respiratory emergencies east region washington otep m 7 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Respiratory Emergencies East Region (Washington) OTEP M-7 PowerPoint Presentation
Download Presentation
Respiratory Emergencies East Region (Washington) OTEP M-7

Loading in 2 Seconds...

play fullscreen
1 / 69

Respiratory Emergencies East Region (Washington) OTEP M-7 - PowerPoint PPT Presentation


  • 95 Views
  • Uploaded on

Respiratory Emergencies East Region (Washington) OTEP M-7. Brian Reynolds, MD Deaconess Medical Center Spokane, WA. Respiratory Emergencies. We are going to cover material for ALL levels of training YOU CAN ONLY PRACTICE AT THE LEVEL YOU HAVE BEEN CERTIFIED. Topics.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Respiratory Emergencies East Region (Washington) OTEP M-7' - ciara-oneil


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
respiratory emergencies east region washington otep m 7
Respiratory EmergenciesEast Region (Washington) OTEPM-7

Brian Reynolds, MD

Deaconess Medical Center

Spokane, WA

respiratory emergencies
Respiratory Emergencies
  • We are going to cover material for ALL levels of training
  • YOU CAN ONLY PRACTICE AT THE LEVEL YOU HAVE BEEN CERTIFIED
topics
Topics
  • Anatomy and function of the Respiratory System
  • Patient Assessment
  • Airway Management
upper airway
Upper Airway
  • Nasal cavity
  • Oral cavity
  • Pharynx
nasal cavity
Nasal Cavity
  • Nares
  • Mucous membranes
  • Sinuses
oral cavity
Oral Cavity
  • Cheeks
  • Hard palate
  • Soft palate
  • Tongue
  • Gums
  • Teeth
pharynx
Pharynx
  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
larynx
Larynx
  • Thyroid cartilage
  • Cricoid cartilage
  • Glottic opening
  • Vocal cords
  • Arytenoid cartilage
  • Pyriform fossae
  • Cricothyroid cartilage
lower airway anatomy
Lower Airway Anatomy
  • Trachea
  • Bronchi
  • Alveoli
  • Lung parenchyma
  • Pleura
definitions
Definitions
  • Atelectasis – collapse of small segments of lung
  • Hypoxia – lack of oxygen
  • Hypoxemia – lack of oxygen in arterial blood
introduction
Introduction
  • Ventilation is the mechanical process that brings O2 to the lungs, and clears CO2 from the lungs
  • Oxygenation is the diffusion of O2 to the blood
  • Perfusion is the flow of blood through the lungs (thus exchanging oxygen and CO2)
  • Brain stem is the involuntary regulator of respirations
respiratory physiology
Respiratory Physiology
  • Ventilation
    • Body Structures
      • Chest Wall
      • Pleura
      • Diaphragm
    • Tidal Volume:
      • 7ml/kg

(Adult 500ml)

pathophysiology
Pathophysiology
  • Disruption in Ventilation
    • Upper & Lower Respiratory Tracts
      • Obstruction due to trauma or infectious processes
    • Chest Wall & Diaphragm
      • Trauma
        • Pneumothorax
        • Hemothorax
        • Flail chest
      • Neuromuscular disease
oxygenation
Oxygenation
  • Room air – 21% FiO2
  • Roughly 3% increase per liter
  • Nasal cannula – 8L max (40%)
  • Mask – 10L (55%)
  • NRB mask – 15L (80%)
respiratory physiology1
Respiratory Physiology
  • Pulmonary Perfusion
    • Requirements
      • Adequate blood volume
      • Intact pulmonary capillaries
      • Efficient pumping by the heart
    • Hemoglobin
    • Carbon Dioxide
pathophysiology1
Pathophysiology
  • Disruption in Perfusion
    • Alteration in systemic blood flow
    • Changes in hemoglobin
    • Pulmonary shunting
    • Damaged alveoli
respiratory factors

