Respiratory Emergency

‫ب س ماللهال ر حم نال ر ح يم‬
Medical Emergeny
By
Assist Prof. Dr. Tarik Sarhan
Medical Emergeny
By
CHAPTER 16
Respiratory
Emergencies
Medical Emergeny
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Medical Emergeny
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Medical Emergeny
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RESPIRATORY
Introduction
DISTRESS IS USUALLY
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CAUSED BY
RESPIRATORY
SYSTEM PROBLEMS.
Epidemiology

Medical Emergeny
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Respiratory disease is one of the most Respiratory distress is one of the most
common pathologic conditions. common EMS dispatches.
Asthma and COPD are among the top

10 chronic conditions causing
restricted activity.
Pneumonia is one of the most
common fatal illnesses in developing
countries.
Epidemiology

 Some respiratory diseases are genetic while others are caused by
Medical Emergeny
external factors.
 Many respiratory diseases are caused by a combination of factors.
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 Intrinsic factors, such as genetics, cardiac disease, and even stress,
are thought to combine with extrinsic factors, such as smoking and
environmental pollutants.
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Anatomy and Physiology
RESPIRATORY SYSTEM STRUCTURES LOOK LIKE AN INVERTED TREE.
Structures of the
Lower Airway

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 Tracheobronchial tree
…..Trachea—trunk of tree
Carries air to the lungs
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
 Extends from the larynx to the

mainstem bronchi
 The point at which the tracheal
cartilage bifurcates is called the
carina.
 The carina is at roughly the level
of the fifth intercostal space.
Structures of the
Lower Airway

Medical Emergeny
 In adults, the right mainstem bronchus
typically branches at a less acute angle than
the left. This explains why an endotracheal
By
(ET) tube that is advanced too far almost
always goes into the right mainstem bronchus
in an adult.
 Similarly, aspirated foreign bodies often end
up in the right mainstem bronchus.
Structures of
 Tracheobronchial tree (cont’d)

 Mainstem bronchi branch into:
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the Lower 

Lobar bronchi
Segmental bronchi
Airway
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 Subsegmental bronchi
 Bronchioles
Structures of the Lower Airway
 Bronchi and bronchioles are lined with cilia.

Medical Emergeny
Inset photo: © Dr. Kessel &
Dr. Kardon/Tissue &
Organs/Visuals Unlimited.
© Dr. Kessel & Dr.
Kardon/Tissue &
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Organs/Visuals Unlimited
Inset photo: © Dr. Kessel &
Dr. Kardon/Tissue &
Organs/Visuals Unlimited.
Structures of the
Lower Airway

Medical Emergeny
 Bronchioles
 Significant amount of gas
exchange
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 The terminal bronchioles are thin
and have little cellular structure
 This anatomic design is helpful for
gas exchange, but it also means
the bronchioles lack cilia, have no
protective blanket of mucus, and
are not shielded by smooth
muscle or more rigid structures.
Structures of
 Alveoli

 Gas exchange interface
Medical Emergeny
the Lower  Deoxygenated blood releases carbon dioxide
and is resupplied with oxygen.
Airway  Made up of two types of cells:
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 Type I: almost empty
 Type II: can make new type I cells
Structures of the
Lower Airway

Medical Emergeny
 Alveoli (cont’d)
 Function best when kept
partially inflated
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 Collapsed, fluid-filled, or pus-
filled alveoli do not play a
part in gas exchange.
Structures of
 Alveoli (cont’d)

 Pulmonary capillary bed
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the Lower  Pulmonary circulation starts at the right
ventricle.
Airway  Pulmonary capillaries are narrow.
By
 Patients with chronic lung disease and
chronic hypoxia often have thick blood
(polycythemia).
 Strains right side of heart, leads to cor
pulmonale
of the
Lower
Airway
Structures
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Structures of
 Chest wall

 Forms a bellows system with chest muscles
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the Lower  The diaphragm is the primary muscle.
Causes pressure changes to move air in and
Airway

out
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 Ribs maintain pressure.
 Pleural membranes allow organs to move
smoothly.
Structures of the Lower
Airway

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 Chest wall (cont’d)
 Trauma and diseases of the bones and muscles can
significantly impair air movement.
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 Causes restrictive lung diseases
Heart

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Large blood vessels
Structures of Mediastinum:
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Consists of:
middle of the chest
the Lower
The large
conducting
(trachea and
Airway mainstem bronchi)
Other organs
Respiration

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Functions of
process of oxygen taken into
By
the body and distributed to the cells
Respiratory for energy
System
Carbon dioxide is returned to the
lungs by the circulatory system
and exhaled.
Ventilation

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Functions of • Movement of air in and out of
the lungs
By
the
Respiratory • Best measured by the carbon
System dioxide level
• PACO2 must be 35 to 45 mm
Hg for normal ventilation.
Diffusion

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• For oxygen to go from an
Functions of alveolus to a red blood cell, it
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the must:
Respiratory • Diffuse into the alveolar cell
System and out the other side.
• Diffuse into the capillary wall
and out the other side.
Perfusion

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•Circulatory component of
Functions of respiratory system
•If blood does not flow through the
By
the pulmonary vessels, then good
Respiratory ventilation and diffusion are wasted
System •Blood must keep flowing through
pulmonary vessels.
•A large embolus can block blood
flow to the lung.
Mechanisms of Respiratory Control

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Neurologic control
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•Centered in the medulla
•At least four parts of brainstem
responsible for unconscious breathing

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Neurologic control (cont’d)
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•Other neurologic control mechanisms:
•Phrenic nerve innervates diaphragm.
•Thoracic spinal nerves innervate intercostal
muscles.

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Cardiovascular regulation
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•Lungs closely linked to cardiac function
•Heart changes have pulmonary consequences.
•Left-sided heart failure progresses faster than
right-sided heart failure.

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Cardiovascular regulation (cont’d)
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•Mild hypoxia causes increase in heart rate
•Severe hypoxia causes bradycardia.
•Uncorrected hypoxic insults may trigger lethal
cardiac arrhythmia.
Muscular

control
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• Body takes in air
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by negative
pressure
• Air through
mouth and nose,
over turbinates,
around epiglottis
and glottis

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Muscular control (cont’d)
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•Thorax: airtight box with diaphragm at bottom
and trachea at top
•Diaphragm flattens during quiet breathing.
•Air is sucked in to fill the increasing space.

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Muscular control (cont’d)
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• Minute ventilation can be increased by:
• Deep breathing
• Rapid breathing
• Accessory muscles cause dramatic pressure changes
when greater amounts of air must be moved.
Muscular

control (cont’d)
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•Traumatic opening
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in thorax provides
route for air to be
sucked in
•Sucking chest
wound
•Exhalation is a
passive process.

