hello and welcome to chapter 16 respiratory emergencies of the emergency care and transportation of the sick and injured 12th edition after you complete this chapter in the related coursework you will understand the significance and characteristics of respiratory emergencies in infant child and adult populations you will be able to demonstrate a fundamental comprehension of the following topics respiratory anatomy and physiology pathophysiology signs and symptoms of various respiratory ideologies including asthma copd and pneumonia and the assessment and management necessary to provide basic care in a pre-hospital setting so let's start emts will often encounter patients complaining of dyspnea and so what is dypsnia dyspnea is difficulty breathing okay so dipsnia can be caused by many different conditions it can be caused um and the cost can also be difficult to determine so even without a definitive diagnosis you may still be able to save the patient's life so to understand this let's talk a little bit about the anatomy of the respiratory system and if you've already listened to the airway chapter a lot of this is going to be a review for you okay so let's get started the respiratory system consists of all the structures that contribute to breathing and these include the diaphragm the chest wall muscles and also what we call accessory muscles and nerves from the brain and spinal cord to all these muscles all right so the upper and lower airway uh first we're going to talk about the upper airway and they consist of all the auto atomic structures above the vocal cords above the larynx right and so um or the larynx and above so you have the nose and the mouth the jaw the oral cavity the pharynx and then the larynx and this is a good picture this slide shows a good picture of the division of the upper and the lower airway right there at the larynx you could see this the division okay the principal function of the lungs is respiration and that's the exchange of oxygen and carbon dioxide air travels through the trachea into the lungs and then on to the bronchi eye bronchioles and then the alveoli and that's where the actual exchange takes place of the gases let's talk about the physiology of the respiration so there are two processes and it occurs during respiration so during respiration you have the inspiration and the expiration oxygen is provided to the blood and carbon dioxide is removed and in healthy lungs this exchange of gases takes place rapidly at the lever of the alveolae and this figure shows an up close exchange of that oxygen carbon dioxide within the alveoli okay so the alveoli lie against the pulmonary capillary vessels and oxygen passes freely through these tiny passages in the alveolar wall into the capillaries through a process called diffusion and it is then carried to the heart which pumps oxygen throughout the body carbon dioxide returns to the lungs and is exhaled out of the body the brain stem it can sense the level of carbon dioxide in the arterial blood and if the level of carbon dioxide drops too low the person will breathe slower then if the level of carbon dioxide raises in the in the blood above normal the person will breathe more rapidly and more deeply all right so some of the pathophysiology so a proper exchange of oxygen and carbon dioxide can be hindered and this can happen by abnormal conditions in the anatomy of the airway okay so like a process where it's blocked okay and then also disease process or some traumatic conditions and also abnormalities in the pulmonary vessels can cause oxygens change to be hindered so as an emt you have to be able to recognize the signs and symptoms of inadequate breathing and you need to know what to do about it all right so carbon dioxide retention and a hypoxic drive and we're going to talk a little bit about carbon dioxide retention and why somebody would retain carbon dioxide okay so patients will sometimes have elevated levels of carbon dioxide in their arterial blood and if the levels remain elevated for years the respiratory center in the brain will not function properly and these are patients such as chronic obstructive pulmonary disease patients with these patients the exhale or getting the co2 out through the alveoli is hindered okay and so they maintain for years they can have an elevated of carbon dioxide levels in their blood so the brain at that point gradually acclimates to high levels of carbon dioxide and then it switches to this backup system and this backup system to control breathing is based on low levels of oxygen and this is known as a hypoxic drive all right so carb so copd chronic obstructive pulmonary disease patients which maintain higher levels of carbon dioxide in their arterial blood they switch to what's known as a hypoxic drive so use caution we always say when administering oxygen to these patients all right so causes of the of dipsneh so dypsnia can be caused by many different conditions and so altered mental status may be a sign that the brain is hypoxic so patients often have difficulty breathing or hypoxia with some of the following medical conditions all right so pulmonary edema and what this is is the