Chapter 17: Respiratory Emergencies Flashcards
Inspiration/Inhalation
an active process in which the intercostal (rib) 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 (rib) muscles and the diaphragm relax, causing the chest cavity to decrease in size and forcing air from the lungs
Adult normal breathing rate
12-20 breaths per minute
Child normal breathing rate
15-30 breaths per minute
Infant normal breathing rate
25-50 breaths per minute
Decision points for inadequate breathing
- Is the pt breathing?
- is the pt breathing?
- Do I have an intervention to help this pt?
- Will this pt benefit from ALS?
Inadequate breathing signs in children/infants
- nasal flaring
- grunting
- seesaw breathing
- retractions between the ribs, above the clavicles, and above the sternum
Adequate breathing signs
Pt is breathing adequately, but needs supplemental O2 due to a medical or trauma condition
- rate and depth of breathing are adequate
- no abnormal breath sounds
- air moves freely in and out of the chest
- skin color normal
Adequate breathing EMT intervention
O2 by nonrebreather mask or nasal canula
Inadequate breathing signs
Pt is moving some air in and out, but it is slow or shallow and not enough to live
- pt has some breathing but not enough to live
- rate and/or depth outside of normal limits
- shallow ventilations
- diminished or absent breath sounds
- noises such as crowing, stridor, snoring, gurgling, or gasping
- blue (cyanosis) or gray skin color
- decreased minute volume
Inadequate breathing EMT intervention
assisted ventilations (positive pressure vent) with a pocket face mask, BCM, or FROPVD
Signs the pt is not breathing at all
- no chest rise
- no evidence of air being moved from the mouth or nose
- no breath sounds
EMT intervention for pt not breathing at all
assisted ventilations w/ a pocket face mask, BVM, or FROPVD at 12-15 l/m for an adult and 20/m for a child or infant
Adequate artificial ventilation rate
10-12 breaths per minute for adults
20 breaths per minute for an infant or child
Wheezes
- high-pitched sounds that will seem almost musical in nature
- the sound is created by air moving through narrowed air passages in the lungs
- it can be heard in a variety of diseases, but is common in asthma and sometimes chronic obstructive lung diseases such as emphysema and chronic bronchitis.
- most commonly heard during expiration
Crackles
- a fine crackling or bubbling sound heard on inspiration
- the sound is cause by fluid in the alveoli or by the opening of closed alveoli
Rhonchi
- lower-pitched sounds that resemble snoring or rattling
- caused by secretions in larger airways as might be seen with pneumonia or bronchitis or when
- rhonchi are generally louder than crackles
Stridor
- high-pitched sound hear on inspiration
- an upper-airway sound indicating partial obstruction of the trachea or larynx
Continuous positive airway pressure (CPAP)
a form of noninvasive positive pressure ventilation (NPPV) consisting of a mask and a means of blowing oxygen or air into the mask to prevent airway collapse or to help alleviate difficulty breathing
Anatomic-physiologic contraindications for CPAP
- altered mental status
- inability to follow instruction
- lack of a normal, spontaneous respiratory rate
- inability to sit up
- hypotension, less than 90
- inability to get a get and maintain a good mask seal
Pathological contraindications for CPAP
- nausea and vomiting
- penetrating chest trauma (pneumothorax especially)
- shock
- upper gastrointestinal bleed or recent gastric surgery
- any condition that would prevent a good mask seal
Emphysema
- the walls of the alveoli break down, greatly reducing the surface area for respiratory exchange
- lungs lose elasticity
- those factors combine to allow stale air laden with CO@ to be trapped in the lungs reducing the effectiveness of normal breathing efforts
Asthma
the small bronchioles that lead to the air sacs of the lungs become narrowed b/c of contractions of the muscles that make up the airway.
Pulmonary Edema Treatment
- high-concentration O2 by mask unless the pt’s breathing is inadequate and you need to ventilate the pt
- keep the pt’s legs in a dependent position (hanging down)
- CPAP could be very useful in these pts since it can physically push the fluid back out of the lungs and into the capillaries where it belongs
Pneumonia
an infection of one or both lungs caused by bacteria, viruses, or fungi; results from the inhalation of certain microbes that grow in the lungs and cause inflammation.
Spontaneous pneumothorax
- when a lung collapses without injury or any other obvious cause; usually the result of rupture of a bleb, a small section of the lung that is weak
- treat like you would treat anyone with shortness of breath, except CPAP
Pulmonary embolism
when something that is not blood – such as a blood clot, air, or fat – tries to go through these blood vessels, it gets stuck and blocks an artery in the lungs
Cystic Fibrosis
a genetic disease that causes thick, sticky mucus that accumulates in the lungs and digestive system
Bronchoconstriction
constriction, or blockage, of the bronchi that lead from the trachea to the lungs
