Respiratory Distress/Failure - General
|
|
- Gervais Gilbert
- 5 years ago
- Views:
Transcription
1 Respiratory Distress/Failure - General Criteria: Dyspnea WITHOUT a clear etiology O 2 V/S and SpO 2 (with and without Oxygen therapy if possible) Blood glucose analysis: if less than 80 mg/dl, refer to hypoglycemia protocol Albuterol 2.5 mg via nebulizer (6L/min.) IV NS at TKO (if hypotensive, titrate to SBP of greater than 100 mmhg) As soon as reasonably possible, reference a more specific protocol. Consider these differentials: Foreign Body Airway Obstruction - sudden onset, stridor or snoring, cyanosis, no air movement Asthma - relatively rapid onset, wheezing or silence, history of asthma COPD - gradual onset, history of COPD or long-term cigarette use Pneumonia - gradual onset, recent history of upper respiratory infection, fever, chest wall pain Pulmonary edema - sudden onset, history of hypertension, or cardiac or renal problems, presents with hypertension and/or irregular HR Pulmonary embolus - sudden onset, chest or back pain, history of recent surgery, childbirth, long-term immobility, or irregular HR Allergic reaction - sudden onset, urticaria, itching, edema, history of allergies Hyperventilation - recent history of anxiety/emotional upset, facial tingling and/or carpopedal spasms Myocardial infarction - chest pain, accompanied by nausea, diaphoresis, radiating pain PEDIATRIC Consideration: Cardiopulmonary arrest in infants and children is not usually a sudden event. Instead, it is often the end-result of a progressive deterioration in respiratory and circulatory function, the common pathway of which is cardiopulmonary failure, regardless of the underlying disease. Respiratory failure and shock may begin as two distinct syndromes, but they progress to an indistinguishable state of cardiopulmonary failure in the final moments before arrest. Their common denominator lies in the insufficient oxygen delivery to tissues and reduced clearance of metabolites. In shock, low cardiac output rates may deliver well-oxygenated blood to the tissues, but it is delivered too slowly to meet the tissues' metabolic demand. In advanced respiratory failure, poorly oxygenated blood may be delivered at a normal or elevated flow rate to the tissues. In both cases, hypoxia is present. 47
2 Respiratory Distress/Failure (continued) Respiratory failure may occur because of intrinsic lung or airway disease or because of inadequate respiratory effort. As with shock, respiratory failure is often preceded by a "compensated" state (respiratory distress) in which the patient is able to maintain adequate gas exchange at the expense of an increase in the work of breathing. This is seen in the use of accessory muscles of respiration, inspiratory retractions, tachypnea, and tachycardia. Any child manifesting the following conditions requires immediate attention and treatment: Respiratory rate greater than 60 Heart rate greater than 180 or less than 80 (under 5 years) Greater than 160 or less than 60 (over 5 years) Persistent respiratory distress Cyanosis Diminished level of consciousness Failure to recognize parents Seizures Fever with petechiae Fever with rash EVERY EMS PROVIDER WORKING WITH SICK CHILDREN SHOULD BE ABLE TO DIAGNOSE PULMONARY AND CIRCULATORY FAILURE AND IMPENDING CARDIOPULMONARY ARREST BASED ON A RAPID CARDIOPULMONARY ASSESSMENT. This assessment should take less than half a minute to complete and, by integrating important physical findings, is designed to evaluate pulmonary and cardiovascular integrity. 48
3 Asthma/ COPD /Pneumonia Criteria: Shortness of breath AND Auscultated findings of bronchospasm (wheezes or silence) Exacerbation of chronic bronchitis or emphysema WITH: Shortness of breath or dyspnea History of COPD O 2 V/S Albuterol 2.5 mg via nebulizer. May repeat once in 5 min if dyspnea not relieved. Pediatric treatment: Albuterol 2.5 mg via nebulizer. Blood glucose analysis: if less than 80 mg/dl refer to hypoglycemia protocol If febrile (greater than 100.5º F), Acetaminophen (see dosage chart) IV NS TKO Consider endotracheal intubation if patient condition warrants (especially when SpO2 <90%) See BRONCHIOLITIS/PNEUMONIA: PEDIATRIC for further pediatric treatment details. Asthma: The asthma treatment regimen may be thought of as oxygenate, dilate, and hydrate. o IV should be NS at ml/hr. o Bronchial/alveolar dehydration (due to tachypnea) is a component of an "asthma attack". o Hydration will often allow the patient to clear mucous plugs and may result in as much relief as bronchodilation. The severely dyspneic and hypoxic asthma patient may require intubation. COPD: CO 2 retention and hypercarbia resulting in a respiratory acidosis are major culprits in COPD. Hypercarbia can be managed ONLY by increasing tidal volume by PPV with a BVM. BVM assist should be used in the patient with marked obtundation or respiratory insufficiency (rate less than 12/min or greater than 40/min). COPD patients can be very difficult to "wean" from the ET tube and/or ventilator. If the patient's airway and ventilatory status can be managed without intubation, try to do so. DO NOT, however, jeopardize the patient's survival in order to avoid intubation. 49
