Prehospital Emergency Care Eleventh Edition Chapter 16 Respiratory

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Prehospital: Emergency Care Eleventh Edition Chapter 16 Respiratory Emergencies "Slides in this presentation contain

Prehospital: Emergency Care Eleventh Edition Chapter 16 Respiratory Emergencies "Slides in this presentation contain hyperlinks. JAWS users should be able to get a list of links by using INSERT+F 7" Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Learning Readiness • EMS Education Standards, text p. 472 • Chapter Objectives, text p.

Learning Readiness • EMS Education Standards, text p. 472 • Chapter Objectives, text p. 472. • Key Terms, text p. 473. • Purpose of lecture presentation versus textbook reading assignments. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Setting the Stage (1 of 2) • Overview of Lesson Topics – Respiratory Anatomy,

Setting the Stage (1 of 2) • Overview of Lesson Topics – Respiratory Anatomy, Physiology, and Pathophysiology – Respiratory Distress – Pathophysiology of Conditions that Cause Respiratory Distress – Metered-Dose Inhalers and Small-Volume Nebulizers Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Setting the Stage (2 of 2) • Overview of Lesson Topics – Age Related

Setting the Stage (2 of 2) • Overview of Lesson Topics – Age Related Variations: Pediatrics and Geriatrics – Assessment and Care: General Guidelines. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study Introduction (1 of 3) EMTs Jake Pratt and Paul Berg arrive at

Case Study Introduction (1 of 3) EMTs Jake Pratt and Paul Berg arrive at a residence to find 62 -year-old Margaret Brown sitting at the kitchen table, leaning forward on her hands to breathe. They immediately note that she is a thin woman with a barrel-shaped chest who is using accessory muscles to breathe. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study Introduction (2 of 3) Despite an increased respiratory rate and increased work

Case Study Introduction (2 of 3) Despite an increased respiratory rate and increased work of breathing, Mrs. Brown's skin color is pink. Jake notices a portable oxygen concentrator, as well as a nebulizer, nearby. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study (1 of 7) • What is your general impression of this patient

Case Study (1 of 7) • What is your general impression of this patient so far? • What additional information will help you complete your general impression? • What immediate actions should the EMTs take while completing the primary assessment? Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Introduction • Respiratory distress is frightening, and potentially life threatening. • You must be

Introduction • Respiratory distress is frightening, and potentially life threatening. • You must be able to recognize signs and symptoms of respiratory distress and provide immediate intervention. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Anatomy, Physiology, and Pathophysiology (1 of 4) • The respiratory system consists of:

Respiratory Anatomy, Physiology, and Pathophysiology (1 of 4) • The respiratory system consists of: – Upper airway – Lower airway – Lungs • Normal Breathing – Normal respiratory rates are based on patient age and medical history. – Certain findings are consistent with a person who is breathing adequately. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Anatomy, Physiology, and Pathophysiology (2 of 4) • Abnormal Breathing – Conditions that

Respiratory Anatomy, Physiology, and Pathophysiology (2 of 4) • Abnormal Breathing – Conditions that impair gas exchange ▪ Increased space between alveoli and pulmonary capillaries ▪ Lack of perfusion of the pulmonary system from the right heart ▪ Fluid, blood, or pus in the alveoli Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Anatomy, Physiology, and Pathophysiology (3 of 4) • Abnormal Breathing – Assessing Breath

Respiratory Anatomy, Physiology, and Pathophysiology (3 of 4) • Abnormal Breathing – Assessing Breath sounds ▪ Auscultation of breath sounds provide additional evidence of breathing difficulty. ▪ To achieve the most accurate breath sounds, it is important to auscultate in the appropriate fashion. ▪ Have the patient sit upright and use the diaphragm end of your stethoscope over bare skin. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

EMT Skills 16 -1 Auscultating the Chest Copyright © 2018, 2014, 2010 Pearson Education,

EMT Skills 16 -1 Auscultating the Chest Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Auscultate the Anterior Chest at the Second Intercostal Space at Each Midclavicular Line Copyright

Auscultate the Anterior Chest at the Second Intercostal Space at Each Midclavicular Line Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Auscultate the Lateral Chest at the Fourth to Fifth Intercostal Space at Each Midaxillary

Auscultate the Lateral Chest at the Fourth to Fifth Intercostal Space at Each Midaxillary Line Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Auscultate the Posterior Chest Below the Tip of the Scapula on Each Midscapular Line

Auscultate the Posterior Chest Below the Tip of the Scapula on Each Midscapular Line Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Anatomy, Physiology, and Pathophysiology (4 of 4) • Abnormal Breathing – Assessing Breath

Respiratory Anatomy, Physiology, and Pathophysiology (4 of 4) • Abnormal Breathing – Assessing Breath Sounds ▪ Abnormal breath sounds – Wheezing – Rhonchi – Crackles Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Distress (1 of 7) • Inadequate breathing leads to hypoxemia (Sp. O 2

Respiratory Distress (1 of 7) • Inadequate breathing leads to hypoxemia (Sp. O 2 <94%) and hypercarbia. • Hypoxemia leads to cardiovascular failure and hypoperfusion. • Untreated, inadequate breathing leads to death. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Distress (2 of 7) • Common findings in respiratory distress – Complaint of

Respiratory Distress (2 of 7) • Common findings in respiratory distress – Complaint of shortness of breath – Restlessness – Increased or decreased pulse rate – Changes in breathing rate or depth – Skin color changes Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Distress (3 of 7) • Causes – Narrowing of the bronchioles from inflammation,

Respiratory Distress (3 of 7) • Causes – Narrowing of the bronchioles from inflammation, swelling, or bronchoconstriction. – Bronchodilators can provide relief – Injuries to the head, neck, face, spine, chest, or abdomen. – Cardiac compromise. – Hyperventilation. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Distress (4 of 7) • Causes – Abdominal conditions – Dysfunction of the

