Chapter 10

1. Chapter 10 Respiratory Emergencies

2. Lesson Objectives • Describe the anatomy and physiology of the respiratory system. • Assess and treat chest injuries, including rib fractures, pneumothorax, hemothorax, and open injuries. • Assess and manage respiratory illnesses, including chest pain, asthma, colds, bronchitis, pneumonia, and hyperventilation.

3. Anatomy and Physiology (1 of 2) • Respiratory system includes: • Air passages • Lungs • Chest wall • Diaphragm

4. Anatomy and Physiology (2 of 2) • Chest is bounded by the collarbones and lower margin of the rib cage. • Main structures in the chest • Lungs • Heart • Arteries and veins • Respiratory emergencies can be caused by injury or illness.

5. Chest Injury (1 of 15) • Usually result from high-energy incidents. • Always consider the mechanism of injury.

6. Chest Injury (2 of 15) • Assessment and treatment of chest injuries • What to look for: • Abnormal breathing and obstruction • Painful breathing and coughing • Noisy breathing • Bluish lips or fingernails • Coughing up blood or pink froth • Wounds

7. Chest Injury (3 of 15) • Assessment and treatment of chest injuries • What to look for: • Sucking noise from moving air in and out of wound • Decreased movement on one or both sides of the chest • Grating or clicking sound • Increased pulse rate • Signs of internal bleeding and shock

8. Chest Injury (4 of 15) • Assessment and treatment of chest injuries • What to look do: • Keep airway open. • Help victim into a comfortable position. • Encourage deep breathing. • If breathing or coughing is painful, splint affected area. • Evacuate if victim cannot speak in complete sentences, is cyanotic, or if condition worsens.

9. Chest Injury (5 of 15) • Rib fractures • Can be isolated or associated with internal organ damage. • Flail chest: Chest wall loses support for breathing.

10. Chest Injury (6 of 15) • Rib fractures • What to look for: • Severe, localized chest pain • Tenderness directly over ribs • Deformity • Grating or clicking sound • Shortness of breath • Coughing up blood or pink froth • Abdominal pain, distention, and tenderness

11. Chest Injury (7 of 15) • Rib fractures • What to do: • Give painkillers. • Hold a pillow against the painful area. • Tape or strap a bulky pad over area for flail chest. • Evacuate all severe injuries.

12. Chest Injury (8 of 15) • Pneumothorax and hemothorax • Pneumothorax: Air enters pleural space. • Hemothorax: Blood enters pleural space.

13. Chest Injury (9 of 15) • Pneumothorax and hemothorax • What to look for: • Signs of serious chest injury • Progressively worsening shortness of breath • Possible penetrating injury

14. Chest Injury (10 of 15) • Pneumothorax and hemothorax • What to do: • Allow victim to assume position of comfort. • Evacuate immediately.

15. Chest Injury (11 of 15) • Tension pneumothorax • Flap-like tear on surface of the lung acts as a one-way valve. • Air enters pleural space and becomes trapped. • Pressure in the chest builds rapidly. • Condition quickly becomes life threatening.

16. Chest Injury (12 of 15) • Tension pneumothorax • What to look for: • Gasping, labored breathing • Cyanosis • Severe shortness of breath • Bulging of the affected chest • Trachea shifted away from affected side • Bulging veins in face and neck • Shock

17. Chest Injury (13 of 15) • Open injury • A wound large enough for air to enter chest from outside • The lung collapses. • Wound must be sealed. • “Sucking chest wound”

18. Chest Injury (14 of 15) • Open injury • What to look for: • Injury after a severe blow or fall • Broken skin with an obvious hole • Signs of pneumothorax

19. Chest Injury (15 of 15) • Open injury • What to do: • Seal the wound with an impermeable dressing. • If condition worsens, release a corner of dressing to allow escape of air with expiration.

20. Respiratory Illnesses (1 of 19) • Relatively common • Mild or severe • Upper and lower respiratory infections • Non-infectious problems • Chest wall problems

21. Respiratory Illnesses (2 of 19) • What to look for: • Shortness of breath, cough, pain • History of asthma, smoking, heart problems, or respiratory illnesses • Pain with movement of arms and tenderness of chest • Fever and generalized muscle aches

22. Respiratory Illnesses (3 of 19) • What to look for: • Chest pain with exertion, suggesting heart problems • Coughing up sputum, runny nose, sore throat, stuffy nose • Headache • Severe breathing problems • Swollen lymph nodes

23. Respiratory Illnesses (4 of 19) • Serious when there is: • Shortness of breath, weakness, cold, clammy skin • History of lung disease or heart disease • Difficulty with breathing • Noisy breathing • Blood in sputum • Cyanosis

24. Respiratory Illnesses (5 of 19) • What to do: • Serious respiratory problems: • Keep victim warm. • Allow victim to assume position of comfort. • Administer pain medication or assist victim with his or her own respiratory medications. • Evacuate immediately.

25. Respiratory Illnesses (6 of 19) • What to do: Non-urgent problems • Allow patient to assume position of comfort. • Encourage rest and fluids. • Have victim breathe vapors from boiling pan of water. • Encourage use of acetaminophen or ibuprofen (except in children). • Use decongestants for upper respiratory symptoms.

26. Respiratory Illnesses (7 of 19) • Chest pain • Common • Usually not serious • Should not be ignored • Seek immediate medical attention immediately for chest pain due to exertion or associated with shortness of breath.

27. Respiratory Illnesses (8 of 19) • Chest wall pain • Can be caused by exercise or minor injury • Treat symptoms with activity modification, stretching, and painkillers

28. Respiratory Illnesses (9 of 19) • Asthma • Lung condition characterized by recurring spells of shortness of breath, wheezing, and cough due to spasm and swelling of the small air passages.

29. Respiratory Illnesses (10 of 19) • Asthma • What to look for: • Shortness of breath • Difficulty exhaling • Audible wheezing • Exposure to environmental triggers

30. Respiratory Illnesses (11 of 19) • Asthma: What to do • Place victim in comfortable, upright position. • Assist with medication. • Give clear fluids. • Evacuate if medication does not help.

31. Respiratory Illnesses (12 of 19) • Cold • What to look for: • Runny nose • Headache • Malaise • Fever and chills • Cough

32. Respiratory Illnesses (13 of 19) • Cold • What to do: • Rest • Fluids • Decongestants • Painkillers

33. Respiratory Illnesses (14 of 19) • Bronchitis • What to look for: • Productive cough • Fever • Malaise • Congestion

34. Respiratory Illnesses (15 of 19) • Bronchitis • What to do: • Treat as for a cold. • Keep victim away from smoke. • Evacuate if there is shortness of breath or signs of pneumonia.

35. Respiratory Illnesses (16 of 19) • Pneumonia • What to look for: • Ill victim • Productive cough • High fever • Localized chest pain • Possible shortness of breath • One side of chest may not expand fully.

36. Respiratory Illnesses (17 of 19) • Pneumonia • What to do: • Treat as for bronchitis or cold. • Evacuate if victim does not improve.

37. Respiratory Illnesses (18 of 19) • Benign hyperventilation • What to look for: • Dizziness or light-headedness • Increasing shortness of breath • Numbness, coldness, tingling of the mouth, hands, and feet • Chest tightness or discomfort

38. Respiratory Illnesses (19 of 19) • Benign hyperventilation • What to do: • Reassure the victim. • Remove from cause of anxiety. • Encourage slow, regular breathing. • If hyperventilation persists, consider other causes and plan to evacuate.