lungs you have fluid so edema fluid in the lungs hay fever pleural effusion obstruction of the airway hyperventilation syndrome environmental or industrial exposures carbon monoxide poisoning or drug overdose can all cause hypoxia or difficulty breathing okay so be aware that one or more of the following situations may exist in a dis dipsnic patient okay so just breathing too fast patient breathing too fast dips think all right so gas exchange between the alveoli and the pulmonary circulation could be obstructive it could be obstructed by fluid or an infection or perhaps a collapsed alveoli okay so that's at the pulmonary alveoli when it at the exchange the alveoli are damaged and cannot transport gas properly across the wall the air passages are obstructed by maybe a spasm or mucus or weakened also blood flow to the lungs could be obstructed by a blood clot and the pleural space is filled with air or excessive fluid so that the lungs cannot properly expand so all those conditions can cause a patient to breathe fast okay and so this is a table and this is going to show the signs and symptoms of inadequate breathing it's written kind of small so if you can't see it it's going to be table 16-2 in your book right dypsnia is a common complaint patients with cardiopulmonary diseases all right so if you break that down it's heart and lung diseases cardiopulmonary alright so congestive heart failure causes the heart to pump ineffectively and deprives the body of oxygen and severe pain can cause a patient to experience rapid shallow breathing without the presence of a pulmonary primary pulmonary dysfunction all right so let's talk about upper and lower airway infections okay so we'll break it down infectious diseases cause dipsnia may affect all parts of the airway okay so oxygen is a problem um if uh inadequate oxygen is delivered to the tissues the primary causing dipsnia is always come from is always some form of obstruction okay so the obstructions that could come from an infectious disease could be mucus and secretions which obstruct uh airflow of the major um passages so maybe a cold or diphtheria you can also have swelling of the soft tissues of the upper airways all right so in children we see a lot of epiglottitis or croup and those are upper airway infections you're going to get some um what we call strider that's the sound that's produced it's a seal bark it's stridor okay and then impaired oxygen of gases in the alveoli itself and that's pneumonia so when the the infection is lower in the lower airways so you have to be diligent about the use of protective equipment when you're ppe when you're in contact with these patients who have those infectious diseases okay all right and so now we're just going to go on through some of these upper airway infections okay so first you have croup and we just mentioned it this is uh typically in children you'll hear it's an inflammation and swelling of the pharynx larynx and trachea and it's typically seen in children between about six months to three years old the hallmark signs of croup are strider and a seal bark cough now croup is good it responds well to administration of humidified oxygen okay so it's an inflammation responds well to humidified oxygen all right you have epiglottitis that's another upper airway infection usually typically in kids okay it's an inflammation up right what it sounds like of the epiglottis and it's usually a result of bacterial infection so more predominant children once again but it can also happen in adults and so what's going to happen you're going to see these children they're in the tripod position sitting upright holding themselves up and they'll be drooling so treat them gently because we don't want to get them to cry don't want to get them all wound up right position comfortably provide high flow oxygen and do not put anything in their mouths okay next we have rsv rsv is common and it's a very common illness in children and causes an infection in the lungs and breathing passages and this leads to bronchitis and pneumonia it's very contagious rsvp is very contagious so assess for signs of dehydration and treat airway and breathing problems appropriately all right and then next we're kind of slowly moving down into the bronchioles and if you break this word apart you can see it's bronchiolitis and just what it sounds like it's a it's a type of infection this is a viral inlandness that occurs um it occurs because of the rsv and usually affects newborns and toddlers and it's the bronchioles become inflamed they swell and they fill with mucus and so we need to provide oxygen therapy and frequently reassess for signs of respiratory distress all right now moving down even further from the bronchials we're going down into the lungs and where we have pneumonia all right so pneumonia is a general term that refers to an infection in the lungs and it's often a secondary infection that begins after some type of upper respiratory tract infection has moved low and so just with gravity kind of goes on down and it's a bacterial pneumonia it will come on quickly and result in high fevers then if you have the viral pneumonia it might present