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Respiratory Respiratory EmergenciesEmergencies

Beyond the ObjectivesBeyond the Objectives

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Discussion Points:Discussion Points:

Respiratory Anatomy & PhysiologyRespiratory Anatomy & Physiology PathophysiologyPathophysiology Assessment of the Respiratory Assessment of the Respiratory

SystemSystem Management of Respiratory Management of Respiratory

DisordersDisorders Specific Respiratory DiseasesSpecific Respiratory Diseases

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Anatomy & PhysiologyAnatomy & PhysiologyReviewReview

• FunctionFunction• Takes in oxygenTakes in oxygen• Disposes of wastesDisposes of wastes

• Carbon dioxideCarbon dioxide• Excess waterExcess water

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Anatomy & PhysiologyAnatomy & PhysiologyReview Review

a) Nose and moutha) Nose and mouth

b) Oropharynxb) Oropharynx

c) Nasopharynxc) Nasopharynx

d) Pharynxd) Pharynx

c) Epiglottis c) Epiglottis

d) Larynx d) Larynx

e) Cricoid cartilagee) Cricoid cartilage

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Anatomy & PhysiologyAnatomy & PhysiologyReviewReview

Lower AirwayLower Airwaya) Tracheaa) Trachea

b) Lungs b) Lungs

c) Bronchi c) Bronchi

d) Bronchiolesd) Bronchioles

e) Alveolie) Alveoli

f) Diaphragmf) Diaphragm

g) Intercostal Musclesg) Intercostal Muscles

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Anatomy & PhysiologyAnatomy & PhysiologyReviewReview

• BronchiolesBronchioles• Smallest airwaysSmallest airways• Walls consist entirely Walls consist entirely

of smooth muscle (no of smooth muscle (no cartilage present)cartilage present)

• Constriction increases Constriction increases resistance to airflowresistance to airflow

• Dilation reduces Dilation reduces resistance to airflowresistance to airflow

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Anatomy & PhysiologyAnatomy & PhysiologyReviewReview

• AlveoliAlveoli• Air sacsAir sacs

• Site of oxygen and Site of oxygen and carbon dioxide carbon dioxide exchange with exchange with bloodblood

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Anatomy & PhysiologyAnatomy & PhysiologyReviewReview

PleuraPleura

-Visceral-Visceral

-Parietal-Parietal

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Anatomy & PhysiologyAnatomy & PhysiologyReviewReview

• InhalationInhalation• Diaphragm and Diaphragm and

intercostal muscles intercostal muscles contract, increasing contract, increasing the size of the thoracic the size of the thoracic cavity.cavity.

• Air flows into the Air flows into the lungs.lungs.

- Active ProcessActive Process

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Anatomy & PhysiologyAnatomy & PhysiologyReviewReview

• Exhalation Exhalation -Diaphragm and intercostal -Diaphragm and intercostal muscles relax decreasing muscles relax decreasing the size of the thoracic the size of the thoracic cavity.cavity.-Air flows out of the lungs. -Air flows out of the lungs. -passive process-passive process

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Anatomy & PhysiologyAnatomy & PhysiologyReviewReview

• Alveolar/capillary exchangeAlveolar/capillary exchange• Oxygen‑rich air enters the Oxygen‑rich air enters the

alveoli during each alveoli during each inspiration.inspiration.

• Oxygen‑poor blood in the Oxygen‑poor blood in the capillaries passes into the capillaries passes into the alveoli.alveoli.

• Oxygen enters the capillaries Oxygen enters the capillaries as carbon dioxide enters the as carbon dioxide enters the alveoli.alveoli.

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Anatomy & PhysiologyAnatomy & PhysiologyReviewReview

• Capillary/cellular Capillary/cellular exchangeexchange• Cells give up carbon Cells give up carbon

dioxide to dioxide to the capillaries. the capillaries.

• Capillaries give up Capillaries give up oxygen to the cells.oxygen to the cells.

