Respiratory Emergencies

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Lewis County On-Going Training and Evaluation
Program 2007-2008
MODULE 9
Respiratory Emergencies
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AGENDA
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Lewis County Protocols
• CPS Quiz
• Skill Stations

• Key Terms
• Patient Assessment
• Vital signs
• Respiratory Emergencies

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Lewis County On-Going Training and Evaluation
Program 2007-2008

• Our OTEP modules contain graphic pictures
  depicting injuries that EMS providers may
  encounter while providing care in the field
• Our goal in providing real-life pictures is to
  enhance the learning experience by making the
  OTEP curriculum more interesting and engaging to
  Yakima County EMS providers

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KEY TERMS
Lewis County On-Going Training and Evaluation
Program 2007-2008
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Agonal Respirations
Lewis County On-Going Training and Evaluation
Program 2007-2008

• The last breath
• Shallow
• Gasping
• Found in the cardiac arrest patient

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(No Transcript)
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Hypoxia
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Decreased oxygen levels in the body
• Enough so to cause impairment of function
• Could be due too
• Insufficient oxygen levels
• Inadequate oxygen transport
• Inability of tissues to use oxygen

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Ventilation Oxygenation
Lewis County On-Going Training and Evaluation
Program 2007-2008
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Patient Assessment
Lewis County On-Going Training and Evaluation
Program 2007-2008
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Initial Assessment
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Safe to approach patient
• Level of consciousness
• Airway
• Breathing (rate quality)
• Circulation (check pulse, skin signs)

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Detailed Assessment
Lewis County On-Going Training and Evaluation
Program 2007-2008

• SAMPLE (Subjective)
• Bystander/family/patient info (Subjective)
• Head-to-Toe Exam (Objective)

observe patients environment
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Focused Assessment
Lewis County On-Going Training and Evaluation
Program 2007-2008

• For ex SOB
• O2 Sats
• Lung sounds
• Have you had a cough?
• Are you able to cough anything up?
• Are you having more trouble breathing at night?

• Usually a stable patient
• Focus in on chief complaint

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Ongoing Assessment
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Repeat Initial Assessment
• Repeat vital signs
• Assess chief complaint
• Assess treatment provided
• Usually performed during transport

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Respiratory Rate Quality
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Quality
• Good volume
• Shallow
• Deep
• Irregular
• Regular

• Rate
• 12 24 normal
• Too slow
• Too fast
• Consider events leading up to illness/incident.

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Assessing the Respiratory Patient
Lewis County On-Going Training and Evaluation
Program 2007-2008
Critical
Not Critical

• Disoriented
• Diaphoretic/clammy
• Speaking 2 3 word sentences
• Respiratory rate is too fast or too slow
• Quality of each breath is poor

• Oriented
• Dry skin
• Speaking full sentences
• Respiratory rate good
• Quality of each breath is good

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Assessing Lung Sounds
Lewis County On-Going Training and Evaluation
Program 2007-2008
Chest
Back
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Assessing Lung Sounds
Lewis County On-Going Training and Evaluation
Program 2007-2008
Right Side
Left Side
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Assessing Lung Sounds
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Rhonchi junky phlegm
• Wheeze whistle tightened airways
• Rales wet heart failure (blood)
• Crackles popping alveoli close and pop open
  on inspiration

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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Respiratory Emergencies
Lewis County On-Going Training and Evaluation
Program 2007-2008
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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Asthma
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Swollen air passage-ways causing increased
  resistance
• Wheeze heard on auscultation
• Can be caused by exertion or allergic trigger

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Asthma
Lewis County On-Going Training and Evaluation
Program 2007-2008
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Asthma - Pharmacology
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Albuterol metered-dose inhaler
• Ventolin metered-dose inhaler

Azmacort duo-neb Flovent ipatroprium Singulair Se
revent Prednisone
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Asthma
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Patient presentation
• wheezing lung sounds, mucus production,
  shortness of breath
• Pre-hospital treatment
• oxygen, encourage or assist patient with their
  own metered-dose inhaler until patient has relief
  (per Lewis County Protocols).

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Allergies
Lewis COunty On-Going Training and Evaluation
Program 2007-2008

• Allergic Reaction
• localized, such as a raised area on the skin
  from a sting
• Anaphylactic Reaction
• systemic, affects the respiratory and
  circulatory systems

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Anaphylactic Reaction
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Patient presentation
• severe shortness of breath, may be unconscious,
  low blood pressure

Pre-hospital treatment Oxygen, assist
ventilations as needed, Epi-Pen.
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Emphysema
Lewis COunty On-Going Training and Evaluation
Program 2007-2008
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Emphysema
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Patient presentation
• Poor volume
• Decreased elasticity
• Pursed lips
• Tripod-positioning
• 3-4 word sentences

Pre-hospital treatment oxygen, assist
ventilations as needed
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COPD
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Chronic Bronchitis
• Cough
• Fever
• Yellow sputum production
• Rhonchi
• Frequently occurring

• Emphysema
• Quiet/wheeze lung sounds
• Poor volume
• Severe shortness of breath
• White sputum production or no sputum production

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Lung Cancer
Lewis County On-Going Training and Evaluation
Program 2007-2008
Patient presentation shortness of breath, cough,
productive (bright red blood, tissue), chest pain
Pre-hospital treatment oxygen, assist
ventilations as needed, position-of- comfort
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Lewis County On-Going Training and Evaluation
Program 2007-2008
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Cardiac Involvement
Lewis County On-Going Training and Evaluation
Program 2007-2008
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Congestive Heart Failure
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Heart cannot
• pump efficiently