more gradually and is less severe all right so bacterial is quick pneumonia could be a slower gradual onset so pneumonia especially affects people who are chronically or terminally ill so assess a temperature determine the presence of fever alright so fever is a big sign with that it's a body still trying to fight this infection and you're going to have an elevated temperature all right and so provide airway support and supplemental oxygen all right then you have pertussis this is whooping cough and it's an airborne bacterial infection that mostly affects children younger than six okay and so patients will have a fever and exhibit the whoop sound and that's how it's got that name whooping cough um on inspiration after a coughing attack okay so it's again very highly contagious and is passed through droplet infection so watch for signs of dehydration and suction may be necessary all right so influenza type a is the next thing we're going to talk about and this is all still the infectious disease section of the respiratory chapter okay so influenza type a it's an animal respiratory disease that has mutated and it infects humans it's transmitted via direct contact with those basal secretions and aerosolized droplets from coughing symptoms include high fever cough sore throat muscle aches headache and fatigue and it may lead to pneumonia or dehydration all right and so coven 19 sars cov2 this is what we're living in right now real life real time so it's a coronavirus similar to one that causes the common cold preferably attacks the elderly patients living in close quarters with one another and those with weakened immune systems young and healthy adults can also be infected it's transmitted through the droplets through airborne particles generalized by sneezing or coughing and by direct contact so symptoms include high fever cough inspirational chest pain vomiting diarrhea and an inability to smell okay so respiratory deterioration may occur rapidly all right and then tuberculosis you'll hear it called tb referred to it as tuberculosis is a bacterial infection that mostly caught mostly affects the lungs but it can also be found in almost any other organ so it can remain inactive for years before producing any symptoms patients often complain of a fever cough or fatigue night sweats and weight loss and it's the prevalence is higher in homeless people prison inmates nursing home residents and persons who abuse iv drugs or alcohol and those with hiv so if you expect your patients may have tb you need to wear at a minimum your gloves eye protection and an n95 respirator okay all right so now we're going to move out of those transmittable diseases now we're moving into other respiratory conditions and so the first one we're really going to talk about is pulmonary edema okay so the left side of the heart cannot remove blood from the lungs as fast as the right side can deliver it you could start to have pulmonary edema so fluid back up within the alveoli and in the lung tissue so it's usually a result of a thing called congestive heart failure and what congestive heart failure is is uh when the muscle of the heart um cannot pump and keep up it's not strong enough to keep up with the with um basically uh the fluid okay so patients usually experience diphtheria with rapid shallow respirations in severe cases they may have frothy pink sputum which is coming out of their mouth and nose and so it's backing up all the way up out of the trachea the tubes okay so most patients have a long history of chronic congestive heart failure that can be kept under control with usually with medications but not all patients with pulmonary edema have heart disease okay all right so this figure it's going to show uh fluid in the alveoli so you can see the front pulmonary edema fluid fills in the alveoli and separates from the capillaries from the alveolar wall and it interferes with gas exchange and carbon dioxide exchange of course because there's food in there all right so um pulmonary edema which we associate with chf or and then the next major one is going to be chronic obstructive pulmonary disease now this is um you'll hear it copd okay so this is a big one that you'll see a lot and it's a lung disease characterized by chronic obstruction of airflow that interferes with normal breathing and is not fully reversible okay so it's an umbrella term used to describe a few lung diseases and these include emphysema and chronic bronchitis okay and so usually it's some type of tobacco smoke which has um um in the bronchial it's irritated the bronchial a bronchial and can create chronic bronchitis right bronchitis an ongoing irritation of the trachea and the bronchi okay and with uh bronchitis excessive mucus is constantly being produced constantly and what that does is it obstructs the small airways and the ideal life all right so when you have this obstruction the airways are weakened and the protective cells and lung mechanisms that remove form particles are destroyed and so chronic oxygenation problems can lead to right-sided heart failure and fluid retention and then pneumonia can easily develop okay so repeated episodes of irritation