O2 + Glucose

CO2 + H2O

The Cell

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Adequate/Inadequate BreathingAdequate/Inadequate Breathing

Assess….. Assess….. RateRateRhythmRhythmQualityQuality

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Adequate/Inadequate BreathingAdequate/Inadequate Breathing

• RateRate• Normal RateNormal Rate

• Adult – 12-20/minuteAdult – 12-20/minute• Child – 15-30/minuteChild – 15-30/minute• Infant – 25-50/minuteInfant – 25-50/minute

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Adequate/Inadequate Adequate/Inadequate BreathingBreathing

• RhythmRhythm• RegularRegular

• IrregularIrregular

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Adequate/Inadequate Adequate/Inadequate BreathingBreathing

• QualityQuality• Breath SoundsBreath Sounds

• Effort of BreathingEffort of Breathing

• Chest ExpansionChest Expansion

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Adequate/Inadequate Adequate/Inadequate BreathingBreathing

• Other indications that your patient is Other indications that your patient is breathing inadequately.breathing inadequately.• CyanosisCyanosis• Cool Clammy SkinCool Clammy Skin• Nasal FlaringNasal Flaring• Agonal RespirationsAgonal Respirations• TripodingTripoding

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Anatomy & PhysiologyAnatomy & PhysiologyReviewReview

• Infant & Child Airway Infant & Child Airway ConsiderationsConsiderations• Smaller airway passagesSmaller airway passages

• Large tongueLarge tongue

• Softer pliable structuresSofter pliable structures

• Cricoid cartilage is narrowest point.Cricoid cartilage is narrowest point.

• Heavily dependant on diaphragmHeavily dependant on diaphragm

• Larger head Larger head

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Discussion Point:Discussion Point:

In our initial assessment, we find that our In our initial assessment, we find that our lethargic 20y/o patient is breathing lethargic 20y/o patient is breathing 36bpm with shallow respirations and 36bpm with shallow respirations and becoming increasingly cyanotic.becoming increasingly cyanotic.

-What else would you like to know?-What else would you like to know?

-What are our treatment options?-What are our treatment options?

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When you determine that a patient’s breathing is When you determine that a patient’s breathing is inadequate, provide artificial ventilation with inadequate, provide artificial ventilation with supplemental oxygen.supplemental oxygen.

Means of providing Artificial Ventilation:Means of providing Artificial Ventilation:

1- Pocket face mask with supplemental O2.1- Pocket face mask with supplemental O2.2- Two-rescuer BVM ventilation with supplemental O2.2- Two-rescuer BVM ventilation with supplemental O2.3- Flow restricted oxygen-powered ventilation device.3- Flow restricted oxygen-powered ventilation device.

(Not appropriate for infant and children.)(Not appropriate for infant and children.)4- One-rescuer BVM ventilation with supplemental O2.4- One-rescuer BVM ventilation with supplemental O2.

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Oxygen & Artificial Ventilation Oxygen & Artificial Ventilation in Children and Infantsin Children and Infants

• As a general rule in the pre-As a general rule in the pre-hospital setting, apply as much hospital setting, apply as much oxygen as the patient will oxygen as the patient will tolerate.tolerate.

• Utilize artificial/positive Utilize artificial/positive pressure ventilation when the pressure ventilation when the patient is patient is apneic, gasping, or apneic, gasping, or when there is persistent when there is persistent cyanosis despite oxygen.cyanosis despite oxygen.

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Assess for Adequate Artificial Assess for Adequate Artificial VentilationVentilation

Observe for Chest RiseObserve for Chest RiseSufficient Rate Sufficient Rate

-12bpm for adults (1 breath every 5 -12bpm for adults (1 breath every 5 sec.)sec.)

-20bpm for children and infants-20bpm for children and infants(1 breath every 3 sec.)(1 breath every 3 sec.)

Heart rate returns to normal Heart rate returns to normal What are other signs of adequate

artificial ventilation?

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Inadequate Artificial Inadequate Artificial VentilationVentilation

Chest does not rise and fall with artificial Chest does not rise and fall with artificial ventilation.ventilation.

Rate is too slow or too fast.Rate is too slow or too fast.

Heart rate does not return to normal.Heart rate does not return to normal.

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Breathing DifficultyBreathing Difficulty(Signs & Symptoms)(Signs & Symptoms)

Shortness of BreathShortness of Breath RestlessnessRestlessness Increased Pulse RateIncreased Pulse Rate Increased Breathing RateIncreased Breathing Rate Skin Color ChangesSkin Color Changes

• CyanoticCyanotic

• PalePale

• FlushedFlushed

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Breathing DifficultyBreathing Difficulty(Signs & Symptoms)(Signs & Symptoms)

Noisy BreathingNoisy Breathing Inability to SpeakInability to Speak RetractionsRetractions Shallow or Slow BreathingShallow or Slow Breathing Abdominal BreathingAbdominal Breathing CoughingCoughing Irregular Breathing RhythmsIrregular Breathing Rhythms Patient PositionPatient Position

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Scene Size-upScene Size-up• Threats to SafetyThreats to Safety

• Identify rescue environments having decreased Identify rescue environments having decreased oxygen levels.oxygen levels.

