respiratory problems in disasters final

Respiratory Care Issues in Disasters

Prepared by: CPT A. Amin, RRT, RCP and CPT W. Williams, RRT, RCP

HMRG - Galveston Company

Texas State Guard Texas Medical Rangers


• Objectives - at the end of this review, the TMR should be able to demonstrate an understanding of

• Common Environmental problems found in disasters that affect the Respiratory System

• Common Injuries affecting Respiratory System

• Common Respiratory problems found in disasters• Common Respiratory Equipment likely to be found

in residences - clues to problems




What is a chronic illness?

A chronic illness is a medical problem that lasts a year or longer, limits what a person can do, and calls for ongoing care. Examples of common chronic illnesses include:

Diabetes Chronic Obstructive Pulmonary Disease (COPD) Heart disease Chronic pain syndromes Inflammatory diseases, such as rheumatoid arthritis *More than 90 million Americans live with some form of chronic illness.




Surviving a natural or man-made disaster is no small feat, especially for those who have a chronic illness. During a disaster access to health care, personal support and medication are lessened.

This leaves people with chronic medical conditions at risk for serious medical complications—even to the point of death.

Background:




Data collected by the Children's Health Fund and the Columbia University Mailman School of Public Health, post Hurricane Katrina revealed the usual minor injuries, skin conditions and vaccination adminstrations.

However it also revealed high incidences of:• Diabetes • Hypertension• Asthma • CHF• COPD

Background:




The most frequent diagnoses in those individuals who had at least one diagnosis documented were:

•Respiratory:•URI•Asthma •COPD

•Circulatory:•Hypertension•CHF

•Minor injury and Skin conditions

Background:




Background:

During a disaster, access to healthcare, personal support and medication may be limited. Many

problems post disaster include:

• Lost medications

• Loss of electrical power

• Home care equipment damage/misplaced

As disaster responders, these are potential medical problems/issues that may occur and should be planned for.




As disaster medical responders, life support skills are essential. For the patient with respiratory problems, these skills include:

• Physical and Environmental Assessment

• Airway management

• Ventilatory support.

Background:




As disaster medical responders, we will more than likely contribute significantly to:

• Stabilization and monitoring efforts

• Assessment, treatment and consultation throughout the entire medical response

continuum

Background:





Environmental Issues

Common Diseases of the Lung

Common Injuries affecting the Respiratory Systems

Common Equipment found in the residence of the patient with Pulmonary

disease



• Environmental Issues

• Water - drowning or near drowning

• Dust and other airborne particulates

• Humidity (too much or too little)

• Mold and fungi




• Common Diseases of the Lung• Asthma (small airways and secretions)

• Emphysema - COPD (deformed air sacks (air trapping) and secretions)

• Bronchitis (large airways and secretions)




• Asthma – a chronic inflammatory

disorder involving many cell types

– manifesting with episodes of chest tightness

– coughing– labored breathing and

wheezing– all of which are related to

bronchiole inflammation




• Asthma – Need to keep the airway

patent (open)– Prevent collapse of the

airway when exhaling to help decrease work of breathing

– Why the straws?




• Bronchitis & Emphysema– Walls between the air sacs

are destroyed (no longer grape clusters)

– Airways inflamed & thickened

– Copious amounts of secretions




• Typical injuries that can be sustained in traumatic disasters affecting respiration: Head injuries

• Loss of consciousness

• Upper airway injuries – facial fractures– neck injuries




• Facial Fractures– Nose

• bridge

– Jaw / mouth • displacement of jaw• inflammation of the

tongue (airway closure)




• Neck injuries– Cervical injuries

• paralysis

– Wounds • soft tissue of neck

– swollen tongue

• Loss of upper airway– need to establish viable

airway (trach or endotube)




• Typical injuries that can be sustained in traumatic disasters affecting respiration:– Chest injuries

• flail chest (multiple broken ribs on one / both sides of thorax)

• pneumothroax - chest wounds the penetrate the lung• abdominal injuries affecting diaphragm movement




• Chest injuries– Broken ribs (one or

both sides of chest)– May or may not

puncture the lung(s)




Broken Ribs on both sides

• Chest injuries– Pneumothorax

• lung(s) penetrated• collapse of lung(s)

– Internal organs can begin to shift (heart, diaphragm)

– Must release pressure• chest tube(s)




Both lungs collasped

We should become familiar with at least the most commonly prescribed respiratory medications and treatments during an emergency. For example, some patients with lung disease require:

• Breathing treatments • Nebulizer• MDI

• Supplementary oxygen• Mechanical ventilation

These are usually performed by a respiratory therapist but some of these skills can be easily learned by a non therapist health professional.




• Common Equipment found in the residence of the patient with Pulmonary disease

• Clues there may be an impending patient care issue




• Nasal Cannula– Low flow device (2 to 6

lpm) Oxygen % varies from breath to breath.

– Approximate O2% range = 24 to ~ 40 %



Common Respiratory Equipment

• Venti Mask - Total Gas Flow to Patient is determined by variable orifice venturi at varying liter flows (draws in air to combine with Oxygen to give approximate O2 %)

• Setting Suggested Oxygen Flow Total Gas Flow

• 24% 3 LPM 79 LPM• 26% 3 LPM 47 LPM• 28% 6 LPM 68 LPM• 30% 6 LPM 53 LPM• 35% 9 LPM 50 LPM• 40% 12 LPM 50 LPM• 50% 15 LPM 41 LPM




• (Non)Rebreather Mask– Moderate to High O2

concentrations (60% +)– Bag holds additional

Oxygen - flows with each breath

– Bag movement is important




• Trach(eostomy) Collar– Requires high flows – Produces high humidity– Usually find an “H”

cylinder of Oxygen

– Unable to verbalize*




• Oxygen Cylinders– Oxygen Therapy

• cannula• mask

– Different sizes are used• D, E or H size

– Support combustion -things that burn, burn hotter and faster




• Liquid Oxygen Systems– Dewars

• Liquid that vaporizes to a gas

– Depending on size of vessel, can be equivalent of several “H” cylinders

– Extreme freeze burns• loss of limb(s)




• Medication Nebulizer– Metered Dose Inhaler

• Bronchodilator• Steroid

– Some are rescue meds• Fast acting

– Others are maintenance meds – do not use during breathing / airway emergency




• Medication Nebulizer– Fixed, Low flow device (6 to 8

lpm)

– Generally 21% Oxygen

• unless run from alternate Oxygen source

– Electrically powered

– Aerosolizes liquid medications into small particles that are inhaled into lung




• Home care ventilator– Pt unable to breathe

without assistance – May / May not require

O2 – Usually find an “H”

cylinder of Oxygen

– Unable to verbalize*




• Home care ventilator– Various models and

types– Most require use of

electricity • check for backup power

source

– Some are pneumatic• look for cylinders or

compressor




• Home care ventilator– May / May not require

O2 • Look for cylinder gases

• Be aware of cylinder safety

– fire hazards

– electrical hazards




• Observe situation and surroundings– findings may lead you to seek possible

problems

• Assess patient and ask questions– current or previous respiratory health issues

• Provide care – arrange care by appropriate provider



Final Thoughts - Recommendations

respiratory problems in disasters final

Health & Medicine