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Airway Diseases

Airway Diseases. EMT-Intermediate, W06 P. Andrews. Respiratory Distress Profiles. Disease and Trauma Profiles Management Decisions. Objectives. Determine the general approach, assessment an management priorities for respiratory distress

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Airway Diseases

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  1. Airway Diseases EMT-Intermediate, W06 P. Andrews

  2. Respiratory Distress Profiles • Disease and Trauma Profiles • Management Decisions

  3. Objectives • Determine the general approach, assessment an management priorities for respiratory distress • Explain how effective assessment is critical to decisions in airway management of respiratory distress

  4. Objectives • Differentiate between critical life- threatening, potentially life-threatening and non life-threatening patient presentations

  5. Objectives • Discuss normal and abnormal assessment findings with airway disease • Discuss specific observations and specific findings with airway disease

  6. Objectives • Describe the epidemiology, pathophysiology, assessment and management priorities for respiratory distress

  7. Objectives • Compare airway and ventilation techniques used to manage airway disease • Discuss the pharmacological preparations that EMT-Intermediates use for the management of airway disease

  8. Assessment of Respiratory Distress

  9. Scene Size-Up Environmental causes Clues to the potential cause and severity of the dyspnea General Impression Level of consciousness Patient position Skin color Effort required for breathing or speaking Audible lung sounds General Approach to Respiratory Distress

  10. General Approach to Respiratory Distress • Initial Assessment • More focused than the general impression • Focused History • Build from the chief complaint • SAMPLE, OPQRST, etc. • Include a cardiac assessment as well

  11. General Approach to Respiratory Assessment • Focused Physical • Start from the chest and move outward • Chest wall symmetry, signs of trauma or scars • Lung sounds • Accessory muscle use • Productive cough • “Outward” assessment areas • Vitals • Edema • Quality of peripheral circulation

  12. Respiratory Assessment in Detail

  13. Cigarette packs Oxygen tubing Environment Chemistry class Industrial area Bus of hysterical teens # of pillows on bed Recliner Scene Assessment

  14. Level of consciousness Anxious, restless lethargic Position Relaxed Leaning forward Tripod Unable to hold position Body Type Obese Barrel chest Effort with breathing and speaking Winded after speaking #-word sentences 1-3 v. 4-5 Accessory muscles Noises with respirations Wheezes Crackles Stridor General Impression

  15. Categorize her level of distress • Life-threatening • Potentially life-threatening • Non life-threatening

  16. The Initial Assessment • Level of consciousness • Need for ventilatory support • Aggressiveness and methods for support • Adequacy of airway and breathing • Minute volume • Need to support ventilations or respiration? • Adequacy of circulation • Peripheral pulse quality and rate

  17. The Focused History • SAMPLE • Onset and progression are valuable in pinpointing specific causes for the respiratory distress • Exploration of dyspnea • Associated with orthopnea or movement? • Associated with chest pain? • Sharp or dull chest pain?

  18. The Focused History • Cough history and color of sputum • Changes: CHF and COPD • Edema • Presence of pedal edema • Progression of edema

  19. Inspection Skin color Diaphoresis Retractions of chest muscles Accessory muscle use Nasal flaring Tracheal tugging Signs of dehydration Palpation Skin turgor, temperature Pulse rate and quality Chest wall pain Symmetry with respirations Tracheal deviation Focused Physical

  20. Lung Sounds • Rales • Rhonchi • Wheezes • Stridor • Friction Rub • Nothing… yikes!!!

  21. Test your expertise with lung sounds!

  22. Focused Physical • Always correlate sounds with the patient’s history! • Wheezes aren’t always caused by a respiratory problem • Other causes • Pulmonary edema/CHF, allergies/anaphylaxis

  23. Medication Assessment

  24. Respiratory Meds • Inhalers • Albuterol, Alupent, metaproterenol • Vanceril, Beclovent, Azmacort • Pills • Theophylline,aminophylline • Prednisone,methylprednisolone

  25. The “Other” Meds • Blood pressure meds • ACE Inhibitors, beta blockers, weak diuretics • Hypertension may be a risk factor for a variety of conditions • Nitrates + “..olol” drugs + diuretics + digitalis • Chronic history includes CHF • Ask about orthopnea, recent weight gain, chest pain with activity, pedal edema • Dyspnea/wheezing may be from fluid, not chronic irritation • Careful with the albuterol!!!