4 Pneumonia: Signs and symptoms of pneumonia are as follows: Dyspnea WITH one or more of the following: o Fever o Productive cough o Chest wall or pleuritic pain Pneumonia has a high mortality rate, especially among the elderly. EMS personnel must recognize this as a serious chief complaint. EMS personnel often confuse pneumonia, especially severe cases, with pulmonary edema. Pneumonia may present with a wide variety of auscultated breath sounds, including rales. History and associated signs/symptoms are the best tools to differentiate pneumonia from other sources of respiratory distress. Pneumonia is characterized by: o Gradual onset of symptoms, usually over a few days o A recent history of upper respiratory infection symptoms, including a productive (sometimes purulent) cough, fever, and chest wall pain Some pneumonia patients may present with wheezing (as may acute MI, severe allergic reactions, etc.); this may be a product of reactive bronchospasm (in response to the presence of the bacteria), or (more likely) an indication of narrowing of the small airways from the physical obstruction of infectious material. o Occasionally, these patients may show some improvement with the administration of bronchodilators. Most often, however, the bronchodilators will have no appreciable affect, as these are usually not true cases of reversible bronchospasm. 50
5 Bronchiolitis/Pneumonia: Pediatric Criteria: Pediatric patient with: Dyspnea WITHOUT evidence of upper airway obstruction WITH evidence of lower airway involvement (wheezes, crackles, forced exhalation) O 2 with SpO 2 V/S Maintain normothermia Albuterol 2.5 mg via nebulizer for mild to moderate dyspnea If febrile, administer Acetaminophen (see reference for medication doses) IV: NS, titrated to resolve dehydration (initial 20 ml/kg bolus for the child, 10 ml/kg for infant) Typically, an affected child has had a preceding upper respiratory infection, followed by rapid onset of respiratory distress with tachypnea, tachycardia, and a hacking cough. Increasing distress is evidenced by circumoral cyanosis and audible wheezing. The child often appears markedly lethargic, but fever is not always present. Dehydration may develop from vomiting and decreased oral intake. Bronchiolitis is a viral or bacterial infection of the bronchioles themselves. It generally occurs in children under 2 years of age. Pneumonia is a more general infection of the lung, including the large airways and the alveoli. It may occur at any age. In severe cases, it can be confused with pulmonary edema. It may present with a wide variety of breath sounds on auscultation, including rales. History and associated signs/symptoms are the best tools to differentiate pneumonia from other sources of respiratory distress. Pneumonia is characterized by: o Gradual onset of symptoms, usually over a few days o Recent history of upper respiratory infection symptoms, including a productive (sometimes purulent) cough o Fever o Chest wall pain 51
6 Croup: Pediatric Criteria: Pediatric patient with: Dyspnea AND Inspiratory stridor AND Recent history or current symptoms of URI O 2 V/S with SpO 2 if available Maintain normothermia If febrile, Acetaminophen or Ibuprofen (see reference for medication doses) Croup is usually preceded by an upper respiratory infection. A "barking," often spasmodic cough and hoarseness may mark the acute onset of inspiratory stridor, which commonly occurs at night. The child often awakens during the night with respiratory distress and tachypnea. The obvious respiratory distress and the harsh inspiratory stridor are the most dramatic physical findings. Auscultation reveals prolonged inspiration and stridor, often with some expiratory rhonchi and wheezes. Rales also may be present. Fever is present in about 1/2 of the children. The illness usually lasts 3-4 days and generally occurs in children between the ages of 6 months and 4 years. IF THERE IS ANY DOUBT AS TO WHETHER THE PATIENT IS SUFFERING FROM CROUP OR EPIGLOTTITIS, TREAT AS EPIGLOTTITIS, and do everything possible to minimize the child's agitation. 52
7 Epiglottitis: Pediatric Criteria: Pediatric Patient with Dyspnea Evidence of upper airway obstruction (inspiratory stridor, drooling, or hoarseness) AND any one or more of the following: o Fever o Recent history of upper respiratory infection symptoms o Dysphagia or severe sore throat EMT-B/ O 2 V/S with SpO 2 if available Maintain normothermia Onset of epiglottitis is frequently acute and fulminating. Sore throat, hoarseness, and usually high fever develop abruptly in a previously well child. Dysphagia and respiratory distress characterized by drooling, dyspnea, tachypnea, and inspiratory stridor develop rapidly and cause the child to lean forward and hyperextend the neck. Acute epiglottitis usually presents before 5 years of age. It is IMPERATIVE that oxygen administration not result in increased agitation. Great care must be taken not to agitate the child, as agitation may result in sudden, complete airway obstruction. As long as the child has adequate respiratory volume, DO NOT place any instrument in the child's mouth or attempt to visualize the epiglottis with a laryngoscope or tongue blade, since severe laryngospasm and swelling may result. Respiratory arrest can occur from total airway obstruction or a combination of partial airway obstruction and fatigue. If respiratory arrest occurs, PPV with a BVM with 100% oxygen should precede any attempt to intubate the patient. 53
