Unit 4 Breathing Emergencies

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Unit 4Breathing Emergencies

• PE 216 Emergency Response

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Breathing Emergencies

• Establishing and maintaining airway is of
  greatest importance
• No Airway leads to No Breathing
• No Breathing leads to No Circulation
• No Circulation leads to Death

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Clinical Anatomy

• Upper Airway
• Nose/Mouth
• Air entry
• Separated by palate
• Nasopharynx
• Oropharynx
• Pharynx
• Epiglottis
• Larynx
• Trachea

• Lower Airway
• R/L Bronchi
• Branch to lobes of lungs
• Bronchioles
• Alveoli
• Small sacs
• Gas exchange

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Breathing Emergencies

• Difficulty (dyspnea) or lack of breathing (apnea)
• Causes
• Choking
• Illness (pneumonia)
• Medical Conditions (emphysema, asthma)
• Heart Attack (myocardial infarction)
• Allergic reactions
• Electrocution
• Shock
• Drowning
• Poisoning
• Drugs
• Emotional Distress

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Respiratory Distress

• Signs and Symptoms
• Slow or rapid breathing
• Deep or shallow breathing
• Shortness of breath
• Noisy breathing
• Dizziness, drowsiness, light-headedness
• Changes in Level of Consciousness
• Flushed, pale, bluish skin
• Moist, cool skin
• Tingling in hands, feet, lips
• Agitation, apprehension, fear
• Difficulty completing sentences without being out
  of breath

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Respiratory Distress

• Care and Treatment
• Activate EMS
• Rest comfortably
• Comfort the victim
• Assist victim with prescribed
• meds (inhaler)
• Regulate body temperature
• Give emergency oxygen
• In through nose, out through mouth.

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Resuscitation Masks

• Flexible, dome shaped devices that cover the
  victims mouth/nose
• Allow breathing without mouth-to-mouth contact
• Vary in sizes adult, child, pediatric
• Can invert the mask to adapt an adult to
  child/infant

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Resuscitation Masks

• Benefits of Use
• Reduces chance of disease transmission
• Creates seal over mouth/nose
• Can connect to emergency oxygen
• Characteristics
• Easy assembly/use
• One way valve

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Bag Valve Mask

• Primarily used to ventilate a patient in
  respiratory arrest
• BVM is a one-way valve
• Vary in sizes
• Advantages
• Use environmental, not
• exhaled air
• Connect to emergency oxygen
• Protects against disease transmission
• Saves rescuer energy

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Opening the Airway

• Use head-tilt, chin-lift or jaw thrust maneuvers
• When head is flexed, the trachea is blocked,
  usually by the tongue
• Tilting the head or pulling the jaw forward
  removes the tongue from the back of the throat
• Re-tilting the head once after the initial
  attempt fails is the acceptable means of opening
  the airway
• Tongue is 1 blockage

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Tilting the Head

• When performing the head-tilt on children and
  infants, do not tilt as far as adults
• Airway is smaller
• Less fatty tissue in the neck area
• Airway will open easier with smaller movement

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Rescue Breaths

• Provided to victims who are not breathing on
  their own, and have a pulse
• Continue until
• Scene becomes unsafe
• Victim begins breathing on their own
• Another trained rescuer takes over
• You are too exhausted
• The victim loses a pulse, thus begin CPR

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Performing Rescue Breathing

• Scene Size Up
• Open Airway
• Look/Listen/Feel (lt10 sec)
• If no breathing, give 2 rescue breaths
• Check for pulse (lt10 sec)
• If pulse is present, begin rescue breathing
• Adult 1 breath every 5 seconds
• Child/Infant 1 breath every 3 seconds
• Perform re-check after 2 minutes

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Breathing

• Rescue Breaths Should
• Be slow and firm, yet not too forceful
• Last approximately 1 second per breath
• Be preceded by a full, deep breath by the rescuer
• If breaths are given too hard or too fast, air
  will enter stomach, not lungs
• Increased pressure in the stomach will lead to
  vomiting
• Patient will most likely vomit during CPR
  regardless of breath quality

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Timing

• Always count out loud to keep on pace
• Example Adult Rescue Breathing
• 1- one thousand
• 2- one thousand
• 3- one thousand
• 4- Take a deep breath
• 5- Breathe into victim
• 12 cycles 1 minute in adult
• 20 cycles 1 minute in child/infant

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Assessing Breathing Rate

• If victim is breathing, rate/quality must be
  assessed
• Normal Breathing Rates
• Adult/Teen 12-20 bpm
• Child lt10 y/o 15-30 bpm
• Measure breaths for 30 sec, multiply by 2

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Assessing Breathing Quality

• Signs of Respiratory Distress
• Nasal flaring
• Use of accessory muscles
• Cyanosis bluish colored skin
• Gurgling or wheezing
• Dizziness/lightheadedness
• Fear or apprehension
• Excessively shallow breaths

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Breathing Support

• Patients breathing lt8 bpm may need assisted
  ventilations
• Breathe with the patient, and in-between their
  breaths
• Patients breathing gt20 bpm need help reducing
  their rate
• Instruct patient to breathe deeply and slowly, in
  through nose, out through mouth
• Have patient rest comfortably and loosen
  restrictive clothing
• Do not have patient breathe into a paper bag,
  this reduces oxygen levels

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Emergency Oxygen

• Patients in respiratory distress have a decreased
  oxygen flow to body tissues
• Emergency O2 provides high flow support to remedy
  this deficiency
• Provided via
• Nasal Cannula 2-6 liters/min
• Non re-breather 6-15 liters/min
• Must be certified to use, or have standing orders
  from a physician

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Airway Obstructions

• Most common cause of respiratory emergencies
• A blocked airway quickly leads to no breathing
  and can progress to a loss of consciousness (LOC)
  and loss of circulation

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Types of Obstructions

• Anatomical
• Tongue
• Swollen Tissues (Allergic Reaction)
• Trauma
• Foreign
• Food/Candy
• Toys
• Small objects
• Partial or Complete
• Partial will lead to wheezing
• Complete patient cannot cough, speak, or breathe

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Universal Sign of Choking

• Victim clutches throat with both hands, crossing
  arms

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Adult/Child Conscious Choking

• Alternate 5 back blows and 5 abdominal thrusts to
  remove object
• If victim is grossly obese or pregnant, replace
  abdominal thrusts with chest thrusts by moving
  above the abdomen
• Perform until
• Victim is able to cough, speak or breathe
• Victim loses consciousness

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Infant Conscious Choking

• Alternate 5 Back Blows and 5 Chest Compressions
  with victim in arms
• Technique Rescuer standing or seated
• Back Blows Infant cradled face down on the
  forearm with fingers splitting the airway and
  resting on the cheeks, forearm rests on thigh
• Chest Compressions Infant held face up on
  opposite forearm with hand supporting the head,
  forearm rests on thigh

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Unconscious Choking

• After initial assessment reveals no breathing,
  open the airway and give 2 rescue breaths
• If rescue breaths do not go in, re-tilt the head
• Give 2 more rescue breaths
• If breaths still do not go in, give 5 chest
  compressions
• Perform visual inspection of mouth
• Remove object with index finger if something is
  seen (pinky finger for infants)
• Re-Attempt 2 rescue breaths

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Unconscious Choking

• Use pinky finger to sweep objects in infants
• Continue cycles of 5 chest compressions and 2
  breaths until
• Rescue breaths enter the lungs
• Patient begins breathing on their own
• You become too exhausted to continue
• Scene becomes unsafe
• Another trained rescuer takes over