  26. The “Other” Meds • Antibiotics • Levaquin, Cipro, Keflex, Zithromax, etc. • Not prescribed for COPD itself • Pneumonia may be the cause for the changes in dyspnea • Look for other signs • Change in sputum color and productivity • Weakness, less able to tolerate activity • Loss of appetitie

  27. Generalities Regarding Treatment

  28. “Potentially critical” findings in patients with chronic respiratory conditions may actually be normal for them • Find out more about their baseline condition • Moderate-flow oxygen and bronchodilators for initial treatment in a COPD patient • Reassess for changes in making further treatment decisions

  29. Prehospital Medication Options for Dyspnea • Albuterol • Atrovent • Epinephrine • Combi-Vent • Lasix • Benadryl

  30. COPD Emphysema Chronic Bronchitis Pneumonia Asthma ARDS Pulmonary edema Pleural effusion Respiratory Disease Profiles

  31. COPD

  32. COPD Pathophysiology - Review • Chronic irritation of bronchioles and alveoli • Emphysema: destruction and thickening of alveoli walls • Chronic bronchitis: chronic secretion of mucus and thickened bronchiole walls • Results • Narrowed bronchiole passages • Less surface area for gas exchange in the alveoli • Thicker alveolar walls make gas exchange difficult • Alveoli become less elastic and cannot perform effective recoil

  33. Chronic Signs In Moderate COPD • Dyspnea • Increased respiratory rate • Compensates for their inability to increase tidal volume • Sputum changes • Increased productivity in the morning • Color change: brown

  34. Chronic Signs in Moderate COPD • Lung sounds: • Diminished, especially in the bases • Rhonchi in upper lobes • Wheezes

  35. Chronic Signs In Severe COPD • Expiratory wheezes • HTN/CHF (late emphysema) • Some difficulty speaking (2 - 5-word sentences) • Low-dose oxygen therapy • Increased shortness of breath with any physical exertion

  36. Prehospital Management: Mild-moderate COPD • Low-flow oxygen if mild distress • Seated or semi-seated position • Albuterol, Atrovent • ECG • IV, 18-gauge as a standard • Assess for pneumonia • Watch for signs of decompensation

  37. Acute episodes of worsening dyspnea at rest Pursed-lip breathing Altered mentation 1-2 word sentences Focused on breathing or undistracted Accessory muscle use or retractions Clues of Acute COPD Decompensation COPD decompensation typically results from respiratory infections or acute complications from cardiac disease

  38. Tips for Aggressive COPD Management • BVM just to chest rise • Avoid demand valves • Medications will ultimately relieve the obstruction • Signs of improvement: • Change in skin color • Decrease in HR and/or dysrhythmias

  39. Pneumonia

  40. Pathophysiology of Pneumonia • Commonly caused by bacteria • Irritation of the respiratory system • Increase mucus production • bronchoconstriction • Decompensation may occur in patients with later stages of COPD

  41. Fever and chills May not be as evident in the elderly Deep, productive cough Thick sputum Sputum color change to yellow-green Pleuritic chest pain Decreased air movement Wheezes, rhonchi Pneumonia Presentation

  42. Prehospital Care for Pneumonia • Supplemental oxygen • Pulse oximetry • Bronchodilators for wheezing • Reassess lung sounds after each treatment • IV with isotonic fluids • Increase infusion rate with signs of dehydration • Position of patient comfort • Semi-seated for COPD and CHF patients

  43. Asthma

  44. Pathophysiology of Asthma • Exaggerated response to an irritant • Genetic susceptibility • High sensitivity to irritants • High numbers of inflammatory fighters present and ready to respond to the irritant • Result: widespread bronchoconstriction and mucus secretion

  45. High work of breathing with low air movement Pursed-lip breathing Prolonged expiratory phase Wheezes Tachypnea Tachycardia Sitting or leaning forward Mentation Baseline andchanges #-word sentences Changes 1-3: severe impairment Asthma: General Impression

  46. Progressive dyspnea Chest tightness Cough and/or wheezing Associated pain Location OPQRST Triggers Stress Environment Exercise Exposure to perfumes, etc. Previous attacks Hospitalization Intubation Focused History

  47. Asthma Medications • “Rescue” inhalers • Beta agonist: albuterol, Alupent, Bronkosol • Combination: beta agonists and parasympatholytics • Long-term inhalers • Steroids: beclovent, Azmacort, AeroBid, Vanceril • Prevention: Accolate, zafirlukast, cromolyn • Oral medications • Aminophylline, theophylline

  48. Simple Asthma Management • Oxygen • Albuterol • Addition of Atrovent • IV NS tko • Fluid challenge if signs of dehydration • ECG

  49. Status Asthmaticus • At-risk patients • Prior history or respiratory failure • Steroid-dependent patients • Rapid fluctuations in severity of attacks • Profile • Unbroken by medications • Cyanosis, decreased lung sounds • Severe anxiety or lethargy

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