8 Foreign Body Airway Obstruction Criteria: Pediatric Patient with Partial or complete airway obstruction secondary to foreign body aspiration WITH: o Decreased LOC o Cyanosis OR o Obvious inadequate air exchange Abdominal/chest thrusts Reassess airway Direct laryngoscopy Attempt to visualize object and remove with Magill forceps Intubate as needed Foreign body aspiration is the most common cause of sudden respiratory distress or arrest in a previously healthy child and should be the provider's initial suspicion in such patients. In the conscious patient, chest or abdominal thrusts are used (as per AHA guidelines). In the unconscious patient, appropriately certified EMS personnel should attempt to ventilate and intubate. If unable to ventilate with the BVM, go directly to direct laryngoscopy and Magill forceps to remove the foreign object. 54
9 Pulmonary Edema Criteria: Shortness of breath WITH Evidence of pulmonary edema (auscultated findings, history, etc.) AND Cardiac history WITH Systolic BP of greater than 100 mmhg CABC s O 2 V/S with SpO2 if available If hypotensive, place in modified Trendelenburg (elevated feet while sitting upright) IV NS at TKO rate Consider intubation via endotracheal or alternative airway device, if indicated Pulmonary edema often presents as simply dyspnea with wheezes or silence on auscultation; rales may not be heard. Use other signs and history to differentiate CHF from other etiologies. Pulmonary edema is often associated with these indicators: Sudden onset, frequently at night Hypertension Previous cardiac history Be aware that hypotensive patients (systolic BP of less than 90 mmhg) with pulmonary edema may actually be in cardiogenic shock. Oxygen must be by NRB at L/min or by BVM. IV fluid should be NS at TKO rate. Watch the fluid administration rate carefully. 55
10 Seizures Criteria: Patient experiencing active seizures or in a postictal state CABCs O 2, assist with BVM if necessary V/S with SpO 2 if available Temperature Blood glucose analysis: if less than 80 mg/dl refer to hypoglycemia protocol If actively seizing, protect head from trauma Position patient in left lateral recumbent position if decreased level of consciousness IV NS TKO Naloxone for persistent altered mental status o mg IV in the adult May repeat every 2-5 min if patient responds to initial dose. Maximum total dosage of 4 mg Consider Thiamine 50 mg IV and 50 mg IM OR 100 mg IV in suspected alcohol abuse patients Active airway maintenance, the use of airway adjuncts, and ventilatory support with the BVM are essential to the early management of the actively seizing patient. Temperature can be a major factor in seizures. Increased body temperature lowers the seizure threshold (makes a seizure more likely), while lowered temperature raises it. The seizure patient who is hyperthermic or febrile will benefit from external cooling procedures. Seizures generally are classed into four categories: Tonic-Clonic (generalized, "grand-mal" convulsion) Absence ("petit mal") Focal (non-generalized or localized convulsion) Psychomotor (behavioral/personality manifestation) Aggressive, early oxygenation is a must in the seizure patient. Oxygen alone will shorten the postictal state and raise the seizure threshold. Blood glucose should always be assessed in the seizure patient. Hypoglycemia will significantly lower seizure threshold and represents a life-threatening cause of convulsions. Additionally, convulsions may cause hypoglycemia in an otherwise normoglycemic patient. Thiamine is to be given as 50 mg IV and 50 mg IM OR 100 mg IV only in the event of suspected alcohol abuse. 56
Pediatric Shock. Hypovolemia. Sepsis. Most common cause of pediatric shock Small blood volumes (80cc/kg)
Critical Concepts: Shock Inadequate peripheral perfusion where oxygen delivery does not meet metabolic demand Adult vs Pediatric Shock - Same causes/different frequencies Pediatric Shock Hypovolemia Most
More informationChapter 16. Objectives. Objectives. Respiratory Emergencies
Chapter 16 Respiratory Emergencies Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key
More informationParamedic Rounds. Pre-Hospital Continuous Positive Airway Pressure (CPAP)
Paramedic Rounds Pre-Hospital Continuous Positive Airway Pressure (CPAP) Morgan Hillier MD Class of 2011 Dr. Mike Peddle Assistant Medical Director SWORBHP Objectives Outline evidence for pre-hospital
More informationObjectives. Case Presentation. Respiratory Emergencies
Respiratory Emergencies Objectives Describe how to assess airway and breathing, including interpreting information from the PAT and ABCDEs. Differentiate between respiratory distress, respiratory failure,
More informationEpiglottitis. Bronchitis. Bronchiolitis. Pneumonia. Croup syndrome. Miss. kamlah 2
Miss. kamlah 1 Epiglottitis. Bronchitis. Bronchiolitis. Pneumonia. Croup syndrome. Miss. kamlah 2 Acute Epiglottitis Is an infection of the epiglottis, the long narrow structure that closes off the glottis
More information3. Identify the importance in the prehospital setting for the administration of nebulized bronchodilator.