Medical Emergeny
Renal status
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•Kidneys play a part in controlling:
•Fluid balance
•Acid-base balance
•Blood pressure
•Factor into pulmonary mechanics and oxygen delivery to
body tissues
Hypoventilation
1 2 3
Carbon dioxtheide Combines with Results in acidosis
accumulates in the water to form
blood when lungs fail bicarbonate ions
to work well. and hydrogen ions
Hypoventilation
IMPAIRED VENTILATION IS
CAUSED BY A VARIETY OF
FACTORS.
Hypoventilation
Carbon dioxide
level is directly
related to pH
Hyperventilating Hypoventilating
patients usually patients usually
have respiratory have respiratory
alkalosis. acidosis.
Hypoventilation
Causes of hypoventilation include
Conditions that impair lung function
•Atelectasis
•Pneumonia
•Pulmonary edema
•Asthma
•COPD
Hypoventilation
Conditions that impair mechanics of

breathing
•High cervical fracture
•Flail chest
•Severe retractions
•Air- or blood-filled abdomen
•Obesity hypoventilation syndrome
Hypoventilation
Conditions that impair neuromuscular apparatus
• Head trauma, intracranial infections, brain

tumors
• Serious spinal cord injury
• Guillain-Barre syndrome
• Botulism, Clostridium botulinum. food poisoning
Hypoventilation
Conditions that reduce

respiratory drive
•Intoxication with alcohol,
narcotic……..
•Head injury
Hypoventilation
The ultimate
manifestation is
respiratory arrest followed
by cardiac arrest.
Initiate aggressive
treatment to assist the
patient’s respiratory
efforts.
Hyperventilation
Occurs when people breathe in excess by

increasing rate and/or depth of respiration
• Releases more carbon dioxide than normal
• Results in alkalosis
• WhenTriggered by emotional distress or panic: hysterical
hyperventilation or hyperventilation syndrome
Hyperventilation that is not caused by some

metabolic crisis is usually self-limiting.
Hyperventilation
Causes numbness in hands, feet, and

mouth
Ultimately leads to carpopedal spasm
Symptoms often cause more

hyperventilation.
Hyperventilation
Having patient rebreathe carbon dioxide can be

dangerous.
• Patients quickly exhaust the oxygen in the gas they are breathing.
• Hyperventilation in a patient with acidosis may be the body’s attempt to
raise the pH level.
Never conclude that a patient is “just hyperventilating” until

all possible causes of the presentation have been ruled out,
which is difficult or perhaps impossible in the field.
Hyperventilation
• Sedation
• Psychological
support:
Treatment • Breathing with the

patient
may • Having the patient

count to two
include: between breaths
• Distraction
techniques
• Having the patient
sing a song
Assessment of a Patient with
Dyspnea
 Respiratory assessment includes much more than listening to the
patient’s lungs.
 Many respiratory ailments are life threatening.
 Respiratory assessment should be done early.
Scene Size-Up
 Observe standard precautions.

 Use proper PPE.
 Evaluate scene safety for:
 Decreased oxygen concentrations
 Carbon monoxide
 Irritant gasses
 Highly contagious respiratory illness
Primary Assessment
The first priority in assessing and

managing any respiratory condition
is to establish and maintain an open
airway.
Primary Assessment
Form a general impression.
•Body type may be

associated with condition
•Emphysema: barrel chest,
muscle wasting, pursed-lip
breathing, tachypneic
Primary Assessment
Chronic bronchitis: more sedentary and

may be obese as a result. You are likely to
encounter such a patient in a chair or
recliner, in which he or she sleeps in an
upright position. A wastebasket nearby
may overflow with tissues, and you may see
an ashtray filled with cigarette butts or a
cup into which the patient spits his or her
copious secretions.
Primary Assessment
Severely ill patients with

immune system disorders
and those with cancer or
other end-stage diseases
are often easy to identify
by their sickly
appearance
Primary Assessment
Note Position and
Determine Degree of
Distress
• Prefer sitting positions,
such as tripod position
• Lying flat may be a sign
of sudden deterioration.
• Ominous sign: head
bobbing
Primary Assessment
Assess Oxygen Demand and Work of Breathing
•Observe condition during typical exertion.

•Tachycardia, diaphoresis, and pallor can be
triggered by:
•Increased work of breathing
•Anxiety
•Hypoxia
•fever
Primary Assessment
Increased work of
breathing
•Patients using accessory
muscles to breathe are in
danger of tiring out.
•Infants and small
children are in danger of
collapse of flexible
sternum cartilage.
Primary Assessment
Increased work of
breathing (cont’d)
•Profound
intrathoracic
pressure changes
can cause
peripheral pulses to
weaken or
disappear.
Primary Assessment
Altered rate and depth of respiration
• Patient with adequate rate but low volume will

have inadequate minute volume.
• Respiratory rate × tidal volume = minute
volume
• Monitor trends in respiratory rates.
• Note the pattern and inspiratory-to-expiratory
(I/E) ratio.
Primary Assessment
Abnormal breath
sounds
•Auscultate lungs
systematically.
•Some conditions are
gravity-dependent
and others diffuse
throughout the lungs.
Primary Assessment
Abnormal breath sounds

(cont’d)
•Breath sounds are created by
airflow in the large airways.
Primary Assessment
Primary Assessment
Abnormal breath sounds (cont’d)
• Some conditions cause normal breath

sounds to be heard in abnormal places.
• Sounds move better through fluid than in air.
• Quality of sounds is dependent on the
amount of tissue between stethoscope and
structures.
Primary Assessment
Abnormal breath
sounds (cont’d)
•Continuous: wheezes
•Discontinuous: crackles
•Rales
•Rhonchi
•Pleural friction rub
Primary Assessment
Abnormal breath sounds (cont’d)
• Audible sounds include:

• Stridor—upper airway obstruction
• Snoring: Partial obstruction of the upper airway by the
tongue
• Gurgling: Fluid in the upper airway
• Grunting—lower airway obstruction
• Death rattle—patients can’t clear secretions
• The most ominous sounds are no sounds.
• Silence means danger.
Primary Assessment
Sputum
•Has color or
amount
changed from
normal?
Primary Assessment
Abnormal breathing patterns
• May indicate neurological insults

• Brain trauma or any disturbance may
depress respiratory control centers in the
medulla.
• Brain injuries may damage or deprive
blood flow.
Primary Assessment
Primary Assessment
 Most respiratory centers are in and around the brainstem.
Primary Assessment
Circulation
•Assess skin color.

