Overview. The Respiratory System. Chapter 18. Respiratory Emergencies 9/11/2012

Transcription

1 Chapter 18 Respiratory Emergencies Slide 1 Overview Respiratory System Review Anatomy Physiology Breathing Assessment Adequate Breathing Breathing Difficulty Focused History and Physical Examination Emergency Medical Care Oxygen Position and Transport Artificial Ventilation Slide 2 The Respiratory System The respiratory system takes oxygen from the air and makes it available for the blood to transport to every cell and rids the body of excess carbon dioxide Slide 3 1

2 The Respiratory System The Airway Upper airway Extends from the mouth and nose to the trachea Lower airway Extends from the trachea to the alveoli Slide 4 The Upper Airway Slide 5 The Upper Airway Nose and mouth Pharynx Oropharynx Nasopharynx Epiglottis Leaf-shaped structure that prevents food and liquid from entering the trachea during swallowing Slide 6 2

3 The Lower Airway Slide 7 The Lower Airway Trachea (windpipe) Cricoid cartilage Firm cartilage ring forming the lower portion of the larynx Larynx (voice box) Bronchi Two major branches of the trachea to the lungs; bronchus subdivides into smaller air passages ending at the alveoli Lungs Diaphragm Slide 8 Respiratory Terminology Ventilation The movement of air Respiration The exchange of gases Slide 9 3

4 Ventilation Inhalation (active) Diaphragm and intercostal muscles contract, increasing the size of the thoracic cavity Diaphragm moves slightly downward, flares lower portion of rib cage Ribs move upward/outward This creates a negative pressure in the chest cavity. Slide 10 Ventilation Air flows into the lungs because of the negative pressure Slide 11 Ventilation Exhalation Diaphragm and intercostal muscles relax, decreasing the size of the thoracic cavity Diaphragm moves upward Ribs move downward/inward Air is expelled from the lungs Slide 12 4

5 Respiration Alveolar respiration Gas exchange in the lungs Cellular respiration Gas exchange in the tissues of the body Slide 13 Alveolar Respiration Alveolar/capillary exchange Oxygen-rich air enters the alveoli during each inspiration Oxygen-poor blood in the capillaries passes into the alveoli Oxygen enters the capillaries as carbon dioxide enters the alveoli Slide 14 Cellular Respiration Capillary/cellular exchange Cells give up carbon dioxide to the capillaries Capillaries give up oxygen to the cells Slide 15 5

6 Alveolar and Cellular Respiration Slide 16 Normal Breathing Normal respiration should be effortless Slide 17 Normal Respiratory Rates Adult 12-20/minute Child 15-30/minute Infant 25-50/minute Slide 18 6

7 Assessing Breathing Rate Chest expansion Rhythm Effort of breathing Quality Depth (tidal volume) Breath sounds Slide 19 Effort of Breathing Accessory muscles Additional muscles used to draw air into the chest Includes the muscles of the neck, abdomen, and chest Use of accessory muscles is a sign of respiratory distress! Slide 20 Tidal Volume The amount of air exchanged in one breath Slide 21 7

8 Considerations for Infants and Children Slide 22 Adults versus Children Respiratory Anatomy Mouth and nose In general, all structures are smaller and more easily obstructed than in adults Slide 23 Adults versus Children Respiratory Anatomy Tongue Infants and children s tongues take up proportionately more space in the mouth than adults Trachea (windpipe) Narrower tracheas that are obstructed more easily by swelling Softer and more flexible in infants and children Cricoid cartilage Less developed and less rigid Chest wall is softer Tend to depend more heavily on the diaphragm for breathing Slide 24 8

9 Focused History and Physical Examination OPQRST O Onset P Provocation Q Quality R Radiation S Severity T Time SAMPLE S Signs and Symptoms A Allergies M Medications P Past medical history L Last Oral Intake E Events leading to injury or illness Slide 25 Focused History and Physical Examination Remember that a physical exam is required for all patients In the responsive patient, assess the body systems associated with the chief complaint Slide 26 Emergency Medical Care Slide 27 9

10 Emergency Medical Care Administer high-flow oxygen Slide 28 Emergency Medical Care Oxygen is the most important medication you can administer to a patient with respiratory distress. Slide 29 Emergency Medical Care Position and Transport Slide 30 10

11 Emergency Medical Care Patients should be transported in a position most comfortable for them. Slide 31 Artificial Ventilation Slide 32 Artificial Ventilation Preferred ventilation techniques Mouth-to-mask Two-person bag-mask Flow-restricted, oxygen-powered ventilation device One-person bag-mask Slide 33 11

12 Slide 34 Typical inhaler devices Slide 35 Most inhalers used to treat respiratory distress are drugs classified as beta-agonist inhalers Slide 36 12

13 Trade Name Proventil Ventolin Bronkosol Alupent Metaprel Brethine Atrovent Generic Name albuterol albuterol isoetharine metaproterenol metaproterenol terbutaline ipratropium bromide Slide 37 Indications Exhibits signs and symptoms of respiratory emergency Has physician-prescribed, hand-held inhaler Specific authorization by medical direction Slide 38 Contraindications Inability of patient to use device Inhaler is not prescribed for the patient No permission from medical direction Patient has already met maximum prescribed dose prior to EMT-Basic s arrival Slide 39 13

14 Assisting with an inhaler Check inhaler s expiration date Determine if patient has previously taken any doses Make sure that the inhaler is at room temperature Shake inhaler vigorously several times Remove oxygen mask Nasal cannula can be left in place while the inhaler is administered Slide 40 Have patient place inhaler in mouth Have patient inhale slowly and deeply while depressing the inhaler Slide 41 Have the patient inhale deeply and hold his or her breath so the medication can be absorbed Slide 42 14

15 Allow patient to breathe a few times, then repeat the dose if it is ordered Record time, dose, medication name, vital signs, and any changes in the patient s condition Slide 43 Slide 44 Side effects Increased heart rate Tremors Nervousness Nausea or vomiting Slide 45 15

16 Chronic Obstructive Pulmonary Disease COPD is a broad category that encompasses several disease processes Emphysema Chronic bronchitis Asthma Slide 46 Emphysema An abnormal condition of the lungs characterized by overinflation and destructive changes in the alveoli, resulting in decreased lung elasticity and impaired gas exchange Slide 47 Chronic Bronchitis A chronic condition characterized by excessive mucous secretions and inflammatory changes in the bronchial tree Slide 48 16

17 Asthma A lung disorder characterized by recurring episodes of breathing difficulty, wheezing due to construction of the bronchi, coughing, and lung secretions Slide 49 Summary Respiratory System Review Anatomy Physiology Breathing Assessment Adequate Breathing Breathing Difficulty Focused History and Physical Examination Emergency Medical Care Oxygen Position and Transport Artificial Ventilation Slide 50 17