TERMINAL OBJECTIVE At the end of this lesson, the EMT-Basic will be able to utilize the assessment findings to formulate a field impression of bronchospasm and understand the administration of nebulized
More informationRespiratory Management in Pediatrics
Respiratory Management in Pediatrics Children s Hospital Omaha Critical Care Transport Sue Holmer RN, C-NPT Objectives Examine the differences between the pediatric and adults airways. Recognize respiratory
More informationAirway and Ventilation. Emergency Medical Response
Airway and Ventilation Lesson 14: Airway and Ventilation You Are the Emergency Medical Responder Your medical emergency response team has been called to the fitness center by building security on a report
More informationFirefighter Pre-Hospital Care Program Recruit Presentation. Respiratory Emergencies
Firefighter Pre-Hospital Care Program Recruit Presentation Respiratory Emergencies The Respiratory System Anatomy Pharynx Nasopharynx Oropharynx Epiglottis Larynx Trachea Right main bronchus Left main
More informationRespiratory Emergencies. Chapter 11
Respiratory Emergencies Chapter 11 Respiratory System Anatomy and Function of the Lung Characteristics of Adequate Breathing Normal rate and depth Regular breathing pattern Good breath sounds on both sides
More informationPEDIATRIC EMERGENCIES Sandra Horning, MD Sacred Heart Medical Center Emergency Department
PEDIATRIC EMERGENCIES Sandra Horning, MD Sacred Heart Medical Center Emergency Department Overview Roles of the EMS in Pediatric Care Growth and Development Assessment Airway Adjuncts and Intravenous Access
More informationUnconscious exchange of air between lungs and the external environment Breathing
Respiration Unconscious exchange of air between lungs and the external environment Breathing Two types External Exchange of carbon dioxide and oxygen between the environment and the organism Internal Exchange
More informationMICHIGAN. Table of Contents. State Protocols. Adult Treatment Protocols
MICHIGAN State Protocols Protocol Number Protocol Name Adult Treatment Protocols Table of Contents 3.1 Altered Mental Status 3.2 Stroke/Suspected Stroke 3.3 Respiratory Distress 3.4 Seizures 3.5 Sepsis
More information1 Chapter 13 Respiratory Emergencies 2 Respiratory Distress Patients often complain about. Shortness of breath Symptom of many different Cause can be
1 Chapter 13 Respiratory Emergencies 2 Respiratory Distress Patients often complain about. Shortness of breath Symptom of many different Cause can be difficult to determine. Even for physician in hospital
More informationLecture Notes. Chapter 3: Asthma
Lecture Notes Chapter 3: Asthma Objectives Define asthma and status asthmaticus List the potential causes of asthma attacks Describe the effect of asthma attacks on lung function List the clinical features
More informationSTRIDOR. Respiratory system. Lecture
STRIDOR Stridor is a continuous inspiratory harsh sound produced by partial obstruction in the region of the larynx or trachea. Total obstruction cyanosis & death. Etiology Acute stridor Infectious croup
More informationConscious Sedation Permit Evaluation. General Comments Emergency Algorithms
General Comments Emergency Algorithms These algorithms delineate appropriate responses to the simulated emergencies listed in Article 5, Section 1043.4c of the California Code of Regulations. Each algorithm
More informationRespiratory Emergencies. Lesson Goal. Lesson Objectives 9/10/2012
Respiratory Emergencies Lesson Goal Assess and provide timely treatment & transport to patients experiencing respiratory emergencies Lesson Objectives List parts of respiratory system and how they work
More informationAnatomy Review. Anatomy Review. Respiratory Emergencies CHAPTER 16
CHAPTER 16 Respiratory Emergencies Anatomy Review Anatomy Review 1 Pediatric Anatomy Airway structure differences Proportionally larger tongue Smaller, more flexible trachea Abdominal breathers Reasons
More informationRespiratory Emergencies
CHAPTER 16 Respiratory Emergencies Anatomy Review Anatomy Review Pediatric Anatomy Airway structure differences Proportionally larger tongue Smaller, more flexible trachea Abdominal breathers Reasons for
More informationPALS Pulseless Arrest Algorithm.
PALS Pulseless Arrest Algorithm. Kleinman M E et al. Circulation 2010;122:S876-S908 PALS Bradycardia Algorithm. Kleinman M E et al. Circulation 2010;122:S876-S908 PALS Tachycardia Algorithm. Kleinman M
More informationNassau Regional Emergency Medical Services. Advanced Life Support Pediatric Protocol Manual
Nassau Regional Emergency Medical Services Advanced Life Support Pediatric Protocol Manual 2014 PEDIATRIC ADVANCED LIFE SUPPORT PROTOCOLS TABLE OF CONTENTS Approved Effective Newborn Resuscitation P 1
More informationReview. 1. How does a child s anatomy differ from an adult s anatomy?