Respiratory Distress (4 of 7) • Causes – Abdominal conditions – Dysfunction of the respiratory system by: ▪ Mechanical disruption to the airway, lung, or chest wall ▪ Stimulation of receptors in the lungs ▪ Inadequate gas exchange related to a ventilation or perfusion disturbance Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Distress (5 of 7) • A breathing disturbance can be categorized in one

Respiratory Distress (5 of 7) • A breathing disturbance can be categorized in one of three ways – Respiratory distress ▪ Adequate rate and tidal volume. ▪ Patient is compensating. ▪ Administer oxygen to maintain an Sp. O 2 of 94 percent or higher. ▪ Consider CPAP. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Distress (6 of 7) • A breathing disturbance can be categorized in one

Respiratory Distress (6 of 7) • A breathing disturbance can be categorized in one of three ways – Respiratory failure ▪ Rate, tidal volume, or both are inadequate. ▪ Assist ventilations with bag-valve-mask. ▪ Provide supplemental oxygen. ▪ May deteriorate to respiratory arrest. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Respiratory Distress (7 of 7) • A breathing disturbance can be categorized in one

Respiratory Distress (7 of 7) • A breathing disturbance can be categorized in one of three ways – Respiratory arrest ▪ Cessation of respiratory effort. ▪ Leads to cardiac arrest in minutes. ▪ Immediately intervene with bag-valve-mask ventilations and supplemental oxygen. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (1 of 39) • There are many

Pathophysiology of Conditions That Cause Respiratory Distress (1 of 39) • There are many causes of respiratory distress, but assessment and basic emergency care is the same. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Emphysema and Chronic Bronchitis are Chronic Obstructive Pulmonary Diseases (1 of 3) Copyright ©

Emphysema and Chronic Bronchitis are Chronic Obstructive Pulmonary Diseases (1 of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Emphysema and Chronic Bronchitis are Chronic Obstructive Pulmonary Diseases (2 of 3) Copyright ©

Emphysema and Chronic Bronchitis are Chronic Obstructive Pulmonary Diseases (2 of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Emphysema and Chronic Bronchitis are Chronic Obstructive Pulmonary Diseases (3 of 3) Copyright ©

Emphysema and Chronic Bronchitis are Chronic Obstructive Pulmonary Diseases (3 of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (2 of 39) • Obstructive Pulmonary Diseases

Pathophysiology of Conditions That Cause Respiratory Distress (2 of 39) • Obstructive Pulmonary Diseases – Emphysema - Pathophysiology ▪ Lung tissue loses its elasticity ▪ Walls of the alveoli are destroyed ▪ Disruption in gas exchange occurs ▪ The patient purses their lips while exhaling to create their own “physiologic PEEP” ▪ Patient usually complains of shortness of breath upon exertion Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (3 of 39) • Obstructive Pulmonary Diseases

Pathophysiology of Conditions That Cause Respiratory Distress (3 of 39) • Obstructive Pulmonary Diseases – Emphysema - Assessment ▪ Signs and symptoms – Many of the signs and symptoms of emphysema are similar to those listed for respiratory distress. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Man Suffering Respiratory Distress (Indicated by Tripod Position) From Obstructive Lung Disease Copyright ©

Man Suffering Respiratory Distress (Indicated by Tripod Position) From Obstructive Lung Disease Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

CPAP or Bi. PAP May Be Used to Improve Oxygenation Copyright © 2018, 2014,

CPAP or Bi. PAP May Be Used to Improve Oxygenation Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (4 of 39) • Obstructive Pulmonary Diseases

Pathophysiology of Conditions That Cause Respiratory Distress (4 of 39) • Obstructive Pulmonary Diseases – Chronic Bronchitis - Pathophysiology ▪ Swelling, and thickening of bronchi and bronchiole lining ▪ Alveoli remain unaffected by the disease ▪ Associated with smoking ▪ Narrowed bronchioles reduce airflow ▪ Reduced lung ventilation with increased lung perfusion Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (5 of 39) • Obstructive Pulmonary Diseases

Pathophysiology of Conditions That Cause Respiratory Distress (5 of 39) • Obstructive Pulmonary Diseases – Chronic Bronchitis – Assessment. ▪ Productive cough. ▪ The increase in bronchiole obstruction, there is a reduction in the residual volume in the lungs that can lead to bloating and a cyanotic appearance Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (6 of 39) • Obstructive Pulmonary Diseases

Pathophysiology of Conditions That Cause Respiratory Distress (6 of 39) • Obstructive Pulmonary Diseases – Chronic Bronchitis – Emergency Care ▪ Same guidelines as any patient suffering from difficulty breathing ▪ COPD patients can develop hypoxic drive ▪ Maintain the Sp. O 2 between 88%– 92% ▪ Consider the use of CPAP Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study (2 of 7) Jake quickly notes the following as Paul applies oxygen

Case Study (2 of 7) Jake quickly notes the following as Paul applies oxygen by nasal cannula and begins asking Mrs. Brown’s friend some questions. Mrs. Brown is in tripod position, using pursed-lip breathing. She is anxious, and is able to speak three to four words at a time. Her respiratory rate is 28, with adequate tidal volume. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study (3 of 7) Auscultation reveals scattered wheezing and rhonchi throughout both lungs.

