Chapter 16: Respiratory Emergencies

Introduction

• Focus on respiratory emergencies in infants, children, and adults.
• Topics: respiratory anatomy and physiology, pathophysiology, signs, and symptoms of conditions like asthma, COPD, and pneumonia.
• Essential for EMTs to understand and provide basic care.

Respiratory System Overview

• Structures Involved: Diaphragm, chest wall muscles, accessory muscles, nerves from brain and spinal cord.
• Upper Airway: Nose, mouth, jaw, oral cavity, pharynx, larynx.
• Lower Airway: Trachea, bronchi, bronchioles, alveoli.
• Main Function: Respiration – exchange of oxygen and carbon dioxide.

Physiology of Respiration

• Processes: Inspiration and expiration.
• Gas Exchange: Occurs at alveoli, facilitated by diffusion.
• Regulation by Brain Stem: Adjusts breathing based on CO2 levels.

Pathophysiology of Respiratory Conditions

• Causes of Dyspnea: Anatomical abnormalities, disease processes, traumatic conditions.
• Carbon Dioxide Retention: Seen in COPD, can lead to hypoxic drive.

Causes of Dyspnea (Difficulty Breathing)

• Medical Conditions: Pulmonary edema, hay fever, pleural effusion, airway obstruction, hyperventilation syndrome, environmental exposures, carbon monoxide poisoning, drug overdose.
• Pathological Processes: Obstruction of gas exchange, airway obstruction, collapsed alveoli, or fluid-filled pleural space.

Respiratory Infections

• Upper Airway: Croup, epiglottitis, RSV, bronchiolitis.
• Lower Airway: Pneumonia, tuberculosis.
• Viral Infections: Influenza type A, COVID-19.

Chronic Respiratory Conditions

• Pulmonary Edema: Often due to congestive heart failure, fluid backups in lungs.
• COPD (Chronic Obstructive Pulmonary Disease): Includes emphysema and chronic bronchitis, often related to smoking.
• Asthma: Acute spasm of bronchioles, characterized by wheezing.
• Hay Fever and Anaphylaxis: Allergic reactions causing airway swelling.

Mechanical and Environmental Causes

• Pneumothorax: Air in pleural space, often due to trauma.
• Pleural Effusion: Fluid collection in pleural space.
• Airway Obstruction: Can be mechanical (e.g., food) or due to improper head positioning.
• Pulmonary Embolism: Blockage in pulmonary circulation.
• Hyperventilation: Often linked to anxiety or panic attacks.

Assessment and Management

• Scene Size-Up: Use PPE, recognize potential hazmat situations.
• Primary Assessment: Check ABCs (Airway, Breathing, Circulation), use AVPU scale, listen to breath sounds.
• Secondary Assessment: Focus on history of illness, use SAMPLE & OPQRST for history.
• Intervention Strategies: High-flow O2, PPV, CPAP, assist with medication if needed.

Specific Condition Management

• Infections: Use humidified oxygen, avoid suction with epiglottitis.
• Pulmonary Edema: Provide CPAP if needed, suction if necessary.
• COPD and Asthma: Assist with inhalers, manage airway aggressively.
• Anaphylaxis: Remove allergens, administer epi, provide aggressive airway management.
• Obstruction Management: Clear complete obstructions, provide supplemental O2.

Review Questions

• Respiration is the exchange of gases in the lungs.
• Asthma affects the lower airway.
• Tuberculosis is drug-resistant and spread through coughing.
• Emphysema is a chronic disease, while conditions like asthma and pneumo are acute.
• Pulmonary Embolism often causes sudden onset of pleuritic chest pain.