and pneumonia this scars the lungs in some dilation of the obstructive alveoli it leads to chronic obstructive pulmonary disease okay so emphysema is the most common copd so emphysema emphysema is this last loss of elasticity material in the lungs and as a result of chronic stretching of that alveoli okay so smoking can directly destroy the elasticity of that lung tissue and most patients with copd have elements of both chronic bronchitis and emphysema this is a great photo great photo of the examples of copd and how it affects the alveoli and so you have that normal lung then you have this inflamed lung with the blockage of the caused by infection and mucus and then that complete obstructive and then that dilated alveoli or alveolus you could see it it's malformed now okay so you have the malform alveoli and of course it's going to make it crazy hard for that exchange of oxygen you know dioxide and oxygen across the membrane all right so you're going to hear wet lungs versus dry lungs and you'll hear people talking about this okay and so what what how we usually describe it is patients with pulmonary edema it's just what it sounds like pulmonary fluid caused by most often congestive heart failure will have wet lungs in these wet lung sounds we call them bronchi or crackles and you're going to hear that very very often when you listen to lung sounds you'll hear terms crackles and ravioli or crackles and broncos and patients with copd those are dry lung sounds dry lung sounds are wheezes all right so do not assume though that all copd patients will have wheezing and that all chronic congestive heart failure patients will have crackles but treatment of the patient we want to treat the patient not the lung cells okay all right so next we have hay fever asthma and anaphylaxis and and why we have these all grouped together why they're all grouped together is because all of them are result from some type of allergic reaction that's been inhaled ingestion ingested or injected okay so all of these hay fever asthma or anaphylaxis they are all caused by some type of allergen okay all right so when it comes to asthma asthma is a basically as acute spasm of the bronchioles and this is associated with excessive mucous production and swelling of those that mucus lining in the respiratory passages so on this slide you could see a really good figure of a normal um airway um and then a b is that obstructed airway okay because the mucus obstructing the bronchiole right so affects all ages but in is most prevalent in children between like five and 17 years of age asthma is and so it produces a characteristic wheezing as a patient attempts to exhale through a partially obstructed airway so remember we said chronic obstructive pulmonary disease patients they also have dry dry lung sounds that's wheezing okay so an acute asthma attack may be caused by an allergic reaction and that could be some type of food or allergen and it attacks may also be caused by some type of emotional distress or exercise or respiratory infection and in in most severe form an allergic reaction can cause what's called anaphylaxis okay all right so hay fever and hay fever causes cold like symptoms including a runny nose sneezing congestion and sinus pressure so symptoms are caused by an allergic reaction usually some type of outdoor airborne allergens so some people say oh the pollen the pollen in the air it's it's me i had it's creating hay fever all right and then you have anaphylactic reactions okay so this is just a deteriorating another category and anaphylactic reactions are severe allergic reactions and this is characterized by severe airway swelling and dilation of blood vessels all over the body okay so it may be associated with hives itching signs of shock signs of similar similar to asthma the lung sounds okay the airway can swell so much that it can totally obstruct the airway so epinephrine is the treatment of choice and oxygen and of course antihistamines are very helpful okay so we just moved through we did infectious diseases and then we did airway swelling right different airway swellings now we're going to talk about spontaneous pneumos so pneumothorax what is pneumothorax and so pneumothorax is the partial or total accumulation of air in the pleural space okay and so it's most often caused by trauma but may all also be caused by some type of medical condition so a pneumothorax it could be a spontaneous pneumothorax just happening all of a sudden right and so in this photo you could see a real good photo of that and it's a vacuum-like pressure in the pleural space keeps the lungs inflated so when the surface of the lung is disrupted air escapes into this pleural cavity and the negative vacuum pressure is lost okay so spontaneous pneumo occurs in a patient with certain chronic lung infections or sometimes in young people born with weak areas in the lungs a patient with a spontaneous pneumo becomes dipsnic and might complain of pleural ad pleuratic chest pain okay um so breath sounds are absent or decrease on that side and it has a potential to evolve into a very life-threatening uh pneumothorax okay all right so then we have pleural