Case Study (3 of 7) Auscultation reveals scattered wheezing and rhonchi throughout both lungs. Mrs. Brown’s Sp. O 2 is 94 percent. The friend states that Mrs. Brown has emphysema, and has been more short of breath than usual since early this morning. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study (4 of 7) • Would you characterize Mrs. Brown’s condition as respiratory

Case Study (4 of 7) • Would you characterize Mrs. Brown’s condition as respiratory distress, respiratory failure, or respiratory arrest? • What treatments may be appropriate for Mrs. Brown? • How should treatments be integrated with plans for transport? Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (7 of 39) • Obstructive Pulmonary Diseases

Pathophysiology of Conditions That Cause Respiratory Distress (7 of 39) • Obstructive Pulmonary Diseases – Asthma ▪ Increased sensitivity of lower airways leads to narrowing of the bronchioles and increased resistance to airflow – Bronchospasm – Edema of the airways – Increased mucus production – Acute severe asthma or status asthmaticus is a prolonged, life-threatening attack Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Conditions Contributing to Airflow Resistance in Asthma Copyright © 2018, 2014, 2010 Pearson Education,

Conditions Contributing to Airflow Resistance in Asthma Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (8 of 39) • Obstructive Pulmonary Diseases

Pathophysiology of Conditions That Cause Respiratory Distress (8 of 39) • Obstructive Pulmonary Diseases – Asthma – Assessment ▪ Slow onset – 80 percent of the cases of asthma have a slow onset. – Deterioration over six hours to several days. – More prevalent in females. – Usually triggered by upper respiratory tract infection. ▪ Learn signs and symptoms Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (9 of 39) • Obstructive Pulmonary Diseases

Pathophysiology of Conditions That Cause Respiratory Distress (9 of 39) • Obstructive Pulmonary Diseases – Asthma – Assessment ▪ Rapid onset – 20 percent of the cases of asthma have a rapid onset. – Deterioration in less than six hours. – More prevalent in males. – Usually triggered by allergens, exercise, or stress. ▪ Learn signs and symptoms Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (10 of 39) • Obstructive Pulmonary Diseases

Pathophysiology of Conditions That Cause Respiratory Distress (10 of 39) • Obstructive Pulmonary Diseases – Asthma – Assessment ▪ Rapid onset asthma more likely to result in death. ▪ Be prepared for this patient to develop respiratory failure or respiratory arrest. ▪ Critically ill patients require positive pressure ventilation with supplemental oxygen. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (11 of 39) • Obstructive Pulmonary Diseases

Pathophysiology of Conditions That Cause Respiratory Distress (11 of 39) • Obstructive Pulmonary Diseases – Asthma - Emergency Care ▪ Primary assessment interventions. ▪ Supplemental oxygen to maintain Sp. O 2 of 94 percent or above. ▪ Allow sufficient time for exhalation when providing positive pressure ventilation. ▪ Consider CPAP. ▪ Beta 2 agonist. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (12 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (12 of 39) • Other Conditions That Cause Respiratory Distress – Pneumonia - Pathophysiology ▪ Acute infectious disease of the lower respiratory tract. ▪ Causes lung inflammation and fluid - or pus-filled alveoli. ▪ Leads to a ventilation disturbance and poor gas exchange. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Pneumonia Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Pneumonia Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (13 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (13 of 39) • Other Conditions That Cause Respiratory Distress – Pneumonia – Assessment ▪ Generally appears ill ▪ May complain of fever and severe chills ▪ Signs and symptoms Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (14 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (14 of 39) • Other Conditions That Cause Respiratory Distress – Pneumonia – Treatment ▪ Not usually associated with severe bronchoconstriction. ▪ Supplemental oxygen to maintain Sp. O 2 of 94 percent or higher. ▪ Follow protocols for use of beta 2 agonists and C PAP. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (15 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (15 of 39) • Other Conditions That Cause Respiratory Distress – Pulmonary Embolism - Pathophysiology ▪ Obstruction of blood flow in the pulmonary arteries ▪ Several factors increase the risk, including immobility ▪ Usually caused by a blood clot Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

A Blood Clot, Air Bubble, Fat Particle, Foreign Body, or Amniotic Fluid Can Cause

A Blood Clot, Air Bubble, Fat Particle, Foreign Body, or Amniotic Fluid Can Cause an Embolism, Blocking Blood Flow through a Pulmonary Artery Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (16 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (16 of 39) • Other Conditions That Cause Respiratory Distress – Pulmonary Embolism – Assessment ▪ Sudden onset of unexplained dyspnea and chest pain ▪ Signs of hypoxia with normal breath sounds and adequate volume ▪ Include lower legs assessment for DVT Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (17 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (17 of 39) • Other Conditions That Cause Respiratory Distress – Pulmonary Embolism – Treatment ▪ Open airway and administer PPV ▪ Maintain an Sp. O 2 of 94 percent or better ▪ Include lower legs assessment for DVT Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Click on the Item That Best Characterizes Emphysema A. Destruction of alveolar walls with

Click on the Item That Best Characterizes Emphysema A. Destruction of alveolar walls with distention of the alveoli B. An obstruction to blood flow in the pulmonary arteries C. Inflammation of the bronchi and bronchioles with increased mucus production D. Sudden collapse of the lung without history of injury Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (18 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (18 of 39) • Other Conditions That Cause Respiratory Distress – Acute Pulmonary Edema - Pathophysiology ▪ Often due to cardiac dysfunction ▪ Results in hypoxia ▪ Occurs when excessive fluid collects between the alveoli and pulmonary capillaries ▪ Gas exchange is impaired Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Fluid That Collects Between the Alveoli and Capillaries, Preventing Normal Exchange of Oxygen and

Fluid That Collects Between the Alveoli and Capillaries, Preventing Normal Exchange of Oxygen and Carbon Dioxide The fluid may also invade the alveolar sacs Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (19 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (19 of 39) • Other Conditions That Cause Respiratory Distress – Acute Pulmonary Edema - Assessment ▪ Crackles are a sign of pulmonary edema ▪ Auscultate lower lobes ▪ Cardiac symptoms does not occur with ARDS ▪ Anxiety, combativeness and confusion may complicate assessment Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (20 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (20 of 39) • Other Conditions That Cause Respiratory Distress – Acute Pulmonary Edema - Treatment ▪ Positive pressure ventilation may be necessary. ▪ CPAP may be beneficial. ▪ Administer oxygen. ▪ Keep the patient in an upright sitting position. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (21 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (21 of 39) • Other Conditions That Cause Respiratory Distress – Spontaneous Pneumothorax -Pathophysiology ▪ Sudden rupture of visceral lining of lung with partial collapse of lung. ▪ Gas exchange is impaired. ▪ Risk factors include smoking, connective tissue disorders, and COPD. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

