4-2 Respiratory Emergencies

Signs and symptoms

• Inadequate breathing: inadequate rate or volume (normal breathing is 12-20 bpm, or one breath per 3-5 seconds), inadequate chest rise and fall, little air movement from mouth and nose, diminished breath sounds when auscultating.
• Sucking wounds.
• Altered mental status.
• Tripod position.
• Abnormal sounds: snoring, stridor, gurgling, crowing, coughing, wheezing, rhonchi, crackles and rales.
• Use of neck muscles and retractions of the intercostal muscles during breathing.
• Head bobbing.
• See-saw motion of the chest and abdomen.
• Tracheal tugging.
• Nasal flaring.
• Diaphoretic: sweaty from effort to breath.
• Having difficulty talking.
• Hypoxia signs: pallor, cyanosis, puls-ox below 95%, sluggish pupil response.
• Pursed lips during exhalation is characteristic of patients with chronic respiratory diseases.
• Agitated, confused facial expression.
• Pulsus paradoxus: drop in blood pressure (or pulse strength) during inhalation.
• Paradoxical motion: an area of the chest moves inward during inhalation and outward during exhalation.
• Abnormal pulse: fast at first due to anxiety, later slow because the heart is not getting enough oxygen.

Treatment

• Oxygen at 15 lpm through non-rebreather mask.
• Positive pressure ventilation (PPV).
• Clearing the airway: Suction, Heimlich maneuver.
• For vomiting patients, position in the recovery position.
• Head-tilt chin-lift, jaw thrust, or insertion of an airway adjunct for snoring patients.
• For altered mental status patients, protect their airway with an airway adjunct.
• Stabilize any flail segments for patients with paradoxical motion.
• Assist asthma patients in administering their prescribed MDI.
• MDI administration: inhale slowly and deeply, hold for as long as possible, then exhale slowly through pursed lips.
• Ventilate pneumothorax patients carefully and with minimal tidal volume needed. You don't want to push more air into the pleural cavity.
• If a child does not tolerate the non-rebreather mask during oxygen administration, have the parent hold it over the child's face.
• Sucking wounds need to be covered by occlusive dressing and sealed on 3 sides.

Medical conditions and mechanisms

• Chronic obstructive pulmonary disease (COPD): prolonged airway obstruction. Includes emphysema and chronic bronchitis.
• Obstructive pulmonary (lung) disease: airway obstruction. Includes emphysema, chronic bronchitis, and asthma.
• Emphysema: Decreased alveoli surface area, leading to inefficient gas exchange. Increased distal airway resistance, making it difficult to breath.
  • Pink complexion, "pink puffers".
  • Nonproductive cough.
  • Barrel chest.
• Chronic bronchitis: inflammation, swelling and thickening of the lining of the bronchi and bronchioles with excessive mucus production. This narrows the airway, and the patient find it difficult to breath.
  • Cyanotic complexion, "blue bloaters".
  • Productive cough.
• Asthma: allergic reaction in the lower airway, causing bronchospasms that narrow the bronchioles, edema of inner lining, and mucus obstruction.
  • Nonproductive cough.
  • Allergic signs such as runny nose, sneezing, red eyes, stuffy nose.
  • Wheezing on auscultation.
• Pneumonia: bacterial or viral infection to the lower respiratory tract, and causes inflammation and fluid / pus filling the alveoli. This decreases the efficiency of gas exchange, and leads to hypoxia.
  • Signs of hypoxia.
  • Malaise and fever.
  • Coughing.
  • Chest pain.
• Pulmonary embolism: obstruction in the pulmonary arteries. The obstruction can be caused by a clot, air bubble, fat, or other substances. High risk for patients with extended periods of immobility, heart disease, recent surgery, DVT and any other conditions where a blood clot is likely.
  • Sharp, stabbing chest pain.
  • Cough (may cough up blood).
  • Signs of hypoxia.
  • Jugular vein distention.
• Acute pulmonary edema: fluid between alveoli and capillaries, which decreases the efficiency of gas exchange.
  • Crackles upon auscultation.
  • Signs of hypoxia.
  • Frothy sputum.
  • Orthopnea.
• Spontaneous pneumothorax: sudden rupture of the visceral lining and partial collapse of the lung. Spontaneous pneumothorax is not caused by trauma, but is caused by weakened areas of the lung that suddenly ruptures. High risk patients are those with COPD.
  • Sharp chest or shoulder pain.
  • Decreased breath sounds to one side of the chest.
  • Subcutaneous emphysema may be found.
  • Signs of hypoxia.
  • Can lead to tension pneumothorax, which completely collapses the lung.
• Hyperventilation: patients suffering from panic attacks can breath too fast.
  • Numbness and tingling of the mouth, hands and feet.
  • Dizziness.
  • Can lead to seizures for patients with the disorder.

Terms

• Respiratory distress: currently have adequate breathing rate and volume, but is having difficulties.
• Respiratory failure: inadequate breathing.
• Respiratory arrest: not breathing / apnea.
• Dyspnea: shortness of breath.
• Apnea: not breathing.
• Hypoxia: inadequate oxygen.
• Hypercarbia: too much carbon dioxide.
• Rhonchi: snoring and rattling upon auscultation. Indicates mucus obstructions.
• Crackles: also known as rales, are bubbly or crackling sounds during inhalation. Indicates fluid in lungs. These are sounds of alveoli and terminal bronchioles "popping" open with each inhalation.
• Bronchospasm: same as bronchoconstriction.
• Status asthmaticus: severe asthma attack that does not respond to medication.
• Nonproductive cough: no sputum.
• Productive cough: with sputum.
• Orthopnea: difficulty in breathing when lying flat.
• Subcutaneous emphysema: air bubbles under the skin.