• Gases and other chemical or biological agents.Gases and other chemical or biological agents.

• Clues to Patient InformationClues to Patient Information

Assessment of the Respiratory Assessment of the Respiratory EmergencyEmergency

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• Initial AssessmentInitial Assessment• General ImpressionGeneral Impression

• PositionPosition• ColorColor• Ability to speakAbility to speak• Respiratory effortRespiratory effort

• LOCLOC• AVPUAVPU

• Chief Complaint/Apparent Chief Complaint/Apparent Life ThreatsLife Threats

Assessment of the Respiratory Assessment of the Respiratory EmergencyEmergency

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Assessment of the Respiratory Assessment of the Respiratory EmergencyEmergency

Initial Assessment (cont)Initial Assessment (cont):: AirwayAirway

-Assure there is no obstruction-Assure there is no obstruction

-Proper ventilation cannot take place without an adequate airway.-Proper ventilation cannot take place without an adequate airway.

BreathingBreathing-Absent or abnormal breath sounds-Absent or abnormal breath sounds-Speaking limited to 1–2 words-Speaking limited to 1–2 words-Use of accessory muscles or presence of retractions-Use of accessory muscles or presence of retractions

CirculationCirculation-Tachycardia-Tachycardia

-Severe central cyanosis, pallor, or diaphoresis-Severe central cyanosis, pallor, or diaphoresis

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HistoryHistorySAMPLE HistorySAMPLE HistoryOPQRST History OPQRST History

• Paroxysmal nocturnal dyspnea and orthopneaParoxysmal nocturnal dyspnea and orthopnea• Coughing and hemoptysisCoughing and hemoptysis• Associated chest painAssociated chest pain• Smoking history or exposure to secondarySmoking history or exposure to secondary smoke smoke

Similar Past EpisodesSimilar Past Episodes

Focused History Focused History & Physical Exam& Physical Exam

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Physical ExaminationPhysical ExaminationInspectionInspection

• Look for asymmetry, increased diameter, or Look for asymmetry, increased diameter, or paradoxical motion.paradoxical motion.

PalpationPalpation• Feel for subcutaneous emphysema or tracheal Feel for subcutaneous emphysema or tracheal

deviation.deviation.PercussionPercussion

Focused History Focused History & Physical Exam& Physical Exam

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Physical ExaminationPhysical Examination (cont.)(cont.)

AuscultationAuscultation• Normal Breath SoundsNormal Breath Sounds

• ClearClear• EqualEqual

• Abnormal Breath SoundsAbnormal Breath Sounds• Stridor Stridor • Wheezing Wheezing • RhonchiRhonchi• Rales/crackles Rales/crackles

Focused History & Physical ExamFocused History & Physical Exam

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Physical Examination Physical Examination (cont.)(cont.)

ExtremitiesExtremities• Look for peripheral cyanosis.Look for peripheral cyanosis.

• Look for swelling and redness, indicative of a venous clot.Look for swelling and redness, indicative of a venous clot.

• Look for finger clubbing, which indicates chronic hypoxia.Look for finger clubbing, which indicates chronic hypoxia.

Focused History & Physical ExamFocused History & Physical Exam

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Vital SignsVital SignsHeart RateHeart Rate

• Tachycardia.Tachycardia.

Blood PressureBlood Pressure• Pulsus paradoxus.Pulsus paradoxus.

Respiratory RateRespiratory Rate• Observe for trends.Observe for trends.

Focused History & Physical Focused History & Physical ExamExam

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• Assume that an elevated respiratory rate Assume that an elevated respiratory rate in a patient with dyspnea is caused by in a patient with dyspnea is caused by hypoxia. A persistently slow rate hypoxia. A persistently slow rate indicates impending respiratory arrest.indicates impending respiratory arrest.

Focused History Focused History & Physical Exam& Physical Exam

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• Diagnostic Diagnostic TestingTesting• Pulse OximetryPulse Oximetry

• Inaccurate Inaccurate readingsreadings

Focused History & Physical ExamFocused History & Physical Exam

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• Other Diagnostic Other Diagnostic TestingTesting• Peak FlowPeak Flow• Dextrose Dextrose

Monitoring???Monitoring???

Focused History & Physical ExamFocused History & Physical Exam

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Basic PrinciplesBasic Principles• Maintain the airway.Maintain the airway.