A Ruptured Bleb, or Weakened Area of Lung Tissue Causes a spontaneous pneumothorax in

A Ruptured Bleb, or Weakened Area of Lung Tissue Causes a spontaneous pneumothorax in which air enters the pleural cavity and travels upward, beginning collapse of the lung from the top Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (22 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (22 of 39) • Other Conditions That Cause Respiratory Distress – Spontaneous Pneumothorax - Pathophysiology ▪ Primary spontaneous pneumothorax occurs in patients who have no underlying lung disease. ▪ Secondary spontaneous pneumothorax occurs in patients in which there is underlying lung disease. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (23 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (23 of 39) • Other Conditions That Cause Respiratory Distress – Spontaneous Pneumothorax -Assessment ▪ Spontaneous pneumothorax shows with sudden onset shortness of breath without evidence of trauma and decreased breath sounds to one side. ▪ When seated, absent breath sounds will be heard in the apex (top) of the lung. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (24 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (24 of 39) • Other Conditions That Cause Respiratory Distress – Spontaneous Pneumothorax - Treatment – If positive pressure ventilation is required, use the minimum tidal volume necessary. – CPAP is contraindicated. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (25 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (25 of 39) • Other Conditions That Cause Respiratory Distress – Hyperventilation Syndrome - Pathophysiology ▪ Associated emotional upset, excitation, and panic attacks. ▪ Breathing is faster and deeper than normal. ▪ Carbon dioxide levels decrease. ▪ Muscle cramps may occur in feet and hands. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (26 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (26 of 39) • Other Conditions That Cause Respiratory Distress – Hyperventilation Syndrome – Assessment ▪ The patient with true hyperventilation syndrome is in an emotionally charged situation. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (27 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (27 of 39) • Other Conditions That Cause Respiratory Distress – Hyperventilation Syndrome –Treatment ▪ Calm the patient and get them to slow their breathing. ▪ Administer oxygen if the Sp. O 2 is <94%. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (28 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (28 of 39) • Other Conditions That Cause Respiratory Distress – Epiglottitis - Pathophysiology ▪ Infection of the epiglottis leads to swelling that can obstruct the airway. ▪ Males and smokers are more commonly affected. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Epiglottitis Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Epiglottitis Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (29 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (29 of 39) • Other Conditions That Cause Respiratory Distress – Epiglottitis – Assessment ▪ History of upper respiratory infection, usually for one to two days prior to onset. ▪ Inspiratory stridor is an indication of an almost completely occluded airway. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (30 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (30 of 39) • Other Conditions That Cause Respiratory Distress – Epiglottitis – Treatment ▪ Administer oxygen. ▪ Keep the patient calm and comfortable. ▪ Do not inspect the airway. ▪ If ventilation is required, squeeze the bag slowly. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (31 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (31 of 39) • Other Conditions That Cause Respiratory Distress – Pertussis - Pathophysiology ▪ Contagious disease characterized by uncontrollable coughing followed by a “whooping” sound. ▪ Severe complications can lead to death. ▪ Preceded by signs and symptoms of upper respiratory infection. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (32 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (32 of 39) • Other Conditions That Cause Respiratory Distress – Pertussis - Assessment ▪ Three stages to recover: – Stage 1 - symptoms of common cold or upper respiratory infection. – Stage 2 - coughing continues to worsen to the point that medical care is sought. – Stage 3 - the recovery stage, usually gradual, taking several weeks. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (33 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (33 of 39) • Other Conditions That Cause Respiratory Distress – Pertussis - Treatment ▪ Place a surgical mask on the patient. ▪ Position them comfortably. ▪ Supplemental oxygen if Sp. O 2 is <94%. ▪ Expectorate any mucus. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (34 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (34 of 39) • Other Conditions That Cause Respiratory Distress – Cystic Fibrosis ▪ Hereditary disease affecting lungs, digestive system, and sweat glands. ▪ Death occurs in young adulthood, usually from pulmonary failure. ▪ Production of thick mucus leads to repeated respiratory infection. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (35 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (35 of 39) • Other Conditions That Cause Respiratory Distress – Poisonous Exposure - Pathophysiology ▪ Inhalation of toxins leads to hypoxia by various mechanisms, including: – Upper airway swelling – Displacement of oxygen in the atmosphere – Damage to the alveoli – Effects on the body upon entering the bloodstream Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (36 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (36 of 39) • Other Conditions That Cause Respiratory Distress – Poisonous Exposure - Assessment ▪ Criticality determinants – Length of exposure. – Open or enclosed space ▪ Exercise great personal caution when entering the scene of a potential toxic inhalation Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (37 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (37 of 39) • Other Conditions That Cause Respiratory Distress – Poisonous Exposure – Treatment ▪ Limit exposure to the toxin ▪ Open airway ▪ Position of comfort ▪ Oxygen at 15 l p m via non-rebreather ▪ PPV if needed ▪ Gather information about the poison itre er inute Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (38 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (38 of 39) • Other Conditions That Cause Respiratory Distress – Viral Respiratory Infections ▪ Includes colds, the flu, and bronchiolitis. ▪ Usually mild, but significant infections can occur. ▪ Assess for and treat both hypoxia and respiratory distress. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Pathophysiology of Conditions That Cause Respiratory Distress (39 of 39) • Other Conditions That