•Note generalized
cyanosis.
•Pink in healthy © Logical Images/Custom Medical Stock Photo
patients
Primary Assessment
Cyanosis
•Healthy hemoglobin levels: 12 to 14 g/dL

•Cyanosis begins at about 5 g/dL desaturation
•Chocolate brown skin
•May occur from high levels of methemoglobin
•Pale skin
•Caused by a blood flow reduction to small
vessels
Primary Assessment
Transport decisions
• Usually transported to closest hospital

• If available, consider pediatric centers.
• If renal failure, consider a facility that can provide
emergency dialysis.
• If multiple emergency departments are available,
consider taking patient to his or her preferred
facility.
History Taking
Increased
cough
Change
Chest in amount
pain or color of
sputum
Investigate
chief
complaint
Dyspnea Fever
Wheezing
History Taking
• Asthma with fever
• Failure of a metered-dose
inhaler
• Travel-related problems
• Dyspnea triggers
• Seasonal issues
• Noncompliance with therapy
• Failure of technology or
running out of medicine
Patient may
know exact
problem.
History Taking
• Signs and symptoms
SAMPLE history
• Allergies
• Medications
SAMPLE • Antihistamines
• Antitussives
• Bronchodilators
• Diuretics
• Expectorants
• past medical history
• Last oral intake
• Events preceding the onset of the
complaint
Secondary Assessment
• Note level of
consciousness.
• Decline in PaO2:
restlessness, confusion,
and combative
Neurologic behavior
• Increase in PaCO2:
assessment sedative effects
• If lungs are not functioning
correctly, oxygen may not
be delivered and carbon
dioxide may not be
removed.
• Jugular
venous
distention
• Common
Neck with
asthma or
exam COPD
• Rough
measure of
pressure in
right atrium © ejwhite/ShutterStock, Inc.
Neck • Note trachea for
exam deviation.
• Sign of tension
(cont’d) pneumothorax
Courtesy of Stuart Mirvis, MD

•Chest or
abdominal
trauma can cause
Chest and respiratory distress
abdominal by a variety of
mechanisms .
exam •Feel for vibrations
in the chest as the
patient breathes.
• Edema
• Cyanosis.
Examination
• Pulse
of the © Jones & Bartlett Learning. Photographed by Kimberly Potvin.
extremities • Temperature
• Distal
clubbing
© Mediscan/Visuals Unlimited
• Patients under
stress can be
Vital signs expected to have
tachycardia and
hypertension.
• Bradycardia
Ominous • Hypotension
signs: • Falling respiratory
rates
•Diaphragm is for
high-pitched
sounds.
•Bell is for low-
Stethoscope pitched sounds.
•The longer the
tubing, the more
extraneous noise
that is heard.
Pulse Oximetry
•simple, rapid,
safe, and
noninvasive
•measure the
Pulse percentage of
oximeter hemoglobin with
oxygen attached
•Oxygen
saturation over
95% = normal
Pulse Oximetry
Oxygen saturation should

match patient’s palpated
heart rate.
Does not differentiate

between oxygen or carbon
monoxide molecules
Pulse Oximetry
Pulse Oximetry
 Used for:
 Monitoring oxygenation status during intubation attempt or suctioning
 Identifying deterioration in a patient with trauma or cardiac disease
 Identifying high-risk patients patients with respiratoryconditions
 Assessing vascular status in orthopaedic trauma
Pulse Oximetry
 Erroneous readings
may result from:
 Bright ambient light  Nail polish
(cover clip)
 Venous pulsations
 Patient motion
 Abnormal hemoglobin
 Poor perfusion
End-tidal Carbon Dioxide
Assessment
 Carbon dioxide can be described as the “smoke of metabolism.”
Assessment
End-tidal •detect the

carbon presence
dioxide of carbon
(etco2) dioxide in
monitors exhaled
or detector air: 3 types
Assessment
Courtesy of Marianne Gausche-Hill, MD, FACEP, FAAP
•indicates whether
carbon dioxide is
present in
reasonable
A amounts
•between the ET
colorimetric tube and
carbon ventilation device.
•After 6-8 positive-
dioxide pressure the
detector specially-treated
paper inside the
detector should
turn from purple to
yellow
End-tidal CO2 Assessment
• might give a false- Courtesy of Marianne Gausche-Hill, MD, FACEP, FAAP
positive reading if the

patient has carbon
dioxide trapped in the
Colorimetric stomach
• sensitive to extremes of
CO2 temperature and
humidity; it may be less
detector reliable if vomitus or
other secretions get
Limitation inside it;
• the paper inside the
device degrades over
time, resulting in a less
reliable reading.
End-tidal CO2 Assessment
• is a “spot-check”
Courtesy of Marianne Gausche-Hill, MD, FACEP, FAAP
device;you may
use it during initial
Colorimetric confirmation of ET
tube placement,
CO2 • but you should
detector replace it as soon
as possible with a
Limitation more accurate
and reliable
quantitative
device.
Assessment
• provides quantitative
information, in real time, by
displaying a numeric
reading of exhaled carbon
dioxide levels.
• It uses a special adapter,
which attaches between
Capnometer the advanced airway
device and ventilation
device
• Because it provides
quantitative data, the
capnometer is more
reliable than the
colorimetric co2 detector.
Assessment
• provides a graphic
representation of
exhaled carbon
dioxide levels.
Capnogra • It performs the same

function and attaches
pher in the same way as the

capnometer.
• The two types of
capnographers are
waveform and
digital/waveform.
Waveform capnography
 provides quantitative, real-time information

 displays a graphic waveform (Unlike capnometry) .
 has many applications in emergency medicine
 detection of bronchospasm, hypoventilation, and hyperventilation.
 capnography is the recommended method of monitoring initial and
ongoing placement of an advanced airway device.
 Capnography can also serve as an indicator of the effectiveness of
chest compressions and to detect return of spontaneous circulation
(ROSC).
LIFEPAK® defibrillator/monitor. Courtesy of Medtronic.
End-tidal Carbon Dioxide (ETCO2)
Assessment
 Phase A–B: initial stage of
exhalation
 Phase B–C: expiratory upslope
 Phase C–D: expiratory or
alveolar plateau
 Phase D–E: inspiratory down
stroke
 Phase I (A-B) : the respiratory baseline, the initial stage of exhalation; the
gas sample is dead space gas, free of carbon dioxide.
 Phase II (B-C) : the expiratory upslope.
 At point B, alveolar gas mixes with dead space gas, resulting in an abrupt rise in
carbon dioxide levels.
 phase III (C-D): The expiratory or alveolar plateau , the gas sampled is
essentially alveolar.
 Point D is the maximal etco2 level—the best reflection of the alveolar carbon
dioxide level.
 The height of the waveform at point D correlates with the numeric value of
exhaled carbon dioxide that is also displayed on the cardiac
monitor/defibrillator.
 phase IV (D-E) : the inspiratory downstroke, causing the waveform to return
to the baseline level of carbon dioxide— approximately 0 mm Hg.
Peak Expiratory Flow
 Measured to evaluate
bronchoconstriction
 Increasing: patient is
responding to
treatment
 Decreasing: patient’s
condition is
deteriorating
 Perform three times
and take the best
rate.
Arterial Blood Gas Analysis
 Blood is analyzed for pH,
PaO2, HCO3−, base excess,
and SaO2.
 pH, HCO3−: acid-base
status
 PaCO2: effectiveness of
ventilation
 PaO2 and SaO2:
oxygenation
Reassessment
Contact medical control to report any