Chapter 32 Review Review 1. How does a child s anatomy differ from an adult s anatomy? A. The child s trachea is more rigid B. The tongue is proportionately smaller C. The epiglottis is less floppy in
More informationRespiratory Diseases and Disorders
Chapter 9 Respiratory Diseases and Disorders Anatomy and Physiology Chest, lungs, and conducting airways Two parts: Upper respiratory system consists of nose, mouth, sinuses, pharynx, and larynx Lower
More informationSimulation 1: Two Year-Old Child in Respiratory Distress
Simulation 1: Two Year-Old Child in Respiratory Distress Opening Scenario (Links to Section 1) You are the respiratory therapist in a 300 bed community hospital working the evening shift. At 8:30 PM you
More informationA silent chest is. Pediatrics II Asthma, seizures and cardiac arrest. Children are different. Cough variant asthma. Symptoms of severe distress
Asthma ~21% of all asthma cases are school aged Pediatrics II Asthma, seizures and cardiac arrest Identify 3 symptoms of an asthma exacerbation Bronchospasm Edema of the bronchi Increased mucus production
More informationPulmonary Emergencies. Lower Airway Structures Trachea Bronchial tree Primary bronchi Secondary bronchi Bronchioles Alveoli Lungs
Pulmonary Emergencies Lower Airway Structures Trachea Bronchial tree Primary bronchi Secondary bronchi Bronchioles Alveoli Lungs Pulmonary Surfactant Thin film that coats alveoli Prevents alveoli from
More informationChapter 13. Respiratory Emergencies
Chapter 13 Respiratory Emergencies Introduction Patients often complain about dyspnea. Shortness of breath Symptom of many different conditions Cause can be difficult to determine. Even for physician in
More informationChapter 15 - Respiratory Emergencies
1 2 3 4 5 6 7 National EMS Education Standard Competencies (1 of 5) Medicine Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely
More informationChapter 19 - Respiratory_Emergencies
Introduction to Emergency Medical Care 1 OBJECTIVES 19.1 Define key terms introduced in this chapter. Slides 14 15, 41, 54 19.2 Describe the anatomy and physiology of respiration. Slides 13 15 19.3 Differentiate
More informationAIRWAY & HEART ANOTOMY
Objectives I CAN T BREATH Respiratory Emergencies Review of anatomical structures related to heart & lungs Differentiate differences between adult and pediatric airways Identify the need for airway assistance
More informationCounty of Santa Clara Emergency Medical Services System
County of Santa Clara Emergency Medical Services System Policy #700-M12: Continuous Positive Airway Pressure CONTINUOUS POSITIVE AIRWAY PRESSURE Effective: February 8, 2013TBD Replaces: NewFebruary 8,
More informationCardiovascular and Respiratory Disorders
Cardiovascular and Respiratory Disorders Blood Pressure Normal blood pressure is 120/80 mmhg (millimeters of mercury) Hypertension is when the resting blood pressure is too high Systolic BP is 140 mmhg
More informationAirway and Breathing
Airway and Breathing ETAT Module 2 Adapted from Emergency Triage Assessment and Treatment (ETAT): Manual for Participants, World Health Organization, 2005 Learning Objectives Accurately determine whether
More informationProtocol Update 2019
Protocol Update 2019 There have been several questions revolving around protocol updates and how they are to be conducted. As many of you are aware there is a protocol submission process in the appendix
More informationRespiratory System Anatomy Respiratory system: all the structures that contribute to
1 2 3 4 5 6 7 8 Chapter 15 Respiratory Emergencies Respiratory Distress Patients often complain about dyspnea. Shortness of breath Symptom of many different conditions Cause can be difficult to determine.
More informationSTS: Circulatory/Pulmonary
STS: Circulatory/Pulmonary September 27, 2017 You have a 50 y/o male who is complaining of excruciating pain in his chest. You find him sitting down on a bench, arms in a tripod position, breathing heavily.
More informationSimulation 01: Two Year-Old Child in Respiratory Distress (Croup)
Simulation 01: Two Year-Old Child in Respiratory Distress (Croup) Flow Chart Opening Scenario 2 year-old child in respiratory distress - assess Section 1 Type: IG audible stridor with insp + exp wheezing;
More informationOverview of COPD INTRODUCTION
Overview of COPD INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a common lung disease that affects millions of people, and it is the fourth leading cause of death in the United States. It
More informationBronchospasm & SOB. Kim Kilmurray Senior Clinical Teaching Fellow
Bronchospasm & SOB Kim Kilmurray Senior Clinical Teaching Fellow LEARNING OBJECTIVES Perform a comprehensive respiratory examination & link clinical signs to underlying pathology Identify the spectrum
More informationCondensed version.
I m Stu 3 Condensed version smcvicar@uwhealth.org Listen 1. Snoring 2. Gurgling 3. Hoarseness 4. Stridor (inspiratory/expiratory) 5. Wheezing 6. Grunting Listen Crackles Wheezing Stridor Absent Crackles
More informationCHANGES FOR DECEMBER 2008 PREHOSPITAL CARE MANUAL
CHANGES FOR DECEMBER 2008 PREHOSPITAL CARE MANUAL Item Changed Airway Management Procedure Oral Intubation Procedure Tube Confirmation and Monitoring Procedure C10 Chest Pain/ACS M2 Allergic Reaction/Anaphylaxis
More informationMcHenry Western Lake County EMS System Optional CE for Paramedics, EMT-B and PHRN s Croup vs. Epiglottitis. Optional #2 2017
McHenry Western Lake County EMS System Optional CE for Paramedics, EMT-B and PHRN s Croup vs. Epiglottitis Optional #2 2017 The tones go out at 3 am for a child with difficulty breathing. As it is a kid
More informationBronchoconstriction is also treated with medications that inhibit bronchiolar constriction such as: Ipratropium (Atrovent)
Patients with difficulty breathing (dyspnea) may have problems with: Oxygenation due to alveolar problems Ventilation due to bronchiolar problems Oxygenation due to lung perfusion problems Combinations
More informationNIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP)
