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Respiratory Emergencies. Anatomy Review. Nose and mouth Pharynx Oropharynx Nasopharynx Epiglottis – a leaf-shaped structure that prevents food and liquid from entering the trachea during swallowing Trachea (windpipe)

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anatomy review
Anatomy Review

Nose and mouth

Pharynx

Oropharynx

Nasopharynx

Epiglottis – a leaf-shaped structure that prevents food and liquid from entering the trachea during swallowing

Trachea (windpipe)

Cricoid cartilage – firm cartilage ring forming the lower portion of the larynx

Larynx (voice box)

Bronchi – two major branches of the trachea to the lungs. Bronchus subdivides into smaller air passages ending at the alveoli

Alveoli – site of oxygen and carbon dioxide exchange

adequate breathing
Adequate Breathing

Normal Rate

> Adult 12 – 20 bpm

> Child 15 – 30 bpm

> Infant 25 – 50 bpm

Rhythm – regular

Quality – Breath sounds diminished or absent

Chest expansion – adequate/equal

Depth (tidal volume) – normal/adequate (500cc/air)

inadequate breathing
Inadequate Breathing

Rate –

> outside normal ranges <10 or >29

Rhythm – irregular

> Agonal respirations (dying respirations) are sporadic, irregular, or “gasping”

Quality –

  • diminished or absent breath sounds
  • unequal chest expansion, use of accessory muscles.

** Children – seesaw breathing, nasal flaring, grunting, retractions.

**Have smaller airways so easier to obstruct

Skin –

  • pale or cyanotic, cool and clammy
artificial ventilation bvm pocket mask
Artificial Ventilation (BVM/Pocket Mask)
  • Chest should rise and fall with each ventilation.
  • Exhalation (passive)
    • Diaphragm, ribs & muscles relax
    • Decrease in chest size
    • Diaphragm moves up
  • Inhalation (active)
    • Diaphragm moves downward
    • Ribs move up and out
    • Air flows in
breathing difficulty
Breathing Difficulty
  • This is subjective – need to do a thorough assessment.
breathing difficulty1
Breathing Difficulty

Signs and Symptoms

Shortness of breath

Restlessness

Noisy breathing – crowing, wheezing, gurgling, snoring, stridor (harsh sound/upper airway obstruction)

Silent chest – found in asthma patients

Inability to speak due to breathing efforts

Increased or decreased pulse rate

Skin color changes

Tripod position

Change in breathing rate

Unusual anatomy (barrel chest)

emergency care
Emergency Care
  • OPQRSTI
  • Apply oxygen – how would you provide this?????
  • Baseline vital signs
  • Prescribed inhaler if available with medical direction
chronic obstructive pulmonary disease copd
Chronic Obstructive Pulmonary Disease (COPD)

Examples

> emphysema

> chronic bronchitis

> black lung

*Found in middle age or older

*Develops as tissues of the respiratory tract react to irritants – cigarettes most common

emphysema
Emphysema

*Walls of the alveoli break down, the lungs lose elasticity. Patient will develop a hypoxic drive. This patient will breathe based on the levels of oxygen in their system instead of the levels of carbon dioxide.

*Amount of surface area has been reduced for respiratory exchange.

chronic bronchitis
Chronic Bronchitis
  • Bronchiole lining is inflamed and excess mucus is formed
  • Cilia have been damaged or destroyed
black lung
Black Lung
  • Coal worker's pneumoconiosis – due to the inhalation of coal dust.
  • Enlarged heart – suffer from right side heart failure.
asthma
Asthma
  • Can be triggered by an allergic reaction, pollutants, infection, exercise, etc.
  • Young and old can have this
  • Can be episodic
  • There is an over production of thick mucus that close down the small passages restricting air flow.
pulmonary edema
Pulmonary Edema
  • Fluid in/around alveoli, small airways
  • Causes
    • Left heart failure
    • Toxic inhalants
    • Aspiration
    • Drowning
    • Trauma
pulmonary edema1
Pulmonary Edema
  • Signs/Symptoms
    • Labored breathing
    • Coughing
    • Rales, rhonchi, crackles
    • Wheezes
    • Pink, frothy sputum
    • Increased swelling in the extremities
pulmonary edema2
Pulmonary Edema
  • Management
    • Place the patient in a full fowlers position
    • High concentration O2
    • Assist ventilation
    • Be prepared to suction
pulmonary embolism
Pulmonary Embolism
  • Clot from venous circulation
  • Passes through right side of the heart
  • Lodges in pulmonary circulation
  • Shuts off blood flow past part of alveoli
pulmonary embolism1
Pulmonary Embolism
  • Associated with:
    • Prolonged bed rest or immobilization
    • Casts or orthopedic traction
    • Pelvic or lower extremity surgery
    • Phlebitis – inflammation of a vein
pulmonary embolism2
Pulmonary Embolism
  • Signs/Symptoms
    • Dyspnea
    • Chest pain
    • Tachycardia
    • Hemoptysis – coughing up blood

Sudden Dyspnea + No Readily Identifiable Cause = Pulmonary Embolism

pulmonary embolism3
Pulmonary Embolism
  • Management
    • Oxygen
    • Assisted ventilation
    • Transport
respiratory emergencies in infants children
Respiratory Emergencies in Infants & Children
  • Epiglottitis
    • Bacterial infection
    • Causes edema of the epiglottis
    • Children age 4-7 years
    • Rapid onset, high fever, stridor, sore throat, excessive drooling
    • Can progress to complete obstruction
    • Do not look in throat
    • Do not use obstructed airway maneuver
respiratory emergencies in infants children1
Respiratory Emergencies in Infants & Children
  • Croup
    • Viral infection
    • Causes edema of larynx/trachea
    • Children ages 6 months to 4 years
    • Slow onset, mild fever, hoarseness, brassy cough, nightime stridor (seal-like bark), dyspnea
    • Looks less ill than epiglottis patient
    • When in doubt, manage as epiglottitis
respiratory emergencies in infants children2
Respiratory Emergencies in Infants & Children
  • Croup/Epiglottitis
    • Management
      • Blow-by oxygen
      • Assist ventilations as needed
      • Do not excite patient
      • DO NOT look or stick anything in the throat
      • Cool night air or steam from a shower may help a child with croup
      • Consider ALS intercept