• Protect the cervical spine if trauma is suspected.Protect the cervical spine if trauma is suspected.

• Patients breathing inadequately should be assisted Patients breathing inadequately should be assisted with artificial ventilation.with artificial ventilation.

• Any patient with respiratory distress should receive Any patient with respiratory distress should receive oxygen.oxygen.

• Oxygen should never be withheld from a patient Oxygen should never be withheld from a patient suspected of suffering from hypoxia.suspected of suffering from hypoxia.

Management of Management of Respiratory EmergenciesRespiratory Emergencies

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Management of Management of Respiratory EmergenciesRespiratory Emergencies

Basic Principles (cont.)Basic Principles (cont.)All patients in respiratory distress are a All patients in respiratory distress are a

priority transport. priority transport.

They have the potential to decline very They have the potential to decline very rapidly.rapidly.

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What Kind of Respiratory What Kind of Respiratory EmergenciesEmergencies

Might I Encounter???Might I Encounter???

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Upper-Airway ObstructionUpper-Airway Obstruction

• Common CausesCommon Causes• Tongue, Foreign Matter, Trauma, BurnsTongue, Foreign Matter, Trauma, Burns• Allergic Reaction, InfectionAllergic Reaction, Infection

• AssessmentAssessment• Differentiate cause.Differentiate cause.

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Upper-Airway ObstructionUpper-Airway Obstruction

ManagementManagement• Conscious PatientConscious Patient

• If the patient is able to speak, encourage If the patient is able to speak, encourage coughing.coughing.

• If the patient is unable to speak, perform If the patient is unable to speak, perform abdominal thrusts.abdominal thrusts.

• Determine if there is a complete obstruction or Determine if there is a complete obstruction or poor air exchange.poor air exchange.

• If either one is present, provide up to five If either one is present, provide up to five abdominal thrusts in rapid succession.abdominal thrusts in rapid succession.

• If they fail, repeat until obstruction is relieved or If they fail, repeat until obstruction is relieved or patient becomes unconscious. patient becomes unconscious.

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Upper-Airway ObstructionUpper-Airway Obstruction

Management Management (cont.)(cont.)

• Unconscious PatientUnconscious Patient• Open the airway.Open the airway.

• Attempt to give two ventilations.Attempt to give two ventilations.• If they fail, reposition the head and reattempt.If they fail, reposition the head and reattempt.

• Administer abdominal thrusts.Administer abdominal thrusts.

• Attempt finger sweeps if foreign body is visualized.Attempt finger sweeps if foreign body is visualized.• If foreign body is removed, resume ventilation.If foreign body is removed, resume ventilation.

• If unsuccessful, continue abdominal thrusts and sweeps.If unsuccessful, continue abdominal thrusts and sweeps.

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Adult Respiratory Distress Adult Respiratory Distress SyndromeSyndrome

• SepsisSepsis• AspirationAspiration• PneumoniaPneumonia• Pulmonary InjuryPulmonary Injury• Burns/Inhalation InjuryBurns/Inhalation Injury• Oxygen ToxicityOxygen Toxicity• DrugsDrugs• High AltitudeHigh Altitude• HypothermiaHypothermia

• Near-Drowning SyndromeNear-Drowning Syndrome• Head InjuryHead Injury• Pulmonary EmboliPulmonary Emboli• Tumor DestructionTumor Destruction• PancreatitisPancreatitis• Invasive ProceduresInvasive Procedures

• Bypass, hemodialysisBypass, hemodialysis

• Hypoxia, Hypotension, or Hypoxia, Hypotension, or Cardiac ArrestCardiac Arrest

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Adult Respiratory Adult Respiratory Distress SyndromeDistress Syndrome

PathophysiologyPathophysiology• High MortalityHigh Mortality• Multiple Organ FailureMultiple Organ Failure• Affects Interstitial FluidAffects Interstitial Fluid

• Causes increase in fluid in the interstitial spaceCauses increase in fluid in the interstitial space• Disrupts diffusion and perfusionDisrupts diffusion and perfusion

AssessmentAssessment• Symptoms Related to Underlying CauseSymptoms Related to Underlying Cause• Abnormal Breath SoundsAbnormal Breath Sounds

• Crackles and ralesCrackles and rales

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ManagementManagement• Manage the underlying condition.Manage the underlying condition.

• Provide supplemental oxygen.Provide supplemental oxygen.