Introduction NIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) Noninvasive ventilation (NIV) is a method of delivering oxygen by positive pressure mask that allows for the prevention or postponement of invasive
More informationPrehospital Care Bundles
Prehospital s The MLREMS Prehospital s have been created to provide a simple framework to help EMS providers identify the most critical elements when caring for a patient. These bundles do not replace
More informationRespiratory Anesthetic Emergencies in Oral and Maxillofacial Surgery. By: Lillian Han
Respiratory Anesthetic Emergencies in Oral and Maxillofacial Surgery By: Lillian Han Background: Respiratory anesthetic emergencies are the most common complications during the administration of anesthesia
More informationRespiratory Emergencies
29698_CH11_Q_p001_012 4/12/05 2:03 PM Page 1 MEDICAL EMERGENCIES S E C T I O N 4 C H A P T E R Respiratory Emergencies 11 Workbook Activities The following activities have been designed to help you. Your
More informationCapnography Connections Guide
Capnography Connections Guide Patient Monitoring Contents I Section 1: Capnography Introduction...1 I Section 2: Capnography & PCA...3 I Section 3: Capnography & Critical Care...7 I Section 4: Capnography
More informationMICHIGAN. State Protocols. General Treatment Protocols Table of Contents
MICHIGAN State Protocols Protocol Number 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 General Treatment Protocols Table of Contents Protocol Name General Pre-hospital Care Abdominal Pain Nausea
More informationLecture Notes. Chapter 4: Chronic Obstructive Pulmonary Disease (COPD)
Lecture Notes Chapter 4: Chronic Obstructive Pulmonary Disease (COPD) Objectives Define COPD Estimate incidence of COPD in the US Define factors associated with onset of COPD Describe the clinical features
More informationUNIT TERMINAL OBJECTIVE
UNIT TERMINAL OBJECTIVE 5-1 At the end of this unit, the EMT-Enhanced student will be able to utilize the assessment findings to formulate a field impression and implement the treatment plan for the patient
More informationPROTOCOL 1 Endotracheal Intubation (Adult and Pediatric) REQUEST EMT-P RESPONSE DO NOT DELAY TRANSPORT
PROTOCOL 1 Endotracheal Intubation (Adult and Pediatric) 1. Basic Life Support airway management procedures are initiated. 2. Endotracheal Intubation is indicated under any of the following conditions:
More informationExam 1 Review. Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies
Exam 1 Review Cardiopulmonary Symptoms Physical Examination Clinical Laboratory Studies WBC Count Differential A patient had been admitted to the hospital for acute shortness of breath. A CXR examination
More informationTransporting Children With Serious Respiratory Illness: A Presentation For Non-Specialty Teams
Transporting Children With Serious Respiratory Illness: A Presentation For Non-Specialty Teams Laurie Gehrke, R.N., BSN, CPEN, CEN, CMTE Pediatric Transport Team Blank Children s Hospital Des Moines, Iowa
More informationPediatric Patients. BCFPD Paramedic Education Program. EMS Education Paramedic Level
Pediatric Patients BCFPD Program Basic Considerations Much of the initial patient assessment can be done during visual examination of the scene. Involve the caregiver or parent as much as possible. Allow
More informationETCO2 MONITORING NON-INTUBATED PATIENTS
Although the standard of care in ETC02 is well established for intubated patients, there has been little emphasis on the use of capnography in nonintubated patients till now. In addition to confirming
More informationRegion VIII EMS Systems July 2016
Region VIII EMS Systems July 2016 Introduction SME video of the month Review of Respiratory SOPs Three scenarios Announcements Region-None System- New SOP s In Effect July 1 st Dyspnea Common type of emergency
More informationFebruary EMS Training: Pulmonary Emergencies. Used with permission of Silver Cross EMS System
February EMS Training: Pulmonary Emergencies Used with permission of Silver Cross EMS System Goals Review airway anatomy and physiology for adults and pediatrics Review issues and techniques in airway
More informationCPAP. Pre-Hospital Treatment Using The Respironics Whisperflow CPAP Device. Charlottesville Albemarle Rescue Squad - CPAP
CPAP Pre-Hospital Treatment Using The Respironics Whisperflow CPAP Device CPAP What Is It? C ontinuous P ositive A irway P ressure Anatomy Review Anatomy Review Anatomy Review Alveoli Anatomy Review Chest
More informationAppendix (i) The ABCDE approach to the sick patient
Appendix (i) The ABCDE approach to the sick patient This appendix and the one following provide guidance on the initial approach and management of common medical emergencies which may arise in general
More informationPALS Study Guide 2016
Mandatory Precourse Self-Assessment at least 70% pass. Bring proof of completion to class. The PALS Provider exam is 50 multiple-choice questions. Passing score is 84%. Student may miss 8 questions. All
More informationACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv.8.18.18 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) SUDDEN PROGRESSIVE FORM OF ACUTE RESPIRATORY FAILURE ALVEOLAR CAPILLARY MEMBRANE BECOMES DAMAGED AND MORE
More informationEmergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: Pediatric Revised: 11/2013
Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: Pediatric Revised: 11/2013 (10 questions from this outline in the blue section) Emergency Medical
More informationLesson 4-3: Cardiac Emergencies. CARDIAC EMERGENCIES Angina, AMI, CHF and AED
Lesson 4-3: Cardiac Emergencies CARDIAC EMERGENCIES Angina, AMI, CHF and AED THREE FAMILIAR CARDIAC CONDITIONS Angina Pectoris Acute Myocardial Infarction Congestive Heart Failure ANGINA PECTORIS Chest
More informationHandling Common Problems & Pitfalls During. Oxygen desaturation in patients receiving mechanical ventilation ACUTE SEVERE RESPIRATORY FAILURE
Handling Common Problems & Pitfalls During ACUTE SEVERE RESPIRATORY FAILURE Pravit Jetanachai, MD QSNICH Oxygen desaturation in patients receiving mechanical ventilation Causes of oxygen desaturation 1.
