Respiratory Emergencies Flashcards
Respiratory Anatomy & Physiology
Trachea Bronchus Lungs Thoracic Wall Parietal Pleura Visceral Pleura Mediastinum Diaphragm
Inspiration
• Active process: uses muscle contraction to
increase size of chest cavity
• Intercostal muscles and diaphragm contract
• Diaphragm moves down; ribs move upward and outward
• Air is pulled into lungs
• creates negative pressure
Expiration
- Passive process:
- Muscles and diaphragm relax
- Size of chest cavity decreases
- Air flows out of lungs
Adequate Breathing Rate for an Adult
12-20 breaths/minute
Rhythm regular
Breath sound present & equal
Adequate Breathing Rate for a Child
15-30 breaths/minute
Rhythm regular
Breath sound present & equal
Adequate Breathing Rate for a Child
25-50 breaths/minute infant
Rhythm regular
Breath sound present & equal
Inadequate Breathing Definition & Signs
• Breathing not sufficient to support life • Signs – Rate out of normal range – Irregular rhythm – Diminished or absent lung sounds – Poor tidal volume
Signs of Inadequate Breathing in Infants & Children
• Signs of inadequate breathing in infants and children – Nasal flaring – Grunting – Seesaw breathing – Retractions
How does the structure of a infant & child’s airway differ from that of an adult
– Smaller airway easily obstructed
– Proportionately larger tongues
– Smaller, softer, more flexible trachea
– Less developed, less rigid cricoid cartilage
– Heavy dependence on diaphragm for respiration
Treatment for Pt with Inadequate Breathing
Assisted ventilation with supplemental oxygen
– Pocket face mask with supplemental oxygen
– Two-rescuer/one rescuer BVM with
supplemental oxygen
– Flow-restricted, oxygen-powered ventilation device
Artificial Ventilation Rate for and Adult
12 breaths per minute
Artificial Ventilation Rate for infants & children
20 breaths per minute
How do you check for adequate ventilation
chest rise & fall should be visible with each breath
Signs of inadequate Ventilation
• Increasing pulse rates can indicate
inadequate artificial ventilation in adults
• Decreasing pulse rates can indicate inadequate artificial ventilation in pediatric patients
How can you tell if adequate breathing is becoming inadequate - how might your patient change during this transition
My answer: rate and depth change Pulse ox low increased pulse rate increased blood pressure may be anxious
Breathing Difficulty
- Patient’s subjective perception
- Feeling of labored, or difficult, breathing
- Amount of distress felt may or may not reflect actual severity of condition
OPQRST - what questions do you ask
• Onset—When did it begin?
• Provocation—What were you doing when this came on?
• Quality—Do you have a cough? Are you bringing anything up with it?
• Radiation—Do you have pain or
discomfort anywhere else in your body?
• Severity—On a scale of 1 to 10, how bad is your breathing trouble?
• Time—How long have you had this feeling?
If you have a chest pain questions make sure you ask all the questions - for a respiratory pt may not need to ask about radiation
What things should you look for when assessing a patient with difficulty breathing
• Altered mental status • Unusual anatomy – Barrel chest • Patient’s position – Tripod position – Sitting with feet dangling, leaning forward • Pale, cyanotic, or flushed skin • Pedal edema • Sacral edema • Coughing • Noisy breathing – Audible wheezing (heard without stethoscope) – Gurgling – Snoring – Crowing – Stridor
What are the respiratory signs of a patient with work of breathing
– Retractions
– Use of accessory muscles
– Flared nostrils
– Pursed lips - long term smoker -causes
– Number of words patient can say w/o stopping
What do you assess during Auscultation & what might you hear?
- Lung sounds on both sides during inspiration and expiration
- Wheezes—high-pitched sounds created by air moving through narrowed air passages
- Crackles—fine crackling caused by fluid in alveoli or by opening of closed alveoli
- Rhonchi—low sounds resembling snoring or rattling, caused by secretions in larger airways
- Stridor—high-pitched, upper-airway sounds indicating partial obstruction of trachea or larynx
What Vital signs changes do you see in a person with respiratory distress
- Increased or decreased pulse rate
- Changes in breathing rate
- Changes in breathing rhythm
- Hypertension or hypotension
- Oxygen saturation
How do you treat a patient with difficulty in breathing which is adequate
• If breathing is adequate, non- rebreather mask at 15 Lpm
make sure you stay focused on the airway
How do you treat a patient with difficulty in breathing which is inadequate
• If breathing is inadequate, begin artificial ventilation
CPAP Principles
• Simple principles
– Blowing oxygen or air continuously at low pressure into airway
– Prevents alveoli from collapsing at end of exhalation
– Can prevent fluid shifting into alveoli from surrounding capillaries
Common Uses for CPAP
• Common uses – Pulmonary edema – Drowning – Asthma and COPD – Respiratory failure in general
Contraindication for CPAP
• Contraindications – Severely altered mental status – Lack of normal, spontaneous respiratory rate – Hypotension/shock – Nausea and vomiting – Penetrating chest trauma – Upper GI bleeding – Conditions preventing good mask seal
Potential Side Effects of CPAP
• Side effects – Hypotension – Pneumothorax – Increased risk of aspiration – Drying of corneas
Steps in Using CPAP
- Explain procedure to patient
- Start with low level CPAP
- Reassess mental status, vital signs, and dyspnea level frequently
- Raise CPAP level if no relief within a few minutes
- If patient deteriorates, remove CPAP and ventilate with bag- mask
What is Chronic Obstructive Pulmonary Disease
- Broad classification of chronic lung diseases
- Includes emphysema, chronic bronchitis, and black lung
- Overwhelming majority of cases are caused by cigarette smoking
- Bronchiole lining inflamed
- Excess mucus produced
- Cells in bronchioles that normally clear away mucus accumulations are unable to do so
COPD: Chronic Bronchitis
- Inflamed bronchiole
* Excessive mucus
COPD: Emphysema
• Alveoli walls break down—surface area for
respiratory exchange is greatly reduced
• Lungs lose elasticity
• Results in air being trapped in lungs, reducing effectiveness of normal breathing
Thickened mucosa Bronchospasm Mucus Collapsed bronchiole Trapped air in alveoli Decreased elasticity
Characteristics of Asthma
• Chronic disease with episodic
exacerbations
• During attack, small bronchioles narrow (bronchoconstriction); mucus is overproduced
• Results in small airway passages practically closing down, severely restricting air flow
• Air flow mainly restricted in one direction
• Inhalation—expanding lungs exert outward pull, increasing diameter of airway and allowing air flow into lungs
• Exhalation—opposite occurs and air becomes trapped in lungs
Mucus accumulation
Edema of bronchial lining
Mucous plug
Pulmonary Edema
- Abnormal accumulation of fluid in alveoli
- Congestive heart failure (CHF) patients may experience difficulty breathing because of this
• Pressure builds up in pulmonary
capillaries
• Fluid crosses the thin barrier and accumulates in and around alveoli
• Fluid occupying lower airways makes it difficult for oxygen to reach blood
• Patient experiences dyspnea
Pulmonary Edema
• Pressure builds up in pulmonary
capillaries
• Fluid crosses the thin barrier and accumulates in and around alveoli
• Fluid occupying lower airways makes it difficult for oxygen to reach blood
• Patient experiences dyspnea
Common signs & symptoms of Pulmonary Edema
• Common signs and symptoms – Dyspnea – Anxiety – Pale and sweaty skin – Tachycardia – Hypertension – Low oxygen saturation
– In severe cases, crackles or sometimes wheezes may be audible
– Patients may cough up frothy sputum, usually white, but sometimes pink-tinged
Treatment for Pulmonary Edema
– Assess for and treat inadequate breathing
– High-concentration oxygen
– If possible, keep patient’s legs in dependent position
– CPAP
Think about it
• Might it be possible for a patient to have
multiple respiratory disorders?
• Could a person with an underlying diagnosis of COPD also have pulmonary edema? - yes - open up the lungs fluid could move in
What is Pneumonia
• Infection of one or both lungs caused by
bacteria, viruses, or fungi
• Results from inhalation of certain microbes
• Microbes grow in lungs and cause inflammation
Signs and Symptoms of Pneumonia
• Signs and symptoms – Shortness of breath with or without exertion – Coughing – FEVER AND SEVERE CHILLS – Chest pain (often sharp and pleuritic) – Headache – Pale, sweaty skin – Fatigue – Confusion
Treatment for Pneumonia
• Treatment – Care mostly supportive – Assess for and treat inadequate breathing – Oxygenate – Transport
