Class 16 (Respiratory) Ch10 ( Partial) & Ch11

1. Class 16(Respiratory)Ch10 (Partial) & Ch11

2. Respiratory System

3. Anatomy and Functionof the Lung

4. Characteristics of Adequate Breathing • Normal rate and depth • Regular breathing pattern • Good breath sounds on both sides of the chest • Equal rise and fall of chest • Pink, warm, dry skin

5. Characteristics ofInadequate Breathing • Pulmonary vessels become obstructed. • Alveoli are damaged. • Air passages are obstructed. • Blood flow to the lungs is obstructed. • Pleural space is filled.

6. Signs ofInadequate Breathing • Slower than 12 breaths/min or faster than 20 breaths/min • Unequal chest expansion • Decreased breath sounds • Muscle retractions • Pale or cyanotic skin • Cool, damp (clammy) skin • Shallow or irregular respirations • Pursed lips • Nasal flaring

7. Dyspnea • Shortness of breath or difficulty breathing • Patient may not be alert enough to complain of shortness of breath.

8. Emergency Medical Care • Give supplemental oxygen at 10 to 15 L/min via nonrebreathing mask. • Patients with longstanding COPD may be started on low-flow oxygen (2 L/min). • Assist with inhaler if available. • Consult medical control.

9. Upper or Lower Airway Infection • Infectious diseases may affect all parts of the airway. • The problem is some form of obstruction to the air flow or the exchange of gases.

10. Upper or Lower Airway Infection • Administer warm, humidified oxygen. • Do not attempt to suction the airway or insert an oropharyngeal airway in a patient with suspected epiglottitis. • Transport patient in position of comfort.

11. Acute Pulmonary Edema • Fluid build-up in the lungs • Signs and symptoms • Dyspnea • Frothy pink sputum • History of chronic congestive heart failure • Recurrence high

12. Acute Pulmonary Edema • Administer 100% oxygen. • Suction secretions. • Transport in position of comfort.

13. Spontaneous Pneumothorax • Accumulation of air in the pleural space • Caused by trauma or some medical conditions • Dyspnea and sharp chest pain on one side • Absent or decreased breath sounds on one side

14. Spontaneous Pneumothorax • Administer oxygen. • Transport in position of comfort. • Monitor closely.

15. Anaphylactic Reactions • An allergen can trigger an asthma attack. • Asthma and anaphylactic (allergic) reactions can be similar. • Hay fever is a seasonal response to allergens.

16. Pleural Effusion • Collection of fluid outside lung • Causes dyspnea • Caused by irritation, infection, or cancer • Decreased breath sounds over region of the chest where fluid has moved the lung away from the chest wall • Eased if patient is sitting up

17. Pleural Effusion • Definitive treatment is performed in a hospital. • Administer oxygen and support measures. • Transport promptly.

18. Recognizing an Obstruction

19. Mechanical Obstruction of the Airway • Be prepared to treat quickly. • Obstruction may result from the position of head, the tongue, aspiration of vomitus, or a foreign body. • Opening the airway with the head tilt-chin lift maneuver may solve the problem.

20. Obstruction of the Airway • Clear airway. • Administer oxygen. • Transport promptly.

21. Removing a Foreign Body (1 of 4) • If the patient is sitting or standing: • Stand behind the patient. • Make a fist with one hand. • Press your fist into the patient’s abdomen. • Repeat thrusts in sets of five.

22. Removing a Foreign Body (2 of 4) • Chest thrusts • Stand behind the patient. • Wrap your arms around the patient’s chest. • Make a fist with one hand; grasp the fist with the other hand. • Press your fist into the patient’s chest with backward thrusts until the object is expelled or patient becomes unconscious.

23. Removing a Foreign Body (3 of 4) • If the patient is unconscious: • Place the patient in a supine position. • Begin steps of CPR. • If first ventilation does not produce visible chest rise, reposition the head. • If both breaths fail to produce visible chest rise, perform 30 chest compressions then look in the mouth.

24. Removing a Foreign Body (4 of 4) • If an object is visible, attempt to remove it. Do not perform blind finger sweeps. • Reattempt to ventilate • Continue chest compressions, opening the airway and looking inside the mouth, and attempts to ventilate until the airway is clear or ALS help arrives.