Pathophysiology of Conditions That Cause Respiratory Distress (39 of 39) • Other Conditions That Cause Respiratory Distress – Viral Respiratory Infections ▪ Maintain an Sp. O 2 of 94 percent or greater. ▪ Supplemental oxygen and, occasionally, mechanical ventilation can become warranted. ▪ Contact ALS for medication administration in patients with potential deterioration. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study Conclusion (1 of 5) Paul locates Mrs. Brown’s medications, finding that she

Case Study Conclusion (1 of 5) Paul locates Mrs. Brown’s medications, finding that she has both metered-dose inhalers and medications for use in a small-volume nebulizer. Jake questions Mrs. Brown about her recent use of the medications to determine if she is eligible for additional treatment, as Paul consults a drug reference to confirm the nature of the medications. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study Conclusion (2 of 5) Jake consults medical direction, and receives an order

Case Study Conclusion (2 of 5) Jake consults medical direction, and receives an order to administer medication from the metered-dose inhaler. As Jake assists Mrs. Brown with the medication, Paul completes baseline vital signs. They then assist Mrs. Brown to the stretcher and prepare for transport. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study Conclusion (3 of 5) Jake reassesses Mrs. Brown en route to the

Case Study Conclusion (3 of 5) Jake reassesses Mrs. Brown en route to the hospital, noticing some decrease in wheezing and a respiratory rate of 24, with an Sp. O 2 of 96 percent on 4 l p m of oxygen. itre er inute Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Metered-Dose Inhalers and Small-Volume Nebulizers (1 of 6) • Beta 2 specific bronchodilators can

Metered-Dose Inhalers and Small-Volume Nebulizers (1 of 6) • Beta 2 specific bronchodilators can be administered by MDIs or SVNs. • Bronchodilators cause relaxation of the bronchial smooth muscle. • Medication is dispensed as an aerosol, or mist, that the patient inhales. • Most bronchodilators begin to work almost immediately. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Meter-Dosed Inhaler Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Meter-Dosed Inhaler Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Small-Volume Nebulizer Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Small-Volume Nebulizer Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Metered-Dose Inhalers and Small-Volume Nebulizers (2 of 6) • Medications include: – Albuterol –

Metered-Dose Inhalers and Small-Volume Nebulizers (2 of 6) • Medications include: – Albuterol – Metaproterenol – Isoetharine – Bitolterol mesylate – Salmeterol xinafoate – Ipratropium – Levalbuterol – Pirbuterol Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Metered-Dose Inhalers and Small-Volume Nebulizers (3 of 6) • Indications – Patient is in

Metered-Dose Inhalers and Small-Volume Nebulizers (3 of 6) • Indications – Patient is in respiratory distress – Patient has physician-prescribed medication – Approval from medical direction Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Metered-Dose Inhalers and Small-Volume Nebulizers (4 of 6) • Contraindications – Patient is not

Metered-Dose Inhalers and Small-Volume Nebulizers (4 of 6) • Contraindications – Patient is not responsive enough to use the medication. – The medication is not prescribed to the patient. – Medical direction has not given permission. – The patient has taken the maximum number of doses. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Metered-Dose Inhalers and Small-Volume Nebulizers (5 of 6) • Side effects: – Tachycardia –

Metered-Dose Inhalers and Small-Volume Nebulizers (5 of 6) • Side effects: – Tachycardia – Tremors – Nervousness – Dry mouth – Nausea, vomiting Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Table 16 -3 Signs of Improvement During the Administration of CPAP • Reduction in

Table 16 -3 Signs of Improvement During the Administration of CPAP • Reduction in the complaint of dyspnea • Improved Sp. O 2 reading • Normal respiratory effort • Patient becomes more alert Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

EMT Skills 16 -2 Administering Medication by Metered-Dose Inhaler Copyright © 2018, 2014, 2010

EMT Skills 16 -2 Administering Medication by Metered-Dose Inhaler Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Consult with Medical Direction for an Order to Administer the Medication Copyright © 2018,

Consult with Medical Direction for an Order to Administer the Medication Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Check to Make Sure the Medication is for the Patient, That It is the

Check to Make Sure the Medication is for the Patient, That It is the Proper One to Administer, and That It Has Not Reached Its Expiration Date Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Shake the Inhaler Vigorously for at Least 30 Seconds Copyright © 2018, 2014, 2010

Shake the Inhaler Vigorously for at Least 30 Seconds Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Instruct the Patient to Inhale Slowly and Deeply for About Five Seconds. As the

Instruct the Patient to Inhale Slowly and Deeply for About Five Seconds. As the Patient Begins to Inhale, Depress the Canister Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Remove the Inhaler and Instruct the Patient to Hold the Breath for Ten Seconds

Remove the Inhaler and Instruct the Patient to Hold the Breath for Ten Seconds or for as Long as is Comfortable Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Instruct the Patient to Exhale Slowly Through Pursed Lips Copyright © 2018, 2014, 2010

Instruct the Patient to Exhale Slowly Through Pursed Lips Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Replace the Oxygen on the Patient. Reassess the Breathing Status and Vital Signs Copyright

Replace the Oxygen on the Patient. Reassess the Breathing Status and Vital Signs Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

EMT Skills 16 -3 Administering a Metered-Dose Inhaler with a Spacer Copyright © 2018,

EMT Skills 16 -3 Administering a Metered-Dose Inhaler with a Spacer Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Remove the Spacer Cap. Attach the Spacer to the Inhaler Mouthpiece Copyright © 2018,

Remove the Spacer Cap. Attach the Spacer to the Inhaler Mouthpiece Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Depress the Medication Canister to Fill the Spacer with Medication Copyright © 2018, 2014,

Depress the Medication Canister to Fill the Spacer with Medication Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Instruct the Patient to Inhale Slowly and Deeply The spacer may whistle if the

Instruct the Patient to Inhale Slowly and Deeply The spacer may whistle if the patient is inhaling too quickly. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

EMT Skills 16 -4 Administering Nebulized Medications Copyright © 2018, 2014, 2010 Pearson Education,