change in the patient’s level of consciousness
or any increased difficulty breathing.
Document any changes, noting the time at

which they occurred, and document any
orders given by medical control.
 Interventions
 Oxygen (keep saturations above 93%)
 IV line
 Psychological support
Reassessment
 Interventions (cont’d)
 Sympathetic: speeds heart
rate
 Parasympathetic: slows heart
rate
 Anticholinergic medications
block the parasympathetic
response.
Reassessment
 Interventions (cont’d)
 Ipratropium is used today.
 Combination of albuterol and ipratropium
 Anticholinergics are a central component to manage COPD.
Reassessment
 Aerosol therapy
 Nebulizers deliver fine mist of liquid medication.
 Need gas flow of at least 6 L/min to keep particles optimal size.
Reassessment
 Aerosol therapy (cont’d)

 A nebulizer can be attached to:
 A mouthpiece
 Face mask
 Tracheostomy collar
 Can also be held in front of the patient’s face (blow-by technique)
Reassessment
 Aerosol therapy (cont’d)

 Can disperse other drugs through aerosols:
 Corticosteroids
 Anesthetic agents
 Antitussives
 Mucolytics
Reassessment
 Metered-dose inhalers
 Small, easy to carry and
use, convenient
 Ambulance metered-
dose inhalers should have
spacers.
Reassessment
 Metered dose inhalers (cont’d)

 To avoid common errors:
 Inhale deeply at discharge.
 Suck medication out of the bottom.
 Flow should be smooth and low-pressure.
 Inhale deeply; hold breath for a few seconds.
 Make sure the inhaler contains medication.
 Keep the spacer and canister holder clean.
 After using corticosteroid inhaler, rinse mouth.
Reassessment
 Failure of a metered-dose inhaler

 Must be properly used.
 Contraindicated if patient cannot move enough air into the lungs.
 Patient may not realize the inhaler is empty.
 Patient may inhale at the wrong time.
Reassessment
 Dry powder inhalers

 May be dispensed by means of a plastic disk
 Patient inhales deeply to suck out the powder.
 Other devices require the patient to insert a capsule of powdered
medication.
Reassessment
 Communication and documentation

 Contact medical control:
 To report change in level of consciousness or increased breathing difficulty
 Before assisting with prescribed medication
 Document changes, times occurred, orders given by medical control.
Emergency Medical Care
 Goal is to:
 Provide supportive care.
 Administer supplemental oxygen.
 Provide monitoring and transport.
Ensure Adequate Airway
Keep airway
Remove items from Suction if
in optimal
mouth. necessary.
position.
Perform Standard
Interventions
Administering oxygen
to keep the establishing an
saturation greater intravenous (IV) line
than or equal to 95%
Psychological :Your
Allow the patient to
efforts to reduce the
assume the position
patient’s anxiety with
of greatest comfort.
a calm,
Decrease the Work of Breathing
 Muscles work harder during respiratory distress.

 Use substantial energy to compensate for respiratory distress.
 Requires more oxygen and ventilation
 May fatigue to point of decompensation
Decrease the Work of Breathing
 To decrease the work of breathing:

 Help the patient sit up.
 Remove restrictive clothing.
 Do not make the patient walk.
 Relieve gastric distention.
 Do not bind the chest or have the
patient lie on the unaffected lung.
Provide Supplemental Oxygen
Administer in effective Concentrations higher

concentrations. than 50% should be
• Reassess, then adjust as used only with hypoxia
needed. that does not respond
• Pulse oximetry is a good to lower
guide to oxygenation. concentrations.
Administer a Bronchodilator
 Many can benefit from bronchodilation.

 Those without bronchospasms will benefit only slightly.
 Bronchodilators are ineffective in cases of:
 Pneumonia
 Pulmonary edema
 Heart disease
 Fast-acting bronchodilators
 Most stimulate beta-2 receptors in lung
 Provide almost instant relief
 Albuterol is the most common beta-2 agonist.
 Slow-acting bronchodilators
 Do not provide immediate symptom relief
 Daily dose reduces frequency/severity of attacks
 Common medications include:
 Salmeterol
 Cromolyn
 Methylxanthines
 Declining use because of adverse effects
 Overdose can cause cardiac dysrhythmias and hypotension.
 Carefully monitor level in bloodstream.
 Corticosteroids
 Reduce bronchial swelling
 Adverse effects:
 Cushing syndrome
 Rapid change in blood glucose levels
 Blunts the immune system
 Avoid long-term use.
 Inhaled corticosteroids
 Less adverse effects; becoming standard
 Intravenous corticosteroids
 Methylprednisolone and hydrocortisone: used for acute asthma attacks
or COPD
 In a medical emergency, it is common to give corticosteroids
intravenously. A single bolus of IV corticosteroids does not seem to
cause negative long-term consequences and is reasonably safe.
Aerosol Therapy
Metered-Dose Inhalers
Some tips on avoiding common
errors when using or administering a metered-dose inhaler
 The mist from a metered-dose inhaler must enter the lungs.

 Some patients mistakenly blow into the spacer.
 Patients should try to inhale the medication deeply and then hold
their breath for a few seconds.
 Make sure the inhaler contains medication.
 Keep the spacer and canister holder clean
 After using a corticosteroid inhaler, patients should rinse out the
mouth with water or mouthwash.
 Magnesium may have a role in bronchodilation.

 40 mg/kg (maximum dose 2 g) over 15 to 30 minutes
 can cause hypotension if given too quickly
 Some physicians use them as a last-ditch effort before intubation.
Restore Fluid Balance
 Common to give fluid bolus to dehydrated, younger patients.

 Elderly patients or patients with cardiac dysfunction could wind up with
pulmonary edema.
 Assess breath sounds before and after.
Administer a Diuretic
 Helps reduce blood pressure and maintain fluid balance in patients

with heart failure
 Helps remove excess fluid from circulation, keeping it out of the
lungs of patients with pulmonary edema.
Administer a Diuretic
 Many diuretics cause potassium loss.

