stuck or blocks it.
Most common example is a
- DVT - Deep Vein Thrombosis (a dangerous type of clot) that starts in a vein typically in leg or pelvis.
- DVT occurs more in cancer patients or in patients that are seated or prone for extended times
- Fat from marrow of a broken bone can be an embolism
- or significant amount of air introduced to a vein can cause great harm and/or death
Signs and Symptoms
- extremely variable very hard to detect
- Patient has onset of sharp, pleuritic chest pains
- SOB - anxiety - a cough (sometimes with bloody sputum) - sweaty skin that is either pale or cyanotic
- Tachycardia and Tachypnea
- Pedal edema and pain in one or both legs
- if clot large enough may cause Hypotension and cardia arrest
Treatment
- Administer O2
- High priority for transport
Epiglottitis
When an infection inflames the area around and above the epiglottis, the tissue swells
- if swells enough can actually occlude or close airway
- used to be a disease of children
- less common nowadays because of Haemophilus Influenza Type B vaccination
Symptoms
- Sore throat and painful/difficult to swallow
- tripod position
- sick appearance, muffled voice, Fever, drooling,
- Stridor
Children 2-7yrs of age was common to get epiglottis
Treatment
- making patient calm and comfortable
- administer O2
- Transport ASAP
if untreated, up to 10% of children with this diseases may die
Cystic Fibrosis
Genetic disease that typically appears in childhood
- Causes thick, sticky mucus that accumulates in the lungs and digestive system
- Life threatening lung infections and serious problems with digestion
Signs and Symptoms:
- coughing with large amounts of mucus from the lungs
- fatigue
- frequent occurrences of pneumonia but worse like fever, coughing up sputum, SOB, loss of appetite
- abdominal pain and distention
- coughing up blood
- nausea
- weight loss
Viral Respiratory infections
Typically the Common Cold
- last 1-2 weeks
- coughing (sputum yellow or green)
Bronchoconstriction
constriction, or blockage , of the bronchi that lead from the trachea to the lungs
Meter dosed Inhaler
Inhaler used for patients with Asthma, COPD, or similar chronic illnesses that cause bronchoconstriction
- Need to get permission by medical direction to help patient use inhaler
- Provides a metered, or exact measured dose of medication
- Dilates, enlarges air passages
- patient must not be in a AMS
- Inhale deeply with administration
- hold breathe as long as possible when administered
Spacer device
device used with inhaler that makes timing during use less critical
The 5 R’s
- Right patient
- Right time
- Right medication
- Right dose
- Right route
Small volume Nebulizer (SVN)
Nebulizing medication involves running oxygen or air through a liquid medication
- Patients with asthma, emphysema, or chronic bronchitis may have in homes
Side effects
- increased HR
- tremors
- nervousness or jitters
- only use on alert patients that aren’t in respiratory distress/failure