EMT Skills 16 -4 Administering Nebulized Medications Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Complete the Primary Assessment and Assess the Patient’s Pulse Rate and Breath Sounds Copyright

Complete the Primary Assessment and Assess the Patient’s Pulse Rate and Breath Sounds Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Select the Correct Medication and Consult with Medical Direction for an Order to Administer

Select the Correct Medication and Consult with Medical Direction for an Order to Administer the Medication Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Add the Medication to the Nebulizer Chamber Copyright © 2018, 2014, 2010 Pearson Education,

Add the Medication to the Nebulizer Chamber Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assemble the Nebulizer Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assemble the Nebulizer Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Coach the Patient to Inhale the Nebulized Medication from the Mouthpiece Copyright © 2018,

Coach the Patient to Inhale the Nebulized Medication from the Mouthpiece Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Reassess the Patient’s Pulse Rate and Breath Sounds Copyright © 2018, 2014, 2010 Pearson

Reassess the Patient’s Pulse Rate and Breath Sounds Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Click on the Medication that is NOT a Beta 2 Agonist Used in the

Click on the Medication that is NOT a Beta 2 Agonist Used in the Emergency Treatment of Patients with Respiratory Conditions A. Albuterol B. Levalbuterol C. Advair Diskus D. Metaproterenol Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Metered-Dose Inhalers and Small-Volume Nebulizers (6 of 6) • Advair: Not for Emergency Use

Metered-Dose Inhalers and Small-Volume Nebulizers (6 of 6) • Advair: Not for Emergency Use – Advair is a long-acting beta 2 -specific drug (salmeterol xinafoate) that also contains a steroid (fluticasone propionate) that is used as a maintenance drug. – Advair is not to be used as a rescue inhaler for the patient experiencing an acute asthma attack. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (1 of 12) • Pediatric Patients – Respiratory failure

Age-Related Variations: Pediatrics and Geriatrics (1 of 12) • Pediatric Patients – Respiratory failure is the most common cause of respiratory arrest and cardiac arrest. – Common causes are upper airway obstruction and lower airway diseases. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (2 of 12) • Respiratory Distress or Failure in

Age-Related Variations: Pediatrics and Geriatrics (2 of 12) • Respiratory Distress or Failure in the Pediatric Patient: Assessment and Care – Scene Size-Up and Primary Assessment ▪ Look for clues to help rule out trauma. ▪ Breathing difficulty can be spotted as you form your general impression. ▪ Assess mental status, airway, breathing, and circulation. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (3 of 12) • Respiratory Distress or Failure in

Age-Related Variations: Pediatrics and Geriatrics (3 of 12) • Respiratory Distress or Failure in the Pediatric Patient: Assessment and Care – Secondary Assessment - Distress ▪ Signs of respiratory distress typically precede failure in the infant or child. ▪ Recognize early signs and symptoms. ▪ Retractions appear to be more prominent early in respiratory. ▪ Acknowledge when they begin to use the intercostal muscles to assist in breathing. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (4 of 12) • Respiratory Distress or Failure in

Age-Related Variations: Pediatrics and Geriatrics (4 of 12) • Respiratory Distress or Failure in the Pediatric Patient: Assessment and Care – Secondary Assessment - Failure – Bradycardia – Hypotension – Slow, fast, or irregular breathing – Loss of muscle tone Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (5 of 12) • Respiratory Distress or Failure in

Age-Related Variations: Pediatrics and Geriatrics (5 of 12) • Respiratory Distress or Failure in the Pediatric Patient: Assessment and Care – Emergency Medical Care ▪ Allow child to assume a comfortable position. ▪ Do not remove child from their caregiver. ▪ Apply supplemental oxygen. ▪ If breathing becomes inadequate remove them from the parent, establish an open airway, and begin PPV. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

If the Child Does Not Tolerate the Mask, Have the Parent Hold the Mask

If the Child Does Not Tolerate the Mask, Have the Parent Hold the Mask Near the Child’s Face Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (6 of 12) • Respiratory Distress or Failure in

Age-Related Variations: Pediatrics and Geriatrics (6 of 12) • Respiratory Distress or Failure in the Pediatric Patient: Assessment and Care – Emergency Medical Care ▪ Upper airway obstruction from foreign body or disease ▪ Croup ▪ Epiglottitis Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (7 of 12) • Respiratory Distress or Failure in

Age-Related Variations: Pediatrics and Geriatrics (7 of 12) • Respiratory Distress or Failure in the Pediatric Patient: Assessment and Care – Reassessment ▪ Transport any infant or child with difficulty breathing. ▪ Provide reassessment en route. ▪ Be prepared to intervene. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (8 of 12) • Geriatric Patients – Respiratory distress

Age-Related Variations: Pediatrics and Geriatrics (8 of 12) • Geriatric Patients – Respiratory distress has many causes in geriatric patients. – Respiratory function may already be diminished. – Can progress rapidly from respiratory distress to respiratory failure. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (9 of 12) • Respiratory Distress or Failure in

Age-Related Variations: Pediatrics and Geriatrics (9 of 12) • Respiratory Distress or Failure in the Geriatric Patient: Assessment and Care – Scene Size-Up and Primary Assessment ▪ Look for clues to help rule out trauma ▪ Labored or noisy breathing ▪ Tripod position ▪ Unresponsiveness ▪ Additional signs and symptoms will be discovered as you contact the patient Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (10 of 12) • Respiratory Distress or Failure in

Age-Related Variations: Pediatrics and Geriatrics (10 of 12) • Respiratory Distress or Failure in the Geriatric Patient: Assessment and Care – Secondary Assessment ▪ Respiratory distress can quickly proceed to respiratory failure. ▪ Elderly patients decompensate rapidly. ▪ It is difficult for the geriatric patient to move the rib cage. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (11 of 12) • Respiratory Distress or Failure in