 May lead to cardiac dysrhythmias and chronic muscle cramping
 Do not give diuretics to patients with pneumonia or dehydration.
Support or Assist Ventilation
 Breathing may need more aggressive support if the patient

becomes fatigued.
 CPAP and BiPAP may preclude intubation.
 May simply require bag-mask ventilation
 do no harm
 Continuous positive airway pressure

 Used to treat:
 Obstructive sleep apnea
 Respiratory failure
 Patients with obstructive sleep apnea wear a CPAP unit to maintain
airway while they sleep.
 CPAP (cont’d)
 CPAP therapy may be
delivered through a mask.
 Air is forced into the
upper airway.
 Positive pressure is
created in the chest.
 CPAP (cont’d)
 Pressure that is too high  New guidelines
may cause: emphasize:
 Tension  Lower ventilation
pneumothorax rates
 Subcutaneous air  Smaller volumes
 Block venous returns  Lower pressures
 CPAP (cont’d)
 Ensure a seal.
 If a patient is unwilling to
use it, do not fight it.
 Success is related to
respiratory rate after
application
Courtesy of Respironics, Inc., Murrysville, PA. All rights reserved.

 Bi-level positive airway pressure (BiPAP)

 One pressure on inspiration and a different pressure during exhalation
 More like normal breathing
 often more comfortable for patients
 more normal blood flow.
 More complex and expensive
 Automated transport ventilators

 Flow restricted oxygen-powered ventilation
 Deliver a particular oxygen volume at a set rate.
 Good for patients in cardiac or respiratory arrest
 Not intended to be used without direct observation
Courtesy of Airon Corporation (www.AironUSA.com)

Intubate the Patient
 Last option for patients with severe asthma Patients with asthma are
extremely difficult to ventilate and are prone to pneumothorax.
 Be proactive; Ventilate patients before cardiac arrest.
 Consider intubating a patient who has little or no gag reflex—for
example, a patient who has had a stroke or is severely intoxicated.
 With diabetes or overdose, an ampule of 50% dextrose or naloxone
may change the need for intubation
 Use bag-mask ventilation for a few minutes to monitor effects.
Inject a Beta-Adrenergic Receptor
Agonist Subcutaneously
 Use if inhalation techniques are ineffective.
 May cause more tachycardia and hypertension
 Be careful using in elderly patients.
Instill Medication Directly Through
an Endotracheal Tube
 Option if prompt vascular access is delayed
 Epinephrine dose is 2 to 2.5 times the usual
 AHA guidelines discourage this practice.
Anatomic Obstruction
 Pathophysiology
 The tongue is the most common cause of airway obstruction if patient is
semiconscious or unconscious.
 Assessment:
 Risks include:
 Decreased level of consciousness
 Audible signs include:
 Sonorous respirations
 Gurgling
 Squeaking and bubbling
 Management
 Obstructive sleep apnea may be caused by excess soft tissue in airway
 Can be manually displaced
 Place patient in the recovery position
Inflammation Caused by Infection
 Pathophysiology
 Infections can cause upper airway swelling.
 Can lead to laryngotracheobronchitis
 Common cause of croup
 Stridor
 Hoarseness
 Barking cough
 Pathophysiology (cont’d)
 Poiseuille’s law: as the diameter of a tube decreases, resistance to flow
increases.
 Assessment
 Croup and tonsillitis are common, but other conditions are rare.
 Avoid manipulating the airway.
 Management
 Airway may be entirely obscured.
 Laryngoscopy may worsen swelling
 Have partner press on the chest while you check for a bubble stream.
 If effort fails, cricothyrotomy may be necessary.
Aspiration
 Inhalation of anything other than breathable gases

 Patients at risk:
 Tube-fed patients placed supine after large meal
 Geriatric patients with impaired swallowing
 Unresponsive patients
Aspiration
 Pathophysiology
 Aspiration of stomach contents: high mortality
 Aspiration of foreign bodies may occur.
 Chronic aspiration of food is a common cause of pneumonia in older
patients.
Aspiration
 Assessment
 Determine scenario of sudden onset dyspnea
 Immediately after eating?
 Gastric feeding tube?
Aspiration
 Management
 Avoid gastric distention when ventilating.
 Use nasogastric tube to decompress stomach.
 Monitor ability to protect airway; use advanced airway when needed.
 Treat with suction and airway control.
Obstructive Lower Airway Diseases
 Diseases that cause airflow obstruction to the lungs:

 Emphysema and chronic bronchitis (COPD)
 Asthma
Obstructive Lower Airway Diseases
 Physical findings:
 Pursed lip breathing
 Increased I/E ratio
 Abdominal muscle use
 Jugular venous distension
Asthma
 Pathophysiology
 Increased tracheal and
bronchial reactivity
 Causes widespread,
reversible airway
narrowing
(bronchospasm)
© Scott Rothstein/ShutterStock, Inc.