More informationRESPIRATORY EMERGENCIES. Michael Waters MD April 2004
RESPIRATORY EMERGENCIES Michael Waters MD April 2004 ASTHMA Asthma is a chronic inflammatory disease of the airways with variable or reversible airway obstruction Characterized by increased sensitivity
More informationVACCINE-RELATED ALLERGIC REACTIONS
VACCINE-RELATED ALLERGIC REACTIONS Management of Anaphylaxis IERHA Immunization Program September 2016 VACCINE-RELATED ADVERSE EVENTS Local reactions pain, edema, erythema Systemic reactions fever, lymphadenopathy
More informationTraining. Continuous Positive Airway Pressure (CPAP)
Training The training module will follow the national standard curriculum as it relates to the application and use of CPAP. The proposed curriculum will closely resemble the following algorithm utilizing
More informationPEDIATRIC TREATMENT GUIDELINES - CARDIAC VENTRICULAR FIBRILLATION - PULSELESS VENTRICULAR TACHYCARDIA (SJ-PO1) effective 05/01/02
PEDIATRIC TREATMENT GUIDELINES - CARDIAC VENTRICULAR FIBRILLATION - PULSELESS VENTRICULAR TACHYCARDIA (SJ-PO1) effective 05/01/02 Revision #5 04/19/02 Identify Dysrhythmia DEFIBRILLATE: 2 J/kg, 4 J/kg,
More informationPALS PRETEST. PALS Pretest
PALS PRETEST 1. A child with a fever, immune system compromise, poor perfusion and hypotension is most likely to be experiencing which type of shock A. cardiogenic B. Neurogenic C. Septic D. Hypovolemic
More informationMichigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
More informationMEDICAL KIT - ALGORITHMS
MEDICAL KIT - ALGORITHMS Page 2 : BRONCHOSPASM / ASTHMA Page 3 : TENSION PNEUMOTHORAX Page 4 : Page 5 : Page 6 : CONGESTIVE HEART FAILURE/ PULMONARY EDEMA ANAPHYLACTIC SHOCK / ALLERGIC REACTION ANGINA
More informationVACCINE-RELATED ALLERGIC REACTIONS
VACCINE-RELATED ALLERGIC REACTIONS Management of Anaphylaxis Public Health Immunization Program June 2018 VACCINE-RELATED ADVERSE EVENTS Local reactions pain, edema, erythema Systemic reactions fever,
More informationWESTCHESTER REGIONAL EMERGENCY MEDICAL ADVISORY COMMITTEE
WESTCHESTER REGIONAL EMERGENCY MEDICAL ADVISORY COMMITTEE POLICY STATEMENT Supercedes/Updates: New No. 04-02 Date: April 19, 2004 Re: EMT-B Administration of Nebulized Albuterol Pages: 3 Administration
More informationPROFESSIONAL NURSING SERVICES, INC York Road Cockeysville, MD (410)
PROFESSIONAL NURSING SERVICES, INC. 10615 York Road Cockeysville, MD 21030 (410) 683-9770 www.pnsnursing.com Aspiration and Airway Precautions Guideline Purpose: All medical personnel will assess for signs
More informationShelley Westwood, RN, BSN
Shelley Westwood, RN, BSN The body requires a constant supply of oxygen for survival. AMERICAN RED CROSS FIRST AID RESPONDING TO EMERGENCIES FOURTH EDITION Copyright 2006 by The American National Red Cross
More informationAllergic Reactions and Envenomations. Chapter 16
Allergic Reactions and Envenomations Chapter 16 Allergic Reactions Allergic reaction Exaggerated immune response to any substance Histamines and leukotrienes Chemicals released by the immune system Anaphylaxis
More informationAcute respiratory failure
Rita Williams, NP-C, PA PeaceHealth Medical Group Pulmonary & Critical Care Acute respiratory failure Ventilation/perfusion mismatching Most common cause of hypoxemia Normal is 1:1 ratio or 1 Ventilation
More informationChronic obstructive pulmonary disease
Chronic obstructive pulmonary disease By: Dr. Fatima Makee AL-Hakak () University of kerbala College of nursing Out lines What is the? Overview Causes of Symptoms of What's the difference between and asthma?
More informationChapter 23 Outline. Chapter 23: Emergency Drugs. General Measures. Categories of Emergencies. Preparation for Treatment 12/12/2011.