effusion so we just did some some pneumos pleural effusion so this is basically a collection of fluid inside the lung all right and so it compresses the lung and causes dyspnea it can be caused by irritation infection chronic heart failure or cancer and so breast sounds will be decreased all over that area where that effusion is and so patients feel better if they are sitting upright okay all right and then of course you have some type of obstruction of the airway and so with the patient with dipsnia they may have a mechanical obstruction all right so in a semi-conscious or unconscious the airway may be a result the obstruction may be a result of vomit for an object or improper positioning of the head or also the most common cause is that tongue right so tongue to block the airway if the patient was eating just before the onset of dyspnea we always consider that it could be what do you think could be a possible foreign airway body obstruction from eating right all right and so this figure shows the obstruction of the airway such as uh food is lodged in the airway so mechanical obstruction can also occur when the head is just not properly positioned it causes that tongue to fall back okay all right and then you have a pulmonary emboli a pulmonary embolus is anything in the circulatory system that moves from its original origin maybe a distinct site and then lodge is there so it obstructs the blood flow in that area right in the pulmonary area okay so circulation can be cut off completely or partially an emboli can be fragments of a blood clot in an artery or vein that broke off and just travels through the bloodstream or it could be foreign bodies such as a bubble of air so pulmonary implies a blood clot that circulates through the venous system and the right side of the heart and then lodges in the pulmonary artery signs and symptoms of pulmonary emboli include dipsy of course tachycardia so that's fast heart rate tachypnea right so so fast breathing to get you know varying degrees of hypoxia so varying degrees of low oxygen cyanosis and they could have acute chest pain so with the large enough emboli you could have a complete obstruction of the output of the blood from the right side of the heart and that can result in a sudden death all right and then so we move from pulmonary emboli now we're into hyperventilation okay so this is defined as just over breathing to the point that the level of arterial carbon dioxide falls below normal so this may be an indicator of a life-threatening illness the body may be trying to compensate for acidosis so acidosis is a buildup of acid in the blood or body tissues and we'll talk about that type of thing in the endocrine system we talk about it a lot okay it can result in alkalosis so alkalosis means an abnormally low volume it's a basic basic bloodstream so this can be good signs and symptoms of hyperventilation syndrome such as a panic attack so hyperventilation syndrome is a panic attack and this includes anxiety dizziness numbness tingling in the hands and the feet and painful spasms in the hand and the feet and these are carpal pedal spasm carpal pedal spasms okay the decision was that hyperventilation is being caused by life-threatening illness or panic attack should not be made by outside of the hospital okay so we should not make that decision pre-hospital all right other breathing problems could be caused by an environmental or some type of industrial exposure so pesticides cleaning solutions chemicals and chlorine and other gases can be accidentally released at industrial sites and inhaled by employees right so carbon monoxide poisoning is an odorless and highly poisonous gas it's the leading cause of accidental poisoning deaths in the united states and it's produced by fuel burning household appliances and is present in smoke people who have carbon monoxide poisoning complain of a flu-like symptom and even dyphnia so do not put yourself at risk this high flow oxygen given by a non-re-breathing mask it's the best treatment for conscious patients okay so monoxide i always think of machines they produce carbon monoxide all right so next we're going to talk about more leading into the patient assessment we'll discuss treatment of all of these cause all of these respiratory situations okay so of course scene size up is important we always start with that we always use that ppe remember when it comes to the respiratory infectious diseases and toxic substances always remember the the respiratory ppe okay so if there are multiple people with dipsnia consider the possibility of some type of airborne hazardous material release okay so multiple people with some type of shortness of breath think of a hazmat situation okay so if the mechanism of injury or nature of illness is in question ask why 9-1-1 is activated okay so by questioning the patient family or bystanders you should be able to determine the nature of illness all right so identify any immediate life threats of course in this primary assessment and we're going to perform an overall general impression of the patient's level of distress so we're going to note the age and position of the patient we're going to