Asthma
 Patients with potentially fatal asthma often have severely compromised
ventilation all the time.
 Acute bronchospasm or infection presents risk
 Death rates are increasing in the United States.
Asthma
 Status asthmaticus: severe, prolonged attack that does not stop with
conventional treatment
 Struggling to move air through obstructed airways
 Prominent use of accessory muscles
 Hyperinflated chest
 Inaudible breath sounds
 Exhausted, severely acidotic, and dehydrated
Asthma
 Assessment
 Known as reactive airway disease because bronchospasms are caused
by triggers
 Also caused by:
 Airway edema
 Inflammation
 Increased mucus production
Asthma
 Assessment (cont’d)
 Bronchospasm
 Constricting muscle surrounding bronchi
 Wheezing: air forced through constricted airways
 Primary treatment: nebulized bronchodilator medication
Asthma
Asthma
 Bronchial edema
 Swelling of the bronchi and bronchioles
 Bronchodilator medications do not work.
 Increased mucus production
 Thick secretions contribute to air trapping.
 Dehydration makes secretions thicker.
Asthma
 Management
 Bronchospasm: aerosol bronchodilators
 Bronchial edema: corticosteroids
 Excessive mucus secretion: improve hydration, mucolytics
Asthma
 Management (cont’d)
 Transport considerations
 Infection or continuous exposure to a trigger: consider removing patient.
 No improvement in peak flow: consider corticosteroids.
Asthma
 Transport considerations
 Undernourished or dehydrated: consider IV fluids.
 Advanced life support more than a few minutes away: consider transport to
nearest ED.
Chronic Obstructive Pulmonary
Disease
 Pathophysiology
 Emphysema damages or destroys terminal bronchiole structures.
 Chronic bronchitis: sputum production most days of the month for 3 or
more months of the year for more than 2 years
Disease
 Assessment
 Emphysema
 Barrel chest from chronic lung hyperinflation
 Tachypneic
 Use muscle mass for energy to breathe
Disease
 Causes of diffuse wheezing:
 Left-sided heart failure (cardiac asthma)
 Smoke inhalation
 Chronic bronchitis
 Acute pulmonary embolism
 Cause of localized wheezing: obstruction from foreign body or tumor
Disease
 COPD with pneumonia
 Often have lung infection
 Check for:
 Fever
 Change in sputum
 Other infection signs
 Breath sounds consistent with pneumonia
Disease
 COPD with right-sided heart failure
 Look for:
 Peripheral edema
 Jugular venous distention with hepatojugular reflux
 End inspiratory crackles
 Progressive increase in dyspnea
 Greater-than-usual fluid intake
 Improper use of diuretics
Disease
 COPD with left-sided heart failure
 Can be caused by any abrupt left ventricular dysfunction
Disease
 Acute exacerbation of COPD
 Sudden decompensation with no copathologic conditions
 Often from environmental change or inhalation of trigger substances
Disease
 End-stage chronic COPD
 Lungs no longer support oxygenation, ventilation
 Difficult to tell whether situation can be resolved
 Secure documentation of patient’s wishes.
 Follow local protocol or contact medical control.
Disease
 COPD and trauma
 Lessens ability to tolerate trauma
 Monitor closely.
 Oxygen saturation might be less than 90%.
 Achieving a saturation of 98% is unrealistic.
Disease
 Management
 Can help improve immediate distress
 Determine what caused the situation to worsen enough for the patient
to call for help.
 Must understand:
 Hypoxic drive
 Positive end-expiratory pressure (auto-PEEP)
Disease
 Hypoxic drive
 When breathing stimulus comes from decrease in PaO2 rather than
increase in PaCO2
 Affects only a small percentage during end-stage of disease process
 Must decide whether to administer oxygen
Disease
 Hypoxic drive (cont’d)
 Impossible to tell which patients breathe because of hypoxic drive.
 Encourage breathing.
 Skin appearance may remain perfused if patient becomes apneic.
Disease
 Hypoxic drive (cont’d)
 Provide artificial ventilation and consider intubation if patient become
apneic.
 Intubation may mean the patient remains on the ventilator until the end
of life.
 Oxygen saturation values are less useful in patients with COPD.
Disease
 Auto-PEEP
 Allow complete exhalation before the next breath during ventilation.
 Otherwise, pressure in the thorax will continue to rise (auto-PEEP).
 If possibility, patients should be ventilated 4 to 6 breaths/min.
Pulmonary Infections
 Pathophysiology
 Infections from:  Infectious diseases
 Bacteria cause:
 Viruses  Swelling of the

respiratory tissues
 Fungi
 Increase in mucus
 Protozoa production
 Production of pus
 Resistance to airflow increases when the airway diameter is narrowed
(Poiseuille’s law).
 Alveoli can become nonfunctional if filled with pus.
 At greater risk of pneumonia:
 Older people
 People with chronic illnesses
 People who smoke
 Anyone who does not ventilate efficiently
 Those with excessive secretions
 Those who are immunocompromised
 Assessment
 Patients usually report:
 Several hours to days of weakness
 Productive cough
 Fever
 Chest pains worsened by cough
 May start abruptly or gradually
 During physical examination, patient:
 May look grievously ill
 May or may not be coughing
 May present with crackles
 May have increased tactile fremitus and sputum production
 Pneumonia often occurs in the lung bases.
 Patients are often dehydrated.
 Supportive care includes:
 Oxygenation
 Secretion management (suctioning)
 Transport to the closest facility
 Management
 Upper airway infections: aggressive airway management
 Lower airway infections: supportive care, transport
Atelectasis
 Pathophysiology
 Disorders of alveoli
 Collapse from proximal airway obstruction or external pressure
 Fill with pus, blood, or fluid
 Smoke or toxin damage
Atelectasis
 Common for some alveoli to collapse
 Sighing, coughing, sneezing, and changing positions help open closed
alveoli.
 When alveoli do not reopen, entire lung segments eventually collapse.
 Increases chance of pneumonia
Atelectasis
 Assessment
 The affected area can harbor pathogens that result in pneumonia.
 Check if a patient with fever has had recent chest or abdominal surgery.
Atelectasis
 Management
 Postsurgical patients
encouraged to:
 Get out of bed.
 Cough.
 Breathe deeply.
 Use the incentive
spirometer.
© T. Bannor/Custom Medical Stock Photo