• Support respiratory effort.Support respiratory effort.• Provide positive pressure ventilation if respiratory Provide positive pressure ventilation if respiratory

failure is imminent.failure is imminent.

• Monitor vital signs.Monitor vital signs.

Adult Respiratory Adult Respiratory Distress SyndromeDistress Syndrome

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Obstructive Lung DiseaseObstructive Lung Disease

TypesTypes• EmphysemaEmphysema• Chronic BronchitisChronic Bronchitis• AsthmaAsthma

CausesCauses• Genetic DispositionGenetic Disposition• Smoking and Other Risk FactorsSmoking and Other Risk Factors

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EmphysemaEmphysema• PathophysiologyPathophysiology

• Exposure to Noxious SubstancesExposure to Noxious Substances• Exposure results in the destruction of the walls of Exposure results in the destruction of the walls of

the alveoli.the alveoli.• Weakens the walls of the small bronchioles and Weakens the walls of the small bronchioles and

results in increased residual volume.results in increased residual volume.

• Cor Pulmonale – hypertrophy of the right Cor Pulmonale – hypertrophy of the right ventricleventricle

• Polycythemia – an excess of red blood cells Polycythemia – an excess of red blood cells • Increased Risk of InfectionIncreased Risk of Infection

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EmphysemaEmphysema

AssessmentAssessment• HistoryHistory

• Recent weight loss, dyspnea with exertionRecent weight loss, dyspnea with exertion

• Cigarette and tobacco usageCigarette and tobacco usage

• Lack of CoughLack of Cough

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EmphysemaEmphysemaAssessmentAssessment

• Physical ExamPhysical Exam Barrel chestBarrel chest Prolonged Prolonged

expiration and expiration and rapid rest phaserapid rest phase

ThinThin Pink skin due to Pink skin due to

extra red cell extra red cell productionproduction

““Pink puffer”Pink puffer” Hypertrophy of Hypertrophy of

accessory accessory musclesmuscles

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Chronic BronchitisChronic Bronchitis

PathophysiologyPathophysiology• Results from an increase in mucus-Results from an increase in mucus-

secreting cells in the respiratory tree.secreting cells in the respiratory tree.• Alveoli relatively unaffected.Alveoli relatively unaffected.• Decreased alveolar ventilation.Decreased alveolar ventilation.

AssessmentAssessment• HistoryHistory

• Frequent respiratory infections.Frequent respiratory infections.• Productive cough.Productive cough.

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Chronic BronchitisChronic Bronchitis

Assessment Assessment (cont.)(cont.)

• Physical ExamPhysical Exam• Often overweightOften overweight• Rhonchi present on Rhonchi present on

auscultationauscultation• Jugular vein Jugular vein

distentiondistention• Ankle edemaAnkle edema• Hepatic congestionHepatic congestion• ““Blue bloater”Blue bloater”

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Bronchitis and EmphysemaBronchitis and Emphysema

ManagementManagement• Establish and maintain airway.Establish and maintain airway.• Support breathing.Support breathing.

• Find position of comfort.Find position of comfort.• Provide O2Provide O2• Monitor oxygen saturation.Monitor oxygen saturation.• Be prepared to ventilate.Be prepared to ventilate.

• Establish IV access.Establish IV access.• Administer medications.Administer medications.

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AsthmaAsthma

PathophysiologyPathophysiology• Chronic Inflammatory DisorderChronic Inflammatory Disorder

• Results in widespread but variable air flow Results in widespread but variable air flow obstruction.obstruction.

• The airway becomes hyperresponsive.The airway becomes hyperresponsive.• Induced by a trigger, which can vary by Induced by a trigger, which can vary by

individual.individual.• Trigger causes release of histamine, causing Trigger causes release of histamine, causing

bronchoconstriction and bronchial edema.bronchoconstriction and bronchial edema.• 6–8 hours later, immune system cells invade 6–8 hours later, immune system cells invade

the bronchial mucosa and cause additional the bronchial mucosa and cause additional edema.edema.

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AsthmaAsthma

AssessmentAssessment• Identify immediate threats.Identify immediate threats.• Obtain history.Obtain history.

• SAMPLE & OPQRST historySAMPLE & OPQRST history• History of asthma-related hospitalization?History of asthma-related hospitalization?

• History of respiratory failure/ventilator use?History of respiratory failure/ventilator use?

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AsthmaAsthma Assessment Assessment (cont.)(cont.)

• Physical ExamPhysical Exam• Presenting signs may include dyspnea, wheezing, Presenting signs may include dyspnea, wheezing,

cough.cough.• Wheezing is not present in all asthmatics.Wheezing is not present in all asthmatics.