Fever

Increases

Emotion

Increases

Pain

Increases

Hypoxia

Increases

Acidosis

Increases

Increase

Depressants

Decrease

Sleep

Decreases

Respiratory Factors

Effect

Factor

Stimulants

assessment of the respiratory system
Assessment of the Respiratory System
  • Scene Assessment
    • Threats to Safety
      • Make sure you are safe first
      • Identify rescue environments having decreased oxygen levels
      • Gases and other chemical or biological agents
    • Clues to Patient Information
assessment of the respiratory system1
Assessment of the Respiratory System
  • Initial Assessment
    • General Impression
      • Position
      • Color
      • Mental status
      • Ability to speak
      • Respiratory effort
assessment of the respiratory system2
Assessment of the Respiratory System
  • Airway
    • Proper ventilation cannot take place without an adequate airway
  • Breathing
    • Signs of life-threatening problems
      • Alterations in mental status
      • Severe central cyanosis, pallor, or diaphoresis
      • Absent or abnormal breath sounds
      • Speaking limited to 1–2 words
      • Tachycardia
      • Use of accessory muscles or intercostal retractions
abnormal respiratory patterns
Abnormal Respiratory Patterns

Kussmaul’s respirations:

  • Deep, slow or rapid, gasping; common in diabetic ketoacidosis

Cheyne-Stokes respirations:

  • Progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indication brain stem injury
abnormal respiratory patterns1
Abnormal Respiratory Patterns

Agonal respirations:

  • Shallow, slow, or infrequent breathing,indicating brain anoxia
focused history physical exam
Focused History & Physical Exam
  • History
    • SAMPLE History
    • Paroxysmal nocturnal dyspnea and orthopnea
      • Coughing, fever, hemoptysis
      • Associated chest pain
      • Smoking history or environmental exposures
    • Similar Past Episodes
focused history physical exam1
Focused History & Physical Exam
  • Physical Examination
    • Inspection
      • Look for asymmetry, increased diameter, or paradoxical motion
    • Palpation
      • Feel for subcutaneous emphysema or tracheal deviation
    • Percussion
    • Auscultation
focused history physical exam2
Focused History & Physical Exam
  • Auscultation
    • Normal Breath Sounds
      • Bronchial, Bronchovesicular, and Vesicular
    • Abnormal Breath Sounds
      • Snoring
      • Stridor
      • Wheezing
      • Rhonchi
      • Rales/Crackles
      • Pleural friction rub
focused history physical exam3
Focused History & Physical Exam
  • Diagnostic Testing
    • Pulse Oximetry
      • Inaccurate Readings
ausculation
Ausculation
  • Listen at the mouth and nose for adequate air movement
  • Listen with a stethoscope for normal or abnormal air movement
      • Proper listening positions
airway obstruction
Airway Obstruction
  • The tongue is the most common cause of airway obstruction
  • Foreign bodies
  • Trauma
  • Laryngeal spasm and edema
  • Aspiration
congestive heart failure
Congestive Heart Failure
  • Wet, crackly lung sounds
  • Lower extremity edema
  • Must sit and sleep upright
  • Frothy, pink sputum
obstructive lung disease
Obstructive Lung Disease
  • Types
    • Emphysema
    • Chronic Bronchitis
    • Asthma
  • Causes
    • Genetic Disposition
    • Smoking & Other Risk Factors
emphysema
Emphysema
  • Assessment
    • Physical Exam
      • Barrel chest
      • Prolonged expiration and rapid rest phase
      • Thin
      • Pink skin due to extra red cell production
      • Hypertrophy of accessory muscles
      • “Pink Puffers”
chronic bronchitis
Chronic Bronchitis
  • Physical Exam
    • Often overweight
    • Rhonchi present on auscultation
    • Jugular vein distention
    • Ankle edema
    • Hepatic congestion
    • “Blue Bloater”
asthma
Asthma
  • Physical Exam
    • Presenting signs may include dyspnea, wheezing, cough
      • No wheezing is severe disease
      • Speech may be limited to 1–2 word sentences
    • Look for hyperinflation of the chest and accessory muscle use/feel chest wall for crepitus
    • Carefully auscultate breath sounds and measure peak expiratory flow rate
pneumonia
Pneumonia
  • Infection of the Lungs
    • Immune-Suppressed Patients
  • Pathophysiology
    • Bacterial & Viral Infections
      • Hospital-acquired vs. community-acquired
      • Alveoli may collapse, resulting in a ventilation disorder
lung cancer
Lung Cancer
  • Pathophysiology
    • General
      • Majority are caused by carcinogens secondary to cigarette smoking or occupational exposure
      • May start elsewhere and spread to lungs
      • High mortality
    • Types
      • Adenocarcinoma
      • Epidermoid, small-cell, and large-cell carcinomas
toxic inhalation
Toxic Inhalation
  • Pathophysiology
      • Includes inhalation of heated air, chemical irritants, and steam
      • Airway obstruction due to edema and laryngospasm due to thermal and chemical burns
  • Assessment
    • Focused History & Physical Exam
      • SAMPLE & OPQRST History
        • Determine nature of substance
        • Length of exposure and loss of consciousness
carbon monoxide inhalation
Carbon Monoxide Inhalation
  • Pathophysiology
    • Binds to Hemoglobin
      • Prevents oxygen from binding to RBC’s
      • Room air half life – 6 hrs., HBO – 23 minutes
  • Assessment
    • Focused History and Physical Exam
      • SAMPLE & OPQRST History
        • Determine source and length of exposure
        • Presence of headache, confusion, agitation, lack of coordination, loss of consciousness, and seizures
pulmonary embolism
Pulmonary Embolism
  • Pathophysiology
    • Obstruction of a pulmonary artery
      • Emboli may be of air, thrombus, fat, or amniotic fluid
      • Foreign bodies may also cause an embolus
    • Risk Factors
      • Recent surgery, long-bone fractures
      • Pregnant or postpartum
      • Oral contraceptive use, tobacco use
      • Immobility
      • Blood disorders
spontaneous pneumothorax
Spontaneous Pneumothorax
  • Pathophysiology
    • Pneumothorax
      • Can occur in the absence of blunt or penetrating trauma
    • Risk factors
  • Assessment
    • Focused history
      • SAMPLE
      • Presence of risk factors
      • Rapid onset of symptoms
      • Sharp, pleuritic chest or shoulder pain
      • Often precipitated by coughing or lifting
hyperventilation syndrome
Hyperventilation Syndrome
  • Assessment
    • Focused History & Physical Exam
      • SAMPLE
        • Fatigue, nervousness, dizziness, dyspnea, chest pain
        • Numbness and tingling in mouth, feet, and both hands
      • Presence of tachypnea and tachycardia
      • Spasms of the fingers and feet
airway sounds