Age-Related Variations: Pediatrics and Geriatrics (11 of 12) • Respiratory Distress or Failure in the Geriatric Patient: Assessment and Care – Secondary Assessment ▪ Respiratory arrest is a condition in which there are no respirations. ▪ A pulse is still present. ▪ You must immediately intervene and begin positive pressure ventilation. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Age-Related Variations: Pediatrics and Geriatrics (12 of 12) • Respiratory Distress or Failure in

Age-Related Variations: Pediatrics and Geriatrics (12 of 12) • Respiratory Distress or Failure in the Geriatric Patient: Assessment and Care – Emergency Medical Care ▪ Comfortable position. ▪ If the Sp. O 2 is <94% or respiratory distress, hypoxia, hypoxemia, or poor perfusion are present, administer oxygen via a nasal cannula. – Reassess en route to the ED Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (1 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (1 of 13) • Assessment-Based Approach: Respiratory Distress – Scene Size-Up ▪ Look for clues to the condition. ▪ Scan the scene for possible MOI. ▪ Scan the scene for alcohol, which is a common contributor to choking and upper airway obstruction and aspiration of vomitus. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (2 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (2 of 13) • Assessment-Based Approach: Respiratory Distress – Primary Assessment ▪ Form a general impression. ▪ Assess mental status. ▪ Assess airway. ▪ Assess breathing. ▪ Assess circulation. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

A Patient in Respiratory Distress is Commonly Found in a “Tripod” Position Copyright ©

A Patient in Respiratory Distress is Commonly Found in a “Tripod” Position Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (3 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (3 of 13) • Assessment-Based Approach: Respiratory Distress – Primary Assessment ▪ Mental status – Look for restlessness, agitation, confusion, unresponsiveness. ▪ Airway – Assess the airway for any indication of a complete or partial obstruction. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (4 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (4 of 13) • Assessment-Based Approach: Respiratory Distress – Primary Assessment ▪ Breathing – Look at the chest rise and fall – Listen and feel for air flowing – Auscultate the lungs – Determine approximate respiratory rate – Shallow breathing is an indication of inadequate breathing Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (5 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (5 of 13) • Assessment-Based Approach: Respiratory Distress – Primary Assessment ▪ Inadequate breathing – Provide positive pressure ventilation. ▪ Adequate breathing – Administer oxygen. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (6 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (6 of 13) • Assessment-Based Approach: Respiratory Distress – Primary Assessment ▪ Assess circulation – Inspect the skin and mucous membranes. – Assess the heart rate. ▪ Establish priority – A patient with difficulty breathing is a priority patient. – Consider ALS backup and rapid transport. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (7 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (7 of 13) • Assessment-Based Approach: Respiratory Distress – Secondary Assessment ▪ History – OPQRST – Evaluate the chief complaint. – Allergies. – Medications. – History of respiratory or cardiac problems. – Hospitalizations for chronic conditions. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Table 16 -4 Signs of Deterioration During the Administration of CPAP • Increasing respiratory

Table 16 -4 Signs of Deterioration During the Administration of CPAP • Increasing respiratory rate • Lethargy • Patient more exhausted and fatigued • Speechlessness • Abdomen moves inward with inhalation and outward with exhalation • Decreasing Sp. O 2 reading Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Table 16 -6 MDI Administration Dos and Don’ts (1 of 3) When administering a

Table 16 -6 MDI Administration Dos and Don’ts (1 of 3) When administering a metered-dose inhaler, follow these tips: Do Instruct the patient to breathe in slowly and deeply. Be sure the patient is breathing in through his mouth. Shake the canister for at least 30 seconds before removing the cap. If the MDI has not been used for a couple of days, “prime” the MDI by pointing it away from the patient and depressing the canister a couple of times. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Table 16 -6 MDI Administration Dos and Don’ts (2 of 3) Depress the canister

Table 16 -6 MDI Administration Dos and Don’ts (2 of 3) Depress the canister as the patient begins to inhale. Coach the patient to hold his breath as long as possible (10 seconds). Use a spacer or preferably a valved holding chamber device if available and the patient is used to it. Don’t Allow the patient to breathe in too quickly. Allow the patient to breathe in through his nose. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Table 16 -6 MDI Administration Dos and Don’ts (3 of 3) Administer the medication

Table 16 -6 MDI Administration Dos and Don’ts (3 of 3) Administer the medication before shaking the canister. Depress the canister before the patient begins to inhale. Forget to coach the patient to hold his breath as long as possible. The patient may experience a variety of side effects from the medication. The most common are an increased heart rate, tremors, and nervousness. More detailed information about bronchodilators and other side effects are listed in Figure 16 -11. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (8 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (8 of 13) • Assessment-Based Approach: Respiratory Distress – Secondary assessment ▪ Physical exam – Look for cyanosis. – JVD, tracheal deviation, and retractions. – Auscultate the lungs. – Check vital signs and pulse oximetry. – Look for signs of difficulty breathing. – Evaluate the level of difficulty breathing. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (9 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (9 of 13) • Assessment-Based Approach: Respiratory Distress – Secondary assessment ▪ Physical exam – Signs and Symptoms – Perform an accurate assessment. – The severity of shortness of breath does not directly correlate with the level of hypoxia. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (10 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (10 of 13) • Assessment-Based Approach: Respiratory Distress – Emergency Medical Care ▪ Inadequate Breathing – Establish an open airway. – Begin positive pressure ventilation. – Transport expeditiously. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (11 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (11 of 13) • Assessment-Based Approach: Respiratory Distress – Emergency Medical Care ▪ Adequate Breathing – Administer oxygen. – Assess baseline vital signs. – Determine if the patient has an MDI. – Place the patient in a position of comfort. – Complete the secondary assessment. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (12 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (12 of 13) • Assessment-Based Approach: Respiratory Distress – Reassessment ▪ Look for improvement or diminishment in respiratory distress or respiratory failure. ▪ Assess the mental status and airway. ▪ Provide positive pressure ventilation, if needed. ▪ The patient with breathing difficulty is considered a priority patient. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Assessment and Care General Guidelines (13 of 13) • Assessment-Based Approach: Respiratory Distress –

