Respiratory Emergencies Flashcards
Respiratory Drive
A respiratory drive which is driven mostly by the levels of carbon dioxide in the arterial blood, which are detected by central chemoreceptors, via a change in pH.
Increased CO2 causes an increase in respiratory rate/depth. Decreased CO2 causes a decrease in respiratory rate/depth.
Hypoxic Drive
A form of respiratory drive in which the body is sensitive to O2 levels in the arterial blood, and uses oxygen chemoreceptors instead of carbon dioxide receptors to regulate the respiratory cycle.
NOTE: Prolonged administration of O2 will cause respirations to become depressed or stop completely.
Decreased O2 causes an increase in respiratory rate/depth. Increased O2 causes a decrease in respiratory rate/depth.
Positive-End Expiratory Pressure
(PEEP)
The pressure in the lungs above atmospheric pressure that exists at the end of expiration.
Pressure that is applied or increased during an inspiration is termed pressure support.
The Two Types of PEEP Are:
Extrinsic PEEP: provided by a mechanical ventilator Intrinsic PEEP: secondary to incomplete expiration
Epiglottitis
A potentially life-threatening condition that occurs when the tissue protecting the windpipe becomes inflamed.
Epiglottitis is commonly caused by an infection, wherein the resulting inflammation causes swelling, which blocks air to the lungs.
Assessment Findings:
— Prolonged / Sudden onset — Accompanied with fever — Potential Stridor (upper airway noise) — Drooling
Treatments:
— Do not visualize or place airway adjunct — Keep the patient calm — Non-agitating Supplemental O2 — Transport patient in position of comfort
Croup
(Laryngotracheobronchitis)
An upper airway infection that blocks breathing and has a distinctive barking cough.
Assessment Findings:
— Typically seen in children up to 3 years — Seal-like barking cough — Croup Cough (upper airway constriction) — Potential fever or swelling of Larynx
Treatments:
— Supplemental O2 (humidified if possible) — Saline Therapy (nebulized) — Transport patient in position of comfort
Pneumonia
An infection that inflames air sacs in one or both lungs, which may fill with fluid.
With Pneumonia, the air sacs may fill with fluid or pus, and in some cases the infection can be life-threatening to anyone, but particularly to infants, children, and people over 65.
Assessment Findings:
— Acute inflammation of the Alveoli — Wheezing (lower airway sounds) — Shortness of breath — Diaphoresis / Dehydration
Treatments:
— Supplemental O2 — Hospitalized Antibiotics — Transport patient in position of comfort
Acute Pulmonary Edema
(Cardiac)
The abnormal buildup of fluid in the lungs due to a weakened left side of the heart, which can lead to shortness of breath, and in severe cases result in death.
Assessment Findings:
— Prior Heart Attack (MI) — Dyspnea / Syncope / High BP — Frothy sputum (may contain blood) — Tachycardia / Rales
Treatments:
— High-flow O2 / CPAP / BVM — Suctioning (as needed) — 0.4mg Nitroglycerin (1 spray) — 2.5mg/3mL Albuterol (nebulized) — Transport patient in upright position
Acute Pulmonary Edema
(Traumatic)
The abnormal buildup of fluid in the lungs due to the inhalation of heated air, chemicals, toxic fumes, or sustained trauma to the chest.
Assessment Findings:
— Suspected lung / chest trauma — Dyspnea / Tachycardia — Frothy sputum (may contain blood) — Rales (lower airway fluids)
Treatments:
— High-flow O2 / CPAP / BVM — Suctioning (as needed) — Treat for shock (as needed) — 0.4mg Nitroglycerin (1 spray) — 2.5mg/3mL Albuterol (nebulized) — Transport patient in upright position
Chronic Bronchitis
(COPD)
The long-term inflammation of the mucous membrane in the bronchial tubes, which causes severe bronchospasms and coughing.
People with chronic bronchitis tend to get lung infections more easily, and also have episodes of acute bronchitis, when symptoms are worse.
Most commonly seen among smokers.
Assessment Findings:
— Obesity / Potentially Cyanotic — Pursed lip breathing (PEEP) — Frequent and productive cough — Rhonchi (upper airway fluids) — Snoring (upper airway obstruction)
Treatments:
— Supplemental O2 — Assist patient with home medications — 2.5mg/3mL Albuterol (nebulized) — Prescribed Inhalers (# of inhalations) — Transport patient in upright position
Emphysema
(COPD)
A disorder affecting the Alveoli (tiny air sacs) of the lungs, which typically results from the destruction of the Alveolar wall.
In Emphysema, the Alveoli become abnormally inflated, damaging their walls and making it harder to breathe.
Most commonly seen among smokers.
Assessment Findings:
— Reddish / Pink skin — Barrel Chested / Thin figure — Pursed lip breathing (PEEP) — Tachypnea — Wheezing (lower airway constriction)
Treatments:
— Supplemental O2 — Assist patient with home medications — 2.5mg/3mL Albuterol (nebulized) — Prescribed Inhalers (# of inhalations) — Transport patient in upright position
Spontaneous Pneumothorax
(Traumatic Bleb)
The sudden onset of a collapsed lung without any apparent cause, such as a traumatic injury to the chest or a known lung disease (Asthma, Emphysema).
