EMR ch15

Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Emergency Care, Twelfth Edition
Daniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson
Emergency Medical Responder: First on Scene, Ninth Edition
Le Baudour • Bergeron • Wesley
CHAPTERCHAPTER
Caring for Respiratory EmergenciesCaring for Respiratory Emergencies
1515

OVERVIEW OF RESPIRATORYOVERVIEW OF RESPIRATORY
ANATOMYANATOMY

Overview of the respiratory system.

Overview of Respiratory AnatomyOverview of Respiratory Anatomy
• Upper airway
– All spaces and structures above vocal
chords.
• Lower airway
– All structures and spaces below vocal
chords.
• Carina
– Where trachea splits into right and left
main stem bronchi.
(continued)

Overview of Respiratory AnatomyOverview of Respiratory Anatomy
• Bronchioles
– Smaller airways.
• Alveoli
– Where exchange of oxygen and carbon
dioxide takes place.
• Control center for respiratory is within
the brain.
(continued)

RESPIRATORY COMPROMISERESPIRATORY COMPROMISE

Respiratory CompromiseRespiratory Compromise
• Inability of person to breath
adequately.
• Hypoxia: when the body's cells do not
receive adequate supply of oxygen.
– Signs: altered mental status, pale skin,
cyanosis of nail beds/mucous membranes.
• Hypercarbia: condition of having too
much carbon dioxide in blood.

• Respiratory Distress (Dyspnea)
– Result of not getting adequate supply of
oxygen; increased in levels of carbon
dioxide in blood
– Increased work of breathing
– Increased respiratory rate
– Use of accessory muscles

• Respiratory Failure
– When body's normal compensatory
mechanisms fail.
– Breathing rate begins to slow.
– Tidal volume begins to get shallower.

• Common causes:
– Hyperventilation
– Asthma
– Chronic bronchitis
– Emphysema
– Exposure to poison
– Allergic reaction

• Normal Breathing
– Sufficient to support life.
– Easy and effortless (adequate).
– Do not work hard to breathe.
– Able to speak full sentences without having
to catch breath.
– Normal respiratory rate, depth, and very
little effort or work of breathing.

• Characteristics of Normal Breathing
– Normal rate (number breaths per minute):
12 to 24 for adult; 16 to 32 for child; 24 to
48 for infant.
– Normal depth (size of each breath): tidal
volume; normal breaths not too shallow
and not too deep.
(continued)

• Characteristics of Normal Breathing
– Work of breathing: effort it takes for
patient to move each breath in and out.
– Respiratory rhythm regular.

• Abnormal Breathing
– Inadequate; not sufficient to support life.
– Left untreated, will result in death.
– Common signs:
 Increased work of breathing
 Increased respiratory rate
(continued)

– Common signs:
 Decreased respiratory rate
 Respirations that are too deep or too shallow
 Irregular breathing rhythm
 Audible breath sounds (gurgling, snoring or
wheezing)
(continued)

– Tripod position: seated or standing with
hands on knees, shoulders arched upward,
head forward.
– Accessory muscles: muscles of neck, chest,
abdomen that assist during respiratory
difficulty.

Signs and symptoms of respiratory distress.

• Signs and Symptoms of Respiratory
Compromise
– Labored or difficulty breathing; a feeling of
suffocation.
– Audible breathing sounds.
– Rapid or slow rate of breathing.
– Abnormal pulse rate (too fast or too slow).
(continued)

• Signs and Symptoms of Respiratory
Compromise
– Changes in skin color, particularly of lips
and nail beds.
– Tripod position.
– Altered mental status.

• Chronic Obstructive Pulmonary Disease
– Conditions: asthma, chronic bronchitis,
emphysema
– Signs and symptoms:
 History of heavy cigarette smoking
 Persistent cough
 Chronic shortness of breath
 Pursed-lip breathing
(continued)

• Chronic Obstructive Pulmonary Disease
 Maintaining tripod position
 Fatigue
 Tightness in chest
 Wheezing

• Asthma
– Condition affecting lungs, characterized by
narrowing of air passages and wheezing.
– Caused by sensitivity to irritants (pollen,
pollutants, exercise).
– Narrowing air passages cause wheezing.
(continued)

• Asthma
 Moderate to severe shortness of breath
 Wheezing
 Anxiety
 Nonproductive cough
(continued)

Asthma causes the bronchioles to become narrow and filled with
mucus.

• Asthma
– Little/no symptoms between attacks.
– Medication in metered-dose inhaler.
(continued)

Metered-Dose Inhaler

Metered-Dose Inhaler with Spacer

• Asthma
– If left untreated, asthma attack can be
severe enough to cause respiratory arrest
and even death.

• Bronchitis
– Causes swelling and thickening of walls of
bronchi and bronchioles.
– Causes overproduction of mucus in air
passages.
– Chronic bronchitis: productive cough for
three consecutive months and occurs at
least two consecutive years.
(continued)

Emphysema affects the alveoli, and bronchitis affects the
bronchioles.

• Bronchitis
 Overweight
 Mild to moderate shortness of breath
 Pale complexion
 Productive cough
 Wheezes

• Emphysema
– Associated with cigarette smoking; disease
of lungs that causes permanent damage to
alveoli.
– Causes destruction of alveoli, making them
useless for exchange of oxygen and carbon
dioxide.
(continued)

• Emphysema
– Loss of lung elasticity and accumulation of
air cause chest wall to become extended
over time; “barrel chest.”
(continued)

• Emphysema
 Very thin in appearance
 Large chest (barrel chest)
 Nonproductive cough
 Extended exhalations

• Hyperventilation Syndrome
– Occurs when person breathes out and
eliminates excess amount of carbon
dioxide.
– Most cases caused by anxiety and do not
represent medical emergency.
(continued)

– Can be a sign of something serious.
– Be alert for cyanosis.
– Monitor for changes in vital signs.
– Reduce anxiety by reassuring and
comforting patient.
(continued)

 Anxiety
 Numbness or tingling of fingers, lips, and/or
toes
 Dizziness
 Spasm of fingers and/or toes
 Chest discomfort

• Emergency Care for Respiratory
Compromise
– Observe body language.
– Determine characteristics of breathing.
– Pay attention to level of distress and facial
expression.
– Reassure patient.
(continued)

• Emergency Care for Respiratory
Compromise
– Gather a history.
– Ability to speak clearly and in full
sentences.
– Listen for sounds as patient breathes.

• Take appropriate BSI precautions.
• Perform primary assessment; support
ABCs.
• Ensure patent airway; administer
oxygen per local protocols.
• Allow patient to maintain position of
comfort.
• Arrange for ALS response if available.
(continued)

• Assist with prescribed medication per
local protocols and medical direction.
• Obtain vital signs.
• Continue to monitor patient and
provide reassurance.

• Positive Pressure Ventilations
– Use bag-mask device to provide rescue
breaths when breathing determined to be
inadequate.
– Place mask firmly over patient's face;
provide rescue breaths at rate appropriate
for patient's age.

When breathing is inadequate, provide positive pressure ventilations
with a bag-mask device.

• Metered-Dose Inhalers (MDI)
– Small device that stores and delivers
medication that patient inhales into lungs.
– Encourage patient to take medication
exactly as prescribed.
– Check expiration date.

EMR ch15

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