Assessment and Care General Guidelines (13 of 13) • Assessment-Based Approach: Respiratory Distress – Reassessment ▪ Monitor respiratory rate and tidal volume. ▪ Closely monitor the Sp. O 2. ▪ Monitor the heart rate. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study Introduction (3 of 3) EMTs Troy Steel and Oscar Herzog are caring

Case Study Introduction (3 of 3) EMTs Troy Steel and Oscar Herzog are caring for 5 -yearold Sarah Gross, who has a history of asthma and began having difficulty breathing at daycare. Sarah is coughing, and the EMTs can hear wheezing without using a stethoscope. Sarah appears a bit pale, but is alert and cooperative. Sarah's teacher hands Oscar a metered-dose inhaler, telling him it belongs to Sarah. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study (5 of 7) • What anatomical and physiological differences should the EMTs

Case Study (5 of 7) • What anatomical and physiological differences should the EMTs keep in mind when assessing a patient of Sarah’s age? • What information is needed before the EMTs consider administering medication by metered-dose inhaler? Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study (6 of 7) Troy asks the teacher for the original packaging for

Case Study (6 of 7) Troy asks the teacher for the original packaging for the MDI to confirm the medication belongs to Sarah, and also confirms that Sarah has not already received any of the medication. Because of Sarah’s age, protocol requires Troy to contact medical direction for an order, which he does. After hearing the report on Sarah’s condition, the physician orders the use of the MDI. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study (7 of 7) • What are the steps Troy will use in

Case Study (7 of 7) • What are the steps Troy will use in administering the MDI? • What will Troy look for to determine the effect of the medication? Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study Conclusion (4 of 5) Troy coaches Sarah through two inhalations from the

Case Study Conclusion (4 of 5) Troy coaches Sarah through two inhalations from the MDI. En route to the hospital, Troy reassesses Sarah, and finds that her wheezing has nearly resolved, with only faint, scattered expiratory wheezes heard on auscultation. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Case Study Conclusion (5 of 5) Sarah’s respiratory rate has decreased from 24 to

Case Study Conclusion (5 of 5) Sarah’s respiratory rate has decreased from 24 to 20 per minute, her Sp. O 2 has remained steady at 98 percent, and her heart rate has increased from 88 to 96. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Lesson Summary (1 of 4) • Respiratory emergencies range from respiratory distress, to respiratory

Lesson Summary (1 of 4) • Respiratory emergencies range from respiratory distress, to respiratory failure, to respiratory arrest. • There are many causes of respiratory emergencies. • Infants, children, and geriatric patients can present differently than adults when experiencing a respiratory emergency. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Lesson Summary (2 of 4) • No matter the underlying cause, respiratory emergencies have

Lesson Summary (2 of 4) • No matter the underlying cause, respiratory emergencies have many signs and symptoms in common. • EMTs must know when to administer oxygen and must recognize when to provide positive pressure ventilation. • Respiratory compromise is the most common cause of cardiac arrest in pediatric patients. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Lesson Summary (3 of 4) • Some patients with histories of respiratory conditions have

Lesson Summary (3 of 4) • Some patients with histories of respiratory conditions have metered-dose inhalers or small-volume nebulizers to deliver beta 2 agonists, which act as bronchodilators. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Lesson Summary (4 of 4) • Infants, children, and geriatric patients may present differently

Lesson Summary (4 of 4) • Infants, children, and geriatric patients may present differently than adults with respiratory problems, and the EMT must be prepared to intervene promptly. • Reassessment is a critical step in the management of patients with respiratory emergencies. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Correct! (1 of 2) Emphysema is characterized by destruction of alveolar walls with loss

Correct! (1 of 2) Emphysema is characterized by destruction of alveolar walls with loss of elasticity and distention of the alveoli, which impairs gas exchange and increases resistance in the airway. Click here to return to the program. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Incorrect (1 of 6) The obstruction of blood flow through the pulmonary arteries, often

Incorrect (1 of 6) The obstruction of blood flow through the pulmonary arteries, often from a blood clot, is called a pulmonary embolism, which leads to decreased lung perfusion, despite normal ventilation. Click here to return to the quiz. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Incorrect (2 of 6) Inflammation of the bronchi and bronchioles, with increased mucus production

Incorrect (2 of 6) Inflammation of the bronchi and bronchioles, with increased mucus production and persistent coughing is characteristic of chronic bronchitis. Click here to return to the quiz. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Incorrect (3 of 6) When a lung suddenly partially collapses without a history of

Incorrect (3 of 6) When a lung suddenly partially collapses without a history of trauma, this is known as spontaneous pneumothorax. Click here to return to the quiz. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Correct! (2 of 2) Advair Diskus is a combination of a long-acting beta 2

Correct! (2 of 2) Advair Diskus is a combination of a long-acting beta 2 agonist and a steroid and is not intended for use in a respiratory emergency. Click here to return to the program. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Incorrect (4 of 6) Albuterol is a beta 2 agonist that may be used

Incorrect (4 of 6) Albuterol is a beta 2 agonist that may be used in a respiratory emergency. Click here to return to the quiz. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Incorrect (5 of 6) Levalbuterol is a beta 2 agonist that may be used

Incorrect (5 of 6) Levalbuterol is a beta 2 agonist that may be used in a respiratory emergency. Click here to return to the quiz. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Incorrect (6 of 6) Metaproterenol is a beta 2 agonist that may be used

Incorrect (6 of 6) Metaproterenol is a beta 2 agonist that may be used in a respiratory emergency. Click here to return to the quiz. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved