Airway and Respiratory Emergencies Anatomy of the Respiratory

Airway and Respiratory Emergencies

Anatomy of the Respiratory System

Anatomy of the Upper Airway Nasopharynx – Formed by the union of facial bones – Warms and humidifies air as it enters the body

Anatomy of the Upper Airway

Anatomy of the Upper Airway

Ventilation, Oxygenation, and Respiration

Inspiration Exhalation

Respiration • External respiration (pulmonary respiration) – Breathes fresh air into respiratory system – Exchanges oxygen and carbon dioxide between alveoli and blood in pulmonary capillaries

Respiration • Internal respiration – Exchange of oxygen and carbon dioxide between systemic circulatory system and cells

Respiration

Regulation of Ventilation • Pulmonary Ventilation is simply the movement of air into and out of the lungs. • Body is a constantly changing environment • Chemoreceptors monitor bodies CO 2 levels and adjust respirations to correct highs and lows. • Hypoxic drive is back-up system if normal system breaks down. (COPD)

Chief Complaint SOB • Common EMS Response • Initial Assessment – Appearance – LOC – ABCs

Signs of Adequate Breathing • Normal Rate 12 – 20 breaths/min • Regular pattern, with smooth flow of air • Clear and equal breath sounds bilaterally • Regular and equal chest rise and fall • Adequate depth (tidal Volume)

Signs of Inadequate Breathing • Labored breathing • Altered LOC • Respiratory rate less than 12 or greater than 20 with dyspnea • Irregular Rhythm (Cheyne Stokes, Kussmaul, Ataxic pattern) • Unequal chest expansion. • Shallow breathing • Skin Condition • Retractions

Factors Effecting Respiration • External factors – – Elevation Oxygen levels Toxic chemicals Confined Spaces • Internal Factors – – – Medical conditions Non functioning Alveoli Fluid in lungs Circulatory problems Metabolic problems

Foreign Body Obstruction • Partial – If able to talk or cough forcefully allow person to attempt to relieve on their own. – If poor air exchange and weak cough provide immediate intervention • Complete – Abdominal thrusts – If pulseless and apneic begin CPR. – Use tongue jaw lift and check back of oropharynx foreign body – No blind finger sweeps

Other Obstructions • Dental Appliances – If well fitting and in place leave in – If loose remove to prevent obstruction • Facial injuries – Blood may need to be suctioned – Broken teeth removed

Oxygen Delivery • Nasal Cannula – 1 - 6 lpm 24%-44% • Non Rebreather – 10 -15 lpm up to 90% • Bag Mask with reservoir – 15 lpm 100% • Mouth to Mask – 15 lpm 55%

Ventilation Rates • Adults – 1 breath every 5 - 6 seconds • Children and Infants – 1 breath every 3 - 5 seconds

CPAP • Mechanism – Increases pressure in the lungs – Opens collapsed alveoli – Pushes more oxygen across the alveolar membrane – Forces interstitial fluid back into the pulmonary circulation – Therapy is delivered through a face mask held to the head with a strapping system. – Use caution with patients with potentially low blood pressure.

CPAP • Indications – – – Awake & Alert Over 12 Patent airway GCS>10 BP above 90 systolic 2 of following • Retractions/Accessory muscle use • Respiratory rate >24 • Pulse Ox <92% • Inability to speak in complete sentences • Contraindications – – – – – GCS <11 Respiratory Arrest BP <90 Systolic Suspected Pneumothorax Tracheostomy Foreign body obstruction Facial deformity or trauma Actively vomiting Recent neuro, facial or gastric surgery – Chest head or face trauma

Airway Adjuncts • Oropharyngeal Airway • Nasopharyngeal Airway • BVM • Pocket Mask • Combi-tube • King Airway

Skills Practice

Respiratory Emergencies

Anatomy of the Respiratory System • Function of lungs is respiration. – Exchange of oxygen and carbon dioxide • Air travels through trachea into lungs, then on to: – Bronchi (larger airways) – Bronchioles (smaller airways) – Alveoli

Anatomy of the Respiratory System • Alveoli are microscopic air sacs. – Thin-walled – Actual exchange of oxygen and carbon dioxide occurs here.

Physiology of Respiration

Physiology of Respiration

Upper and Lower Airway Infection

Acute Pulmonary Edema • Heart muscle can’t circulate blood properly. • Fluid builds up within alveoli and in lung tissue. – Referred to as pulmonary edema – Usually result of congestive heart failure – Common cause of hospital admission

Chronic Obstructive Pulmonary Disease (COPD) • Slow process of dilation and disruption of airways and alveoli • Caused by chronic bronchial obstruction • Fourth leading cause of death • Tobacco smoke can create chronic bronchitis.

Chronic Obstructive Pulmonary Disease (COPD) • Emphysema is another type of COPD. – Loss of elastic material around air spaces – Causes include inflamed airways, smoking. • Most patients with COPD have elements of both chronic bronchitis and emphysema.

Asthma • Asthma is acute spasm of smaller air passages (bronchioles).

Spontaneous Pneumothorax • Pneumothorax is accumulation of air in pleural space. • Most often caused by trauma • Vacuum-like pressure in pleural space is lost. • When caused by medical conditions, is called “spontaneous. ”

Spontaneous Pneumothorax

Pulmonary Embolism • Passage of blood clot formed in vein into pulmonary artery – Circulation cut off partially or completely – Becomes lodged – Significantly decreases blood flow – If large enough, can cause sudden death

Pulmonary Embolism Cont. • Signs and symptoms include: – Dyspnea – Acute chest pain – Hemoptysis (coughing up blood) – Cyanosis – Tachypnea – Hypoxia

Other Respiratory Emergencies • Croup – Inflammation and swelling of pharynx, larynx, and trachea – Easily passed between children – Responds well to humidified oxygen • Epiglottitis – Bacterial infection causing swelling of flap over larynx – Position comfortably and provide oxygen.

Other Respiratory Emergencies • Pneumonia – Worldwide leading cause of death in children – Often a secondary infection – Will come on quickly and result in high fever. – Obtain a core temperature and treat with airway, ventilatory, and circulatory support.

Discuss Case Scenarios and Treatment Options