Primary Spontaneous Pneumothorax is likely due to the formation of small sacs of air (blebs) in lung tissue that rupture, causing air to leak into the pleural space.
Assessment Findings:
— Sharp / Stabbing Quality of pain — Dyspnea / Pain on inspiration — Can be difficult to detect — Decreased or Normal lung sounds
Treatments:
— Supplemental O2 — Continuously monitor / Reassess patient — Hospitalized chest tube — Transport patient in position of comfort
Asthma
(COPD)
A respiratory condition marked by smooth muscle spasms in the bronchi and bronchiole of the lungs, causing difficulty in breathing and increased mucous production.
It usually results from an allergic reaction or other forms of hypersensitivity.
NOTE: “Silent Chest” is a severe case which needs to be treated immediately.
Assessment Findings:
— Sharp / Stabbing Quality of pain — Dyspnea (fast onset is more severe) — Persistent coughing spell(s) — Tachypnea / Poor sentence speech — Wheezing (lower airway constriction)
Treatments:
— Supplemental O2 — Assist patient with medications — 2.5mg/3mL Albuterol (nebulized) — Prescribed Inhalers (# of inhalations) — Epi-Pen (onset of Anaphylaxis) — Communication Therapy — Transport patient in position of comfort
Anaphylaxis
A severe, potentially life-threatening allergic reaction which produces extreme Vasodilation and Bronchoconstriction.
The reaction can occur within seconds or minutes of exposure to an allergen.
Assessment Findings:
— Sharp / Stabbing Quality of pain — Dyspnea / Airway Obstruction — Hypotension (decreased blood pressure) — Tachypnea / Poor sentence speech — Severe Itching / Hives — Wheezing (lower airway constriction)
Treatments:
— Supplemental O2 — Assist patient with medications — 2.5mg/3mL Albuterol (nebulized) — 0.3mg Epinephrine (adult) — 0.15mg Epinephrine (child/infant) — Communication Therapy — Transport patient in position of comfort
Pleural Effusions
A collection of fluid outside the lungs on one or both sides of the chest, which may compress the lung or lungs bilaterally.
Most commonly seen in lung cancer patients.
Assessment Findings:
— Sharp / Stabbing Quality of pain — Labored coughing — Dyspnea — Orthopnea (dyspnea while lying) — Pleural Rubs (upper airway sounds)
Treatments:
— Supplemental O2 — Assist patient with medications — Hospitalized Thoracentesis Catheter — Transport patient in position of comfort
Pulmonary Embolus
(PE)
A condition in which one or more arteries in the lungs become blocked by a blood clot.
Most times, a pulmonary embolism is caused by blood clots that travel from the legs or, rarely, other parts of the body (Deep Vein Thrombosis).
Assessment Findings:
— Sharp / Stabbing Quality of pain — Severe Chest Pain — Tachycardia — Dyspnea / Tachypnea — Coughing blood tinged sputum
Treatments:
— Supplemental O2 — 160-325mg Aspirin (2-4 baby ASA) — 0.4mg Nitroglycerine (1 tablet / 1 spray) — Transport patient in position of comfort
Hyperventilation Syndrome
A common disorder that is characterized by repeated episodes of excessive ventilation in response to anxiety or fear.
Symptoms range from sensations of breathlessness, dizziness, paresthesias, chest pains, generalized weakness, syncope, and several others.
Assessment Findings:
— Sharp Quality of pain — Chest Pain — Tachycardia — Dyspnea / Tachypnea — Numbness / Tingling (mouth, hands) — Carpopedal Spasms (fingers, toes)
Treatments:
— Supplemental O2 (as needed) — Calm the patient / Environmental change — Never obstruct the patient’s breathing — Treat for PE If not absolutely sure — Communication Therapy — Transport patient in position of comfort
Allergen
A substance that can cause an allergic reaction (Anaphylaxis).
In some people, the immune system recognizes allergens as foreign or dangerous — which as a result — reacts by making a type of antibody called IgE to defend against the allergen.
This reaction leads to allergy symptoms.
Histamine
A chemical compound which is released by cells in response to injury and in allergic and inflammatory reactions, causing contraction of smooth muscle and dilation of capillaries.
Antibody
A blood protein produced in response to and for counteracting a specific antigen.
Antibodies combine chemically with substances which the body recognizes as alien, such as bacteria, viruses, and foreign substances in the blood.
Allergic Reaction
A condition, sometimes severe, in which the immune system reacts abnormally to a foreign substance.
The reaction can occur within seconds or minutes of exposure to an allergen.
Commonly seen either as Acute Allergic Reaction or Chronic Allergic Reaction.
Assessment Findings:
— Itching / Hives — Contact Dermatitis — Flushing (red skin) — Swelling (Edema) — Cyanosis
Treatments:
— Supplemental O2 — Remove patient from allergen(s) — Assist patient with medications — 2.5mg/3mL Albuterol (nebulized) — 0.3mg Epinephrine (adult) — 0.15mg Epinephrine (child/infant) — Communication Therapy — Transport patient in position of comfort