Cancer
 Pathophysiology
 Lung cancer is one of most common forms of cancer.
 Cigarette smoking
 Exposure to occupational lung hazards
Cancer
 Assessment
 First presentation is often hemoptysis.
 Frequently accompanied by COPD and impaired lung function
 Often metastasizes in the lung from other body sites
Cancer
 Other cancers may invade lymph nodes in neck.
 Pulmonary complications from radiation and chemotherapy
 Treatments may cause pleural effusion.
Cancer
 Management
 Little prehospital treatment for pleural effusions or hemoptysis
 Sometimes called for end-of-life issues
Toxic Inhalations
 Pathophysiology
 Damage depends on water solubility of toxic gas.
Toxic Inhalations
 Assessment
 Highly water-soluble gases react with moist mucous membranes.
 Causes upper airway swelling and irritation
 Less water-soluble gases get deep in lower airway.
 More damage over time
Toxic Inhalations
 Moderately water-soluble gases have signs and symptoms between.
 Mixing drain cleaner and chlorine bleach may produce an irritant chlorine
gas.
 Industrial settings often use irritant gas-forming chemicals in higher quantities
and concentrations.
Toxic Inhalations
 Management
 Immediate removal from contact with gas
 Provide 100% oxygen or assisted ventilation.
 If exposure is to slightly water-soluble gases, patients may have acute
dyspnea hours later.
 Consider transport to closest ED for observation.
Pulmonary Edema
 Pathophysiology
 Fluid buildup in lungs occurring when blood plasma fluid enters lung
parenchyma
 Classifications:
 High pressure (cardiogenic)
 High permeability (noncardiogenic)
Pulmonary Edema
 Assessment
 By time crackles can be heard, fluid has:
 Leaked out of capillaries
 Increased diffusion space between capillaries and alveoli
 Swollen alveolar walls
 Begun to seep into alveoli
Pulmonary Edema
 Listen to lower lobes through the back.
 Crackles heard higher in the lungs as condition worsens
 In severe cases, watery sputum, often with a pink tinged, will be
coughed up.
Acute Respiratory Distress
Syndrome
 Pathophysiology
 Seldom seen in field
 Caused by diffuse damage to alveoli from:
 Shock
 Aspiration of gastric contents
 Pulmonary edema
 Hypoxic event
Acute Respiratory Distress
Syndrome
 Assessment
 Document oxygen saturation, breath sounds, and any sudden changes.
 Monitor ventilation pressures.
Pneumothorax
 Pathophysiology
 Air collects between visceral and parietal pleura.
 Weak spots (blebs) can predispose a person.
Pneumothorax
 Assessment
 Patients may have:
 Sharp pain after coughing
 Increasing dyspnea in subsequent minutes or hours
Pneumothorax
 Management
 Most will not require acute intervention.
 They should receive oxygen and close monitoring of their respiratory
status.
Pleural Effusion
 Pathophysiology
 Blister-like sac of fluid
formed when fluid collects
between visceral and
parietal pleura
Pleural Effusion
 Assessment
 Hard to hear breath sounds
 Position will affect ability to breathe.
 Management
 Fowler’s position likely most comfortable
 Supportive care during transport to hospital
Pulmonary Embolism
 Pathophysiology
 Pulmonary circulation compromised by:
 Blood clot
 Fat embolism from broken bone
 Amniotic fluid embolism during pregnancy
 Air embolism from neck laceration or faulty IV
Pulmonary Embolism
 Large embolism usually lodges in major pulmonary artery
 Prevents blood flow
 Venous blood cannot reach alveoli.
Pulmonary Embolism
 Assessment
 Early presentation: normal breath sounds, good peripheral aeration
 Classic presentation: sudden dyspnea and cyanosis, sharp pain in chest
 Cyanosis does not end with oxygen therapy.
Pulmonary Embolism
 Often begin in large leg
veins, then migrate into
pulmonary circulation
 Thrombophlebitis: high risk
Pulmonary Embolism
 Management
 Bedridden patients are often given:
 Anticoagulants
 Special stockings/other devices to reduce blood clot formation
 Greenfield filter: opens to catch clots traveling from the legs in the main
vein
Pulmonary Embolism
 Saddle embolus: exceptionally large embolus lodging at left/right
pulmonary artery bifurcation
 May be immediately fatal
 Cape cyanosis despite CPR and ventilation
Age-Related Variations
 Most common respiratory ailments occur in second half of patient’s

life.
 Asthma often occurs in younger patients but can flare at any time.
 Anatomy
 Important anatomic differences in children include:
 Larger heads relative to body size
 Pathophysiology
 Infants often expend huge amounts of energy to breath and have a
limited ability to compensate.
 Infants and children with respiratory problems may have:
 Respiratory distress
 Respiratory failure leading to decompensation
 Respiratory arrest
 Common pediatric respiratory diseases:

 Foreign body obstruction of the upper airway
 Infections, such as:
 Croup
 Laryngotracheobronchitis
 Epiglottitis
 Bacterial tracheitis
 Retropharyngeal abscesses
 Common pediatric respiratory diseases
(cont’d):
 Lower airway disease
 Asthma
 Bronchiolitis
 Pneumonia
 Pertussis (whooping cough)
 Cystic fibrosis
 Bronchopulmonary dysplasia
Summary
 Respiratory disease is one of the most common pathologic

conditions and reasons for EMS dispatches.
 Impaired ventilation may be caused by upper airway obstruction,
lower airway obstructive disease, chest well impairment, or
neuromuscular impairment.
Summary
 Respiratory failure occurs from many pathologic conditions. Care

includes supplemental oxygen.
 Hyperventilation syndrome is excessive ventilation; patient may
have chest pain, carpopedal spasm, and alkalosis.
 Nasal hairs filter particulates from the air as it flows and is warmed in
the nose, humidified, and filtered.
Summary
 The mouth and oropharynx’s vascular structures are covered with a

mucous membrane. The hypopharynx is the junction of the
oropharynx and nasopharynx.
 The larynx and glottis are the dividing line between upper and lower
airways, with the thyroid cartilage the most obvious external larynx
landmark. The glottis and vocal cords are in the middle of the
thyroid cartilage.
Summary
 The circoid cartilage forms a complete ring and maintains the

trachea in an open position.
 The cricothyroid is between the thyroid and circoid cartilages. It is a
preferred area for inserting large IV catheters or small breathing
tubes.
 The respiratory system primary components look like an inverted
tree.
Summary
 The trachea splits into the left and right mainstem bronchi at the
carina.
 Cilia line the larger airways and help move foreign material out of
the tracheobronchial tree.
 Pulmonary circulation begins at the right ventricle.
Summary
 The interstitial space can fill with blood, pus, or air, which causes
pain, stiff lungs, and lung collapse.
 Ventilation, perfusion, and diffusion are the primary functions of the
respiratory system.
 Mechanisms of respiratory control are neurologic, cardiovascular,
muscular, and renal.
Summary
 Patients with traumatic brain injuries may exhibit abnormal

respiratory patterns.
 Respiratory compromise can cause an altered level of
consciousness because it cannot store the oxygen it needs to
function.
 Respiratory disease can cause ventilation, diffusion, and perfusion
impairment, or a combination of all three.
Summary
 Some respiratory diseases have classic presentations.

 It is critical to evaluate how hard a patient is working to breathe.
 A patient’s position of comfort and speaking difficulty level helps
determine degree of distress.
 Patients in respiratory distress often use the tripod position.
Summary
 Signs of life-threatening respiratory distress:

 Bony retractions
 Soft tissue retractions
 Nasal flaring
 Tracheal tugging
 Paradoxical respiratory movement
 Pursed-lip breathing
 Grunting
Summary
 Audible abnormal respiratory noises indicate obstructed breathing.

 Snoring indicates partial obstruction of the upper airway by the
tongue; stridor indicates narrowing of the upper airway.
 Auscultate the lungs to hear adventitious breath sounds, including
wheezing and crackles.
Summary
 Crackles: discontinuous noises heard during auscultation.

 Wheezes: high-pitched, whistling sounds from air forced through
narrowed airways
 If you can’t hear breath sounds with a stethoscope, there is not
enough breath to ventilate the lungs.
Summary
 The respiratory system delivers oxygen and removes carbon dioxide.

If the lungs do not work, it can lead to hypoxia, cell death, and
acidosis.
 Patients with dyspnea are usually transported to the nearest facility.
 Patients with chronic respiratory disease may have already tried
treatment options.
Summary
 Determine if the problem started suddenly or gradually worsened as

indicators to the underlying cause.
 If the condition is recurrent, compare the current incident with other
episodes.
 If patient cannot speak because of breathing issues, obtain the
history from family members or available clues.
Summary
 Assess the mucous membranes for cyanosis, pallor, and moisture.