• Speech may be limited to 1–2 consecutive words.Speech may be limited to 1–2 consecutive words.

• Look for hyperinflation of the chest and Look for hyperinflation of the chest and accessory muscle use.accessory muscle use.

• Carefully auscultate breath sounds.Carefully auscultate breath sounds.

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AsthmaAsthma

ManagementManagement• Treatment goals:Treatment goals:

• Correct hypoxia.Correct hypoxia.• Reverse bronchospasm.Reverse bronchospasm.• Reduce inflammation.Reduce inflammation.

• Maintain the airway.Maintain the airway.• Support breathing.Support breathing.

• High-flow oxygen or assisted ventilations as High-flow oxygen or assisted ventilations as indicated.indicated.

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AsthmaAsthmaManagement Management (cont.)(cont.)

– Establish IV access.Establish IV access.• Administer medications. Administer medications.

Status AsthmaticusStatus Asthmaticus• A severe, prolonged attack that cannot be A severe, prolonged attack that cannot be

broken by bronchodilators.broken by bronchodilators.• Greatly diminished breath sounds.Greatly diminished breath sounds.• Recognize imminent respiratory arrest.Recognize imminent respiratory arrest.

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Upper RespiratoryUpper RespiratoryInfection (URI)Infection (URI)

Upper Respiratory InfectionsUpper Respiratory Infections• Frequent patient complaint.Frequent patient complaint.

• Common pediatric complaint.Common pediatric complaint.• Rarely life threatening.Rarely life threatening.

PathophysiologyPathophysiology• Frequently caused by viral and bacterial infections.Frequently caused by viral and bacterial infections.• Affect multiple parts of the upper airway.Affect multiple parts of the upper airway.• Typically resolve after several days of symptoms.Typically resolve after several days of symptoms.

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Upper RespiratoryUpper RespiratoryInfection (URI)Infection (URI)

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• AssessmentAssessment• Look for underlying illness.Look for underlying illness.• Evaluate pediatrics for epiglottitis.Evaluate pediatrics for epiglottitis.

• ManagementManagement• Maintain the airway.Maintain the airway.• Support breathing.Support breathing.• Treat signs and symptoms.Treat signs and symptoms.

Upper RespiratoryUpper RespiratoryInfection (URI)Infection (URI)

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PneumoniaPneumonia

Infection of the LungsInfection of the Lungs• Immune-Suppressed PatientsImmune-Suppressed Patients

PathophysiologyPathophysiology• Bacterial & Viral InfectionsBacterial & Viral Infections

• Hospital-acquired vs. community-acquired.Hospital-acquired vs. community-acquired.

• Infection can spread throughout lungs.Infection can spread throughout lungs.

• Alveoli may collapse, resulting in a ventilation Alveoli may collapse, resulting in a ventilation disorder.disorder.

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PneumoniaPneumonia

AssessmentAssessment• Focused History & Physical ExamFocused History & Physical Exam

• SAMPLE & OPQRST:SAMPLE & OPQRST:• Recent fever, chills, weakness, and malaiseRecent fever, chills, weakness, and malaise

• Deep, productive cough with associated pleuritic Deep, productive cough with associated pleuritic painpain

• Tachypnea and tachycardia may be present.Tachypnea and tachycardia may be present.

• Breath sounds:Breath sounds:• Presence of rales/crackles in affected lung segmentsPresence of rales/crackles in affected lung segments

• Decreased air movement in the affected lungDecreased air movement in the affected lung

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PneumoniaPneumonia

ManagementManagement• Maintain the airway.Maintain the airway.• Support breathing.Support breathing.

• High-flow oxygen or assisted ventilation as High-flow oxygen or assisted ventilation as indicated.indicated.

• Monitor vital signs.Monitor vital signs.• Establish IV access.Establish IV access.

• Avoid fluid overload.Avoid fluid overload.

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Lung CancerLung CancerGeneral PathophysiologyGeneral Pathophysiology

• Majority are caused by carcinogens secondaryMajority are caused by carcinogens secondary to cigarette to cigarette smoking or occupational exposure.smoking or occupational exposure.

• May start elsewhere and spread to lungs.May start elsewhere and spread to lungs.• High mortality.High mortality.

AssessmentAssessment• Focused History & Physical ExamFocused History & Physical Exam

• SAMPLE & OPQRST historySAMPLE & OPQRST history• Cancer-related treatments and hospitalizations.Cancer-related treatments and hospitalizations.