25. Manual Removal

26. Mild Airway Obstruction • Breathing is noisy. • Patient may be coughing. • Encourage patient to cough. • Give 100% oxygen using a nonrebreathing mask. • Provide prompt transport.

27. Removing Foreign Bodies in Children

28. Removing Foreign Bodies in Infants • Place one hand on infant’s back and neck. • Deliver five quick back slaps. • Turn infant face up. • Give five quick chest thrusts on the sternum.

29. Pulmonary Embolism • A blood clot that breaks off and circulates through the venous system • Signs and symptoms • Dyspnea • Acute pleuritic pain • Hemoptysis • Cyanosis • Tachypnea • Varying degrees of hypoxia

30. Pulmonary Embolism • Administer oxygen. • Place patient in comfortable position, usually sitting. • Assist breathing as necessary. • Keep airway clear. • Transport promptly.

31. Hyperventilation • Overbreathing resulting in a decrease in the level of carbon dioxide • Signs and symptoms • Anxiety • Numbness • A sense of dyspnea despite rapid breathing • Dizziness • Tingling in hands and feet

32. Hyperventilation • Complete initial assessment and history of the event. • Assume underlying problems. • Do not have patient breathe into a paper bag. • Give oxygen. • Reassure patient and transport.

33. Chronic Obstructive Pulmonary Disease (COPD) • COPD is the result of direct lung and airway damage from repeated infections or inhalation of toxic agents. • Bronchitis and emphysema are two common types of COPD. • Abnormal breath sounds may be present. • Rhonchi and wheezes

34. Chronic Obstructive Pulmonary Disease (COPD) • Assist with prescribed inhaler if patient has one. • Transport promptly in position of comfort.

35. Asthma • Common but serious disease • Asthma is an acute spasm of the bronchioles. • Wheezing may be audible without a stethoscope.

36. Asthma • Obtain history. • Assess vital signs. • Assist with inhaler if patient has one. • Administer oxygen. • Transport promptly.

37. Assisted-Administration Medications

38. Metered-Dose Inhaler • Medication should be delivered as the patient is inhaling. • Device may include spacer.

39. Trade names Proventil Ventolin Alupent Metaprel Brethine Generic names Albuterol Metaproterenol Terbutaline Medications in MDI

40. Prescribed Inhalers • Actions • Relax the muscles surrounding the bronchioles • Enlarge the airways leading to easier passage of air • Side effects • Increased pulse rate • Nervousness • Muscle tremors

41. Prior to Administration • Read label carefully. • Verify it has been prescribed by a physician for this patient. • Consult medical control. • Make sure the medication is indicated. • Check for contraindications.

42. Contraindications for MDI • Patient unable to help coordinate inhalation • Inhaler not prescribed for patient • No permission from medical control • Maximum dose prescribed has been taken.

43. Administration of MDI (1 of 3) • Obtain order from medical control or local protocol. • Check for right medication, right patient, right route. • Make sure the patient is alert. • Check the expiration date. • Check how many doses have been taken.

44. Administration of MDI (2 of 3) • Make sure inhaler is at room temperature or warmer. • Shake inhaler. • Stop administration of oxygen. • Ask the patient to exhale deeply and put lips around opening. • If the inhaler has a spacer, use it.

45. Administration of MDI (3 of 3) • Have the patient depress the inhaler and inhale deeply. • Instruct the patient to hold his or her breath. • Continue administration of oxygen. • Allow the patient to breathe a few times then repeat dose according to protocol.

46. Reassessment • Carefully watch for shortness of breath. • 5 minutes after administration: • Obtain vital signs again. • Perform focused reassessment. • Transport and continue to assess breathing.

47. Respiratory Emergency Walk Through The following slides walk the student through a Respiratory Emergency

48. You are the Provider • You and your EMT-B partner are dispatched to 1465 Dalles Military Rd for a 33-year-old woman with difficulty breathing. • You arrive at the office building and an upset man identifies himself as the patient’s coworker. • He tells you that the patient has had breathing problems before, but he’s never seen it this bad.

49. You are the Provider (continued) • He leads you to a woman who is standing with her arms outstretched on the desk with a metered-dose inhaler in hand. • She acknowledges your presence with a nod. When you ask her what is wrong, she answers with a two-word response, “can’t breathe.” • You hear audible wheezes.

50. Scene Size-UP • How significant is the person’s response to your question and why? • What should you do next? Should you transport this patient or wait for ALS to arrive on scene?