Chapter 23 Outline Chapter 23: Emergency General measures Categories of emergencies Emergency kit for the dental office Emergency 2 Emergency General Measures Haveles (p. 290) Haveles (pp. 290-291) (Boxes
More informationApproach to type 2 Respiratory Failure
Approach to type 2 Respiratory Failure Changing Nature of NIV Not longer just the traditional COPD patients Increasingly Obesity Neuromuscular Pneumonias 3 fold increase in patients with Ph 7.25 and below
More information5/26/10. Upper Airway Emergencies Identify life threatening upper airway infections Recognize and treat anaphylaxis and airway burns in children
Andi Marmor, MD Assistant Clinical Professor, Pediatrics University of California, San Francisco Upper Airway Emergencies Identify life threatening upper airway infections Recognize and treat anaphylaxis
More informationan inflammation of the bronchial tubes
BRONCHITIS DEFINITION Bronchitis is an inflammation of the bronchial tubes (or bronchi), which are the air passages that extend from the trachea into the small airways and alveoli. Triggers may be infectious
More information: ADULT RESPIRATORY DISTRESS
6279.02: ADULT RESPIRATORY DISTESS INTRODUCTION Respiratory distress is one of the most common clinical presentations in pre-hospital care. The etiology may be multifactorial. Successful management requires
More informationGOALS AND INSTRUCTIONAL OBJECTIVES
October 4-7, 2004 Respiratory GOALS: GOALS AND INSTRUCTIONAL OBJECTIVES By the end of the week, the first quarter student will have an in-depth understanding of the diagnoses listed under Primary Diagnoses
More information10/17/2016 OXYGEN DELIVERY: INDICATIONS AND USE OF EQUIPMENT COURSE OBJECTIVES COMMON CAUSES OF RESPIRATORY FAILURE
OXYGEN DELIVERY: INDICATIONS AND USE OF EQUIPMENT J U L I E Z I M M E R M A N, R N, M S N C L I N I C A L N U R S E S P E C I A L I S T E L O I S A C U T L E R, R R T, B S R C C L I N I C A L / E D U C
More informationSAN JOAQUIN COUNTY EMERGENCY MEDICAL SERVICES
EMS Agency SAN JOAQUIN COUNTY EMERGENCY MEDICAL SERVICES Pediatric Advanced Life Support Policies Emergency Medical Services TITLE: Pediatric Routine Medical Care EMS Policy No. 5800 Pediatric Routine
More informationIntroduction to Emergency Medical Care 1
Introduction to Emergency Medical Care 1 OBJECTIVES 22.1 Define key terms introduced in this chapter. Slides 10, 14, 19, 37, 39 22.2 Differentiate between the signs and symptoms of an allergic reaction
More informationPulmonary Pathophysiology
Pulmonary Pathophysiology 1 Reduction of Pulmonary Function 1. Inadequate blood flow to the lungs hypoperfusion 2. Inadequate air flow to the alveoli - hypoventilation 2 Signs and Symptoms of Pulmonary
More informationEmergency Triage Assessment and Management (ETAT) POST-TEST: Module 1
Emergency Triage Assessment and Management (ETAT) POST-TEST: Module 1 For questions 1 through 3, consider the following scenario: A three year old comes with burns to her face and chest after a kerosene
More informationHASPI Medical Anatomy & Physiology 14b Lab Activity
HASPI Medical Anatomy & Physiology 14b Lab Activity Name(s): Period: Date: Respiratory Distress Respiratory distress is a broad medical term that applies to any type of breathing difficulty and the associated
More information1 Chapter 10 Shock 2 Shock Shock: Inadequate State of collapse and failure of the system Leads to inadequate circulation Without adequate blood flow,
1 Chapter 10 Shock 2 Shock Shock: Inadequate State of collapse and failure of the system Leads to inadequate circulation Without adequate blood flow, cannot get rid of metabolic wastes Results in hypoperfusion
More informationChapter 13. Respiratory Emergencies
Student Notes Chapter 13: Respiratory Emergencies 1 Chapter 13 Respiratory Emergencies Unit Summary After students complete this chapter and the related course work, they will understand the significance
More informationPediatric Assessment Triangle
Pediatric Assessment Triangle Katherine Remick, MD, FAAP Associate Medical Director Austin Travis County EMS Pediatric Emergency Medicine Dell Children s Medical Center Objectives 1. Discuss why the Pediatric
More informationABCDE HOW TO RECOGNISE AND TREAT THE SERIOUSLY ILL CHILD
ABCDE HOW TO RECOGNISE AND TREAT THE SERIOUSLY ILL CHILD A B C D E Possible Problems Airway obstruction Partial or complete Foreign body Secretions/blood/vomit Infection Swelling e.g. anaphylaxis trauma
More informationSTATE OF OKLAHOMA 2014 EMERGENCY MEDICAL SERVICES PROTOCOLS
3K NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) ADULT EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC Indications: 1. Dyspnea Uncertain Etiology Adult. 2. Dyspnea Asthma Adult. 3. Dyspnea Chronic
More informationHave you ever managed patients who have experienced an adverse reaction to transfusion?
Have you ever managed patients who have experienced an adverse reaction to transfusion? A. Yes, often B. Yes, occasionally C. No A. 1 in 30 units? B. 1 in 100? C. 1 in 1000? D. 1 in 10,000? SHOT collects
More informationADULT DRUG REFERENCE Drug Indication Adult Dosage Precautions / Comments
ADENOSINE Paroxysmal SVT 1 st Dose 6 mg rapid IV 2 nd & 3 rd Doses 12 mg rapid IV push Follow each dose with rapid bolus of 20 ml NS May cause transient heart block or asystole. Side effects include chest
More informationOverview. The Respiratory System. Chapter 18. Respiratory Emergencies 9/11/2012
Chapter 18 Respiratory Emergencies Slide 1 Overview Respiratory System Review Anatomy Physiology Breathing Assessment Adequate Breathing Breathing Difficulty Focused History and Physical Examination Emergency
More information