• Physical examPhysical exam• Evaluate for severe respiratory distress.Evaluate for severe respiratory distress.

ManagementManagement• Follow general principles.Follow general principles.

• Administer oxygen, support ventilation.Administer oxygen, support ventilation.

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Toxic InhalationToxic Inhalation

PathophysiologyPathophysiology• Includes inhalation of heated air, chemical Includes inhalation of heated air, chemical

irritants, and steam.irritants, and steam.• Airway obstruction due to edema and Airway obstruction due to edema and

laryngospasm due to thermal and chemical laryngospasm due to thermal and chemical burns.burns.

AssessmentAssessment• Focused History & Physical ExamFocused History & Physical Exam

• SAMPLE & OPQRST historySAMPLE & OPQRST history• Determine nature of substance.Determine nature of substance.• Length of exposure and loss of consciousness.Length of exposure and loss of consciousness.

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Toxic InhalationToxic Inhalation

ManagementManagement• Ensure scene safety.Ensure scene safety.

• Enter a scene only if properly trained and Enter a scene only if properly trained and equipped.equipped.

• Remove the patient from the toxic environment.Remove the patient from the toxic environment.

• Maintain the airway.Maintain the airway.• Early, aggressive management may be indicated.Early, aggressive management may be indicated.

• Support breathing & provide O2.Support breathing & provide O2.• Establish IV access.Establish IV access.• Transport promptly.Transport promptly.

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Carbon MonoxideCarbon Monoxide• Odorless, Colorless GasOdorless, Colorless Gas

• Results from the incomplete combustion of Results from the incomplete combustion of carbon-containing compounds.carbon-containing compounds.

• Often builds up to dangerous levels in confined Often builds up to dangerous levels in confined spaces such as mines, autos, and poorly spaces such as mines, autos, and poorly ventilated homes.ventilated homes.

• Hazardous to RescuersHazardous to Rescuers

Carbon Monoxide InhalationCarbon Monoxide Inhalation

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PathophysiologyPathophysiology• Binds to HemoglobinBinds to Hemoglobin

• Prevents oxygen from binding and creates Prevents oxygen from binding and creates hypoxia at the cellular level.hypoxia at the cellular level.

AssessmentAssessment• Focused History & Physical ExamFocused History & Physical Exam

• SAMPLE & OPQRST historySAMPLE & OPQRST history• Determine source and length of exposure.Determine source and length of exposure.• Presence of headache, confusion, agitation, lack of Presence of headache, confusion, agitation, lack of

coordination, loss of consciousness, and seizures.coordination, loss of consciousness, and seizures.

Carbon Monoxide InhalationCarbon Monoxide Inhalation

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Carbon Monoxide InhalationCarbon Monoxide Inhalation

ManagementManagement• Ensure scene safety.Ensure scene safety.

• Enter a scene only if properly trained and equipped.Enter a scene only if properly trained and equipped.• Remove the patient from the toxic environment.Remove the patient from the toxic environment.

• Maintain the airway.Maintain the airway.• Support breathing.Support breathing.

• High-flow oxygen or assisted ventilations as indicated.High-flow oxygen or assisted ventilations as indicated.

• Establish IV access.Establish IV access.• Transport promptly.Transport promptly.

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Pulmonary EmbolismPulmonary Embolism

PathophysiologyPathophysiology• Obstruction of a Pulmonary ArteryObstruction of a Pulmonary Artery

• Emboli may be of air, thrombus, fat, or amniotic Emboli may be of air, thrombus, fat, or amniotic fluid.fluid.

• Foreign bodies may also cause an embolus.Foreign bodies may also cause an embolus.

• Risk FactorsRisk Factors• Recent surgery, long-bone fractures, pregnancy.Recent surgery, long-bone fractures, pregnancy.

• Pregnant or postpartum.Pregnant or postpartum.

• Oral contraceptive use, tobacco use.Oral contraceptive use, tobacco use.

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Pulmonary EmbolismPulmonary Embolism

AssessmentAssessment• Focused History & Physical ExamFocused History & Physical Exam

• SAMPLE & OPQRST historySAMPLE & OPQRST history• Presence of risk factorsPresence of risk factors

• Sudden onset of severe dyspnea and painSudden onset of severe dyspnea and pain

• Cough, often blood-tingedCough, often blood-tinged

• Physical examPhysical exam• Signs of heart failure, including JVD and Signs of heart failure, including JVD and

hypotensionhypotension

• Warm, swollen extremitiesWarm, swollen extremities

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Pulmonary EmbolismPulmonary Embolism

ManagementManagement• Maintain the airway.Maintain the airway.• Support breathing.Support breathing.