 Assess the level of consciousness in dyspneic patients.
 With the patient in a semisitting position, check for jugular venous
distension, which may be caused by cardiac failure.
Summary
 Feel the chest for vibrations during breathing, and check for edema
of the ankles and lower back, peripheral cyanosis, and pulse. Check
skin temperature and apply monitors.
 A pulse oximeter indicates the percentage of hemoglobin with
attached oxygen; greater than 95% is considered normal.
Summary
 Colorimetric end-tidal carbon dioxide devices or wave

capnography can monitor exhaled carbon dioxide.
 Peak flow is the maximum flow rate a patient can expel air from the
lungs.
 Metered-dose inhalers deliver bronchodilators and corticosteroids
as an aerosol treatment; dry powder inhalers use a fine powder to
deliver a measured-dose treatment.
Summary
 Aerosol nebulizers deliver a liquid medication in a fine mist.

 Emergency care for dyspnea may include:
 Decreasing work of breathing
 Supplemental oxygen
 Bronchodilators
 Inhaled corticosteroids, vasodilators, or diuretics
 Supporting or assisting ventilation
 Intubation
Summary
 Ensure an open and maintainable airway. Suction if needed, and

keep the airway optimally positioned. Remove constrictive clothing.
 Inhalation drug administration may be ineffective if airway is
compromised.
 Medications can be given directly into the tracheobronchial tree if
patient is intubated.
Summary
 CPAP is a respiratory failure therapy that increases oxygen

saturation and decreases respiratory rate.
 BiPAP is CPAP that delivers one pressure during inspiration and a
different one during exhalation.
 Automated transport ventilators are flow-restricted oxygen-powered
breathing devices with timers.
Summary
 Patients in respiratory failure may need to be intubated.

 Anatomic or foreign body obstruction of the upper airway can
cause seizures and death.
 Infections can cause upper airway swelling. Croup is one of the
most common causes.
Summary
 Emphysema, chronic bronchitis, and asthma are common

obstructive airway diseases, with emphysema and chronic
bronchitis collectively classified as COPD.
 Asthma is characterized by significant airway obstruction from:
 Widespread, reversible airway narrowing
 Airway edema
 Increased mucous production
Summary
 Primary treatment for bronchospasms is bronchodilatory medicine,

while corticosteroids are the primary treatment for bronchial
edema.
 Status asthmaticus is a severe, prolonged asthmatic attack that
cannot be stopped with conventional treatment. It is a dire
emergency.
Summary
 If an asthma attack is recurring, the inhaler may be empty or the

medication ineffective.
 Asthma attacks can be triggered by noncompliance with a
prescribed medication regimen.
 Emphysema is a chronic weakening and destruction of the terminal
bronchioles and alveoli walls.
Summary
 Chronic bronchitis symptoms include:

 Excessive mucous production in bronchial tree
 Chronic or recurrent productive cough
 For patients with COPD, look for cause of a worsened condition.
Summary
 Hypoxic drive: High oxygen levels decrease the respiratory drive.

 When ventilating, allow the patient to exhale completely before the
next breath is given to avoid auto-PEEP.
 Pneumonia may be caused by bacterial, viral, and fungal agents.
Summary
 Atelectasis is alveolar collapse from:

 Proximal airway obstruction
 Pneumothorax
 Hemothorax
 Toxic inhalation
 Lung cancer often presents with hemoptysis and is increasing
among women.
 Toxic gas inhalation damage depends on the water solubility of the
gas.
Summary
 Pulmonary edema occurs when fluid migrates into the lungs.

 Acute respiratory distress syndrome is caused by diffuse alveolar
damage from aspiration, pulmonary edema, or other alveolar insult.
 In a pneumothorax, air collects between the visceral and parietal
pleuras. Administer supplemental oxygen and monitor.
Summary
 Pleural effusion will cause dyspnea. Give aggressive oxygen

administration and proper positioning.
 A pulmonary embolism occurs when a blood clot travels to the
lungs and blocks blood flow and nutrient exchange.
Summary
 Infants are less able than older children to compensate for

respiratory insults.
 Infants and children may be in:
 Respiratory distress
 Respiratory failure
 Respiratory arrest
Credits
 Chapter opener: © Jones and Bartlett Publishers.

Courtesy of MIEMSS.
 Backgrounds: Blue—Courtesy of Rhonda Beck; Green—
Courtesy of Rhonda Beck; Lime—© Photodisc; Purple—
Courtesy of Rhonda Beck.
 Unless otherwise indicated, all photographs and
illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for Emergency
Medical Services Systems, or have been provided by the
American Academy of Orthopaedic Surgeons.
‫‪Tarik Saber Sarhan‬‬
‫)‪(tssicu‬‬
‫‪www.tssicu.tk‬‬
‫‪tssicu@gmail.com‬‬
‫‪tssicu@icloud.com‬‬
‫‪tssicu@live.com‬‬
‫‪tsarhan@inaya.edu.sa‬‬
‫وءاخر دعوانا أن الحمد هلل رب العالمين وصل اللهم على سيدنا محمد وعلى اله وصحبه كلما ذكره الذاكرون‬
‫وغفل عن ذكره الغافلون‬
‫شكرهللا لكم‬

Respiratory Emergency

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Respiratory Emergency

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‫ب س ماللهال ر حم نال ر ح يم‬

Assist Prof. Dr. Tarik Sarhan

Asthma and COPD are among the top

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

 Extends from the larynx to the

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Airway  Made up of two types of cells:

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Airway  Pulmonary capillaries are narrow.

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Conditions that impair lung function

Conditions that impair mechanics of

Conditions that impair neuromuscular apparatus

• Head trauma, intracranial infections, brain

Conditions that reduce

Occurs when people breathe in excess by

Hyperventilation that is not caused by some

Causes numbness in hands, feet, and

Ultimately leads to carpopedal spasm

Symptoms often cause more

Having patient rebreathe carbon dioxide can be

Never conclude that a patient is “just hyperventilating” until

Treatment • Breathing with the

may • Having the patient

 Observe standard precautions.

The first priority in assessing and

Form a general impression.

•Body type may be

Chronic bronchitis: more sedentary and

Severely ill patients with

Assess Oxygen Demand and Work of Breathing

•Observe condition during typical exertion.

Altered rate and depth of respiration

• Patient with adequate rate but low volume will

Abnormal breath sounds

Abnormal breath sounds (cont’d)

• Some conditions cause normal breath

Abnormal breath sounds (cont’d)

• Audible sounds include:

Abnormal breathing patterns

• May indicate neurological insults

•Assess skin color.