Blood backs up Increased pressure in the
pulmonary arteries Blood backs up into the lungs
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Symptoms of CHF
Lewis County On-Going Training and Evaluation
Program 2007-2008

• SOB
• Rales
• Swollen ankles
• Increase SOB when supine
• History of CHF
• May have history of A-Fib (irregular heart beat)

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CHF - Pharmacology
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Lasix
• Captopril
• Enalapril
• Digitalis

A-fib
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CHF
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Patient presentation
• swollen ankles or Rales or both.
• Anxiety, pale skin and shortness of breath
• Pre-hospital treatment
• oxygen, assist ventilations as needed (consider
  positive-pressure ventilation), keep patient
  seated as upright as level of consciousness
  permits.

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Cardiac Arrhythmias
Lewis County On-Going Training and Evaluation
Program 2007-2008
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Too Slow
Lewis County On-Going Training and Evaluation
Program 2007-2008
Patient presentation weak, lethargic (sleepy),
short of breath, pale, diaphoretic
Pre-hospital treatment lie patient in supine
position, oxygen, assist ventilations as needed
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Too Fast
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Supra-Ventricular Rhythm
• The heart is not able to pump efficiently at this
  rate.
• Patient presentation
• weak, short of breath, palpitations

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Too Fast Bad Origin
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Ventricular Tachycardia
• May or may not produce a pulse
• Patient is at risk for cardiac arrest
• Patient presentation
• weak, short of breath, palpitations

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Lewis County On-Going Training and Evaluation
Program 2007-2008
Mr. Osborne, may I be excused? My brain is
full.
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Brain Involvement
Lewis County On-Going Training and Evaluation
Program 2007-2008
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Drug Overdose
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Decrease respiratory drive
• Inability to clear airway secretions

Pre-hospital treatment oral airway (OPA, NPA),
oxygen, assist ventilations and suction as
needed.
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Cerebral Vascular Accident (CVA)
Lewis County On-Going Training and Evaluation
Program 2007-2008
Depending on location of the CVA within the brain

• Altered mental status
• Difficulty breathing
• Inability to clear own secretions

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CVA
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Pre-hospital treatment
• Oral airway (OPA or NPA)
• Oxygen, assist ventilations as needed
• Suction as needed
• If patient is conscious
• 4. Provide reassurance to the patient

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Trauma
Lewis County On-Going Training and Evaluation
Program 2007-2008
Pre-hospital treatment Face shield, Oxygen,
assist ventilations suction as needed, c-spine,
backboard

• Head injuries, much like a stroke victim,
• can have
• Decreased levels of consciousness
• Irregular respiratory rate
• Decrease respiratory drive
• Inability to clear their own airway

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Seizure
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Patient presentation
• irregular respiratory rate, apneic (not
  breathing) for duration of seizure, inability to
  clear their own secretions.

Pre-hospital treatment clear area, suction as
needed, oxygen, assist ventilations as needed.
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Lewis County Protocols
Lewis County On-Going Training and Evaluation
Program 2007-2008
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Yakima County Protocol - Asthma
Lewis County On-Going Training and Evaluation
Program 2007-2008

• Establish and maintain airway
• Administer oxygen
• If patient has a known history of respiratory
  difficulties, is conscious and having difficulty
  breathing, and has a physician prescribed
  metered-dose inhaler, the EMS provider may
• Encourage the patient to administer his/her own
  MDI
• Assist the patient in administering his/her MDI
• Medical Control/Base Station approval needed

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Lewis County Protocol - Anaphylaxis
Lewis County On-Going Training and Evaluation
Program 2007-2008

• A. Establish and maintain an airway
• B. Administer oxygen
• C. If patient has a known history of anaphylactic
  (allergic) reactions, is displaying signs of
  rash, redness, or respiratory distress, and has
  his/her own antihistamine, the EMS provider may
• Encourage the patient to administer his/her own
  Epi-pen
• 2. Assist the patient in administering his/her
  own Epi-pen
• 3. Medical Control/Base Station approval
  needed

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Lewis County On-Going Training and Evaluation
Program 2007-2008

• D. If patient has a known history of
  life-threatening anaphylactic reactions, is in
  respiratory distress and/or is hypotensive, and
  has a prescribed epinephrine auto-injector, the
  EMS provider may
• Encourage the patient to administer his or her
  own epinephrine auto-injector
• Assist the patient in administering his or her
  own epinephrine auto-injector
• Administer the epinephrine auto-injector for the
  patient
• E. Verbal Order Contact medical control or
  receiving hospital physician prior to giving
  epinephrine to any normotensive patient who is
  elderly or has a history of hypertension or MI
• F. Verbal Order If patient has no relief from
  the epinephrine and has a dual-dose injector,
  contact medical control or receiving hospital for
  further direction

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Lewis County Anaphylaxis Protocol Kristine
Kastner Act
Lewis County On-Going Training and Evaluation
Program 2007-2008

• a.) If the patient is less than 18 years old,
  does not have a prescription EpiPen and gives
  permission, or the parent or guardian gives
  permission, then EMS may administer the EpiPen
  from the unit.

• b.) If the patient is over 18 years old, has no
  prescription, and is having an anaphylactic
  reaction, EMS is allowed to administer the adult
  Epi-pen after consulting with Medical
  Control/Base Station.

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Lewis County On-Going Training and Evaluation
Program 2007-2008
Any Questions?