• High-flow oxygen or assist ventilations as High-flow oxygen or assist ventilations as indicated.indicated.

• Establish IV access.Establish IV access.• Monitor vital signs closely.Monitor vital signs closely.• Transport to appropriate facility.Transport to appropriate facility.

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Spontaneous PneumothoraxSpontaneous Pneumothorax

• PathophysiologyPathophysiology• PneumothoraxPneumothorax

• Occurs in the absence of blunt or penetrating trauma.Occurs in the absence of blunt or penetrating trauma.

• Risk FactorsRisk Factors

• AssessmentAssessment• Focused HistoryFocused History

• SAMPLE & OPQRST historySAMPLE & OPQRST history• Presence of risk factorsPresence of risk factors• Rapid onset of symptomsRapid onset of symptoms• Sharp, pleuritic chest or shoulder painSharp, pleuritic chest or shoulder pain• Often precipitated by coughing or liftingOften precipitated by coughing or lifting

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Spontaneous PneumothoraxSpontaneous Pneumothorax

Assessment Assessment (cont.)(cont.)

• Physical Exam:Physical Exam:• Decreased or absent breath sounds on affected sideDecreased or absent breath sounds on affected side• Tachypnea, diaphoresis, and pallorTachypnea, diaphoresis, and pallor

ManagementManagement• Maintain the airway.Maintain the airway.• Support breathing.Support breathing.• Monitor for tension pneumothorax.Monitor for tension pneumothorax.

• JVD and tracheal deviation away from the affected side.JVD and tracheal deviation away from the affected side.

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Hyperventilation SyndromeHyperventilation Syndrome

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AssessmentAssessment• Focused History & Physical ExamFocused History & Physical Exam

• SAMPLE & OPQRST historySAMPLE & OPQRST history• Fatigue, nervousness, dizziness, dyspnea, chest painFatigue, nervousness, dizziness, dyspnea, chest pain

• Numbness and tingling in hands, mouth, and feetNumbness and tingling in hands, mouth, and feet

• Presence of tachypnea and tachycardiaPresence of tachypnea and tachycardia

• Spasms of the fingers and feetSpasms of the fingers and feet

Hyperventilation Hyperventilation SyndromeSyndrome

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ManagementManagement• Maintain the airway.Maintain the airway.• Support breathing.Support breathing.

• Provide high-flow oxygen or assist ventilations Provide high-flow oxygen or assist ventilations as indicated.as indicated.

• Do NOT allow the patient to rebreathe exhaled Do NOT allow the patient to rebreathe exhaled air.air.

• Reassure the patient.Reassure the patient.

Hyperventilation Hyperventilation SyndromeSyndrome

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CroupCroup

PathophysiologyPathophysiology• Infection of the larynx Infection of the larynx

causing an upper airway causing an upper airway obstruction.obstruction.

AssessmentAssessment• Children < 3 years of age.Children < 3 years of age.

• Low grade feverLow grade fever

• Slow onsetSlow onset

• Barky coughBarky cough

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CroupCroup

• ManagementManagement• Calm PatientCalm Patient

• OxygenOxygen

• Cool AirCool Air

• Prepare for assist Prepare for assist ventilationsventilations

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EpiglottitisEpiglottitis

PathophysiologyPathophysiology• Infection and enflamation of Infection and enflamation of

the epiglottis causing an the epiglottis causing an upper airway obstruction.upper airway obstruction.

AssessmentAssessment• Children > 3 years of age.Children > 3 years of age.• High grade feverHigh grade fever• Rapid onsetRapid onset• DroolingDrooling

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EpiglottitisEpiglottitis

• ManagementManagement• Calm PatientCalm Patient

• OxygenOxygen

• Encourage sitting Encourage sitting positionposition

• Prepare for assist Prepare for assist ventilationsventilations

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Prescribed InhalersPrescribed Inhalers

Generic Names:Generic Names:

-albuterol-albuterol

-isoetharine-isoetharine

-metaproteranol-metaproteranol

Trade Names:Trade Names:

-Proventil-Proventil

-Ventolin-Ventolin

-Bronkosol-Bronkosol

-Alupent-Alupent

-Metaprel-Metaprel

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QUESTIONSQUESTIONS

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