Airflow Compromise

Gas Exchange Compromise

Snoring

Crackles

Gurgling

Rhonchi

Stridor

Wheezing

Quiet

Airway Sounds
advanced airway management1
Advanced Airway Management
  • Endotracheal intubation
  • Combitube
  • CPAP and BiPAP
  • CO2 monitors – measure exhaled CO2
    • Normal – 5-6%
advantages of endotracheal intubation
Advantages of Endotracheal Intubation
  • Isolates trachea and permits complete control of airway
  • Maximizes ventilation and oxygenation
  • Impedes gastric distention
  • Eliminates need to maintain a mask seal
  • Offers direct route for suctioning
endotracheal intubation indicators
Endotracheal Intubation Indicators
  • Respiratory or cardiac arrest
  • Unconsciousness
  • Risk of aspiration
  • Obstruction due to foreign bodies, trauma, burns, or anaphylaxis
  • Respiratory extremis due to disease
  • (Pneumothorax), hemothorax, (hemopneumothorax) with respiratory difficulty
complications of endotracheal intubation
Complications of Endotracheal Intubation
  • Equipment malfunction
  • Teeth breakage and soft tissue injury
  • Hypoxia
  • Esophageal intubation
  • Endobronchial intubation
  • Tension pneumothorax
  • Extubation
tracheostomies stomas
Tracheostomies/Stomas
  • Use patient’s supplies
  • Ambu bag attaches easily
  • Treat as an endotracheal tube
  • Suction
questions
Questions

1. Which one is lack of oxygen in the blood?

  • Hypoxia
  • Hypocarbia
  • Hypoxemia
  • Hypocarbemia
questions1
Questions

2. Which one is the best airway?

  • Nasal cannula
  • Endotracheal tube
  • Oral airway
  • Combitube
questions2
Questions

3. Which one is a contraindication to nasal trumpet use?

  • Seizure
  • Bloody nose
  • DNR patient
  • Significant facial trauma
questions3
Questions

4. Which one is the correct tidal volume for a 200 pound patient?

  • 500cc
  • 600cc
  • 700cc
  • 800cc
questions4
Questions

5. Which one is not an indication for endotracheal intubation?

  • Respiratory failure
  • Cardiac arrest
  • GCS of 5
  • Hyperventilation syndrome
slide69

Questions?

Renee Anderson

andersr@inhs.org

509-232-8155

FAX: 509-232-8344

Garry Frey

freyg@inhs.org

509-242-4263