use avpoo scale so alert verbal painful and responsive skill to check for responsiveness and we're going to ask the patient about his or her chief complaint next of course we're going to move into the abcs so we need to know as they are way open is it open and adequate and we're going to evaluate the patient's breathing and see if it's adequate okay then we're going to listen to lung sounds so we want to listen to lung sounds breast sounds very early in these respiratory patients and we want to check breath sounds on the right and left sides of chest abnormal sounds are going to include just like we talked about wheezing rails ronchi or strider and on this slide you could see the locations of the stethoscope bell for those auscultations of the breast sounds okay so the four on the anterior then you have the six on the posterior all right and then after abc a and b of course we're going to go to c and with c we're going to assess the rate rhythm and quality of the pulse we're going to evaluate for any shock or bleeding and then we're going to assess perfusion by looking at the skin color temp and condition and then of course the d a b c d we're going to make that transport decision so is this a life threat or do we need to proceed with this type of rapid transport so load and go or stay in play all right after that of course we do the history of the illness and are the history of the patient history of the illness we are going to investigate the patient's chief complaint we need to determine what the patient has done for the breathing problem already all right so patients with a history of respiratory distress of course we want to get sample and that is the history of the patient right so history of the patient and if the the patient can't talk we could get it from the bystanders or family if there's any present and then history of the present illness of course is going to be that opqrst so onset provocation quality radiation severity and time and that's assessment that can be used to assess for pain and gather information about the breathing problem okay and then paste paste is an assessment and it's alternative uh assessment for the complaint of shortness of breath or difficulty breathing so paste is that progression associated chest pain sputum is the s t is talking tiredness does she have fragmented speech does he have fragmented speech talking tiredness that's what that means or exercise intolerance right so can he walk across the room without getting short of breath can he walk upstairs so exercise tolerance all right and then of course that's secondary assessment so we're only proceeding with that secondary assessment if the life threats have been addressed okay so we're also going to be using monitoring devices if we have them at this time all right and so we're going to go through the secondary assessments for the different types of breathing issues so let's talk about copd first chronic obstructive pulmonary disease versus our congestive heart failure okay so first the patients with copd these patients are usually older than 50 years old they often have a history of lung problems they are most always long-term active or formal former cigarette smokers they complain of tightness in the chest and constant fatigue now their chest may have a barrel-like appearance they often use accessory muscles to breathe they exhibit abnormal breath sounds often exhale through pursed lips and they could have digital clubbing and so this is an abnormality um an abnormally enlarged uh ends of their fingertips so it's cl it's clubbing of the fingers all right so we want to repeat the primary assessment determine if there's any changes in the patient's condition confirm adequate interventions so interventions for respiratory problems they include so high flow of 2 15 liters non very breather or you might we might need positive pressure ventilations using a bag valve mask a pocket mask or flow restricted or an oxygen powered device using airway management techniques such as an oropharyngeal or nasopharyngeal suctioning and positioning we might also have to provide non-invasive ventilatory support with cpap we might position the patient in a high fowler's position or position of choice and then assist the patient with respiratory medications we have to communicate all this relevant information to staff at the receiving facility all right so management of respiratory distress we're going to administer oxygen immediately and we're going to administer ventilator support if the patient's mental status is declining so if they are if they have moderate or severe respiratory distress or if the depth of the respiration is inadequate okay so we need to monitor the patient's respiratory status we need to provide of course emotional support and the patients who may have a metered dose inhaler or small volume nebulizer we have to call medical control to see if the medication may be indicated all right so we have to ensure that there's no contraindications in the patient's condition and most respiratory inhalation medicines are used to relax muscles that surround air passages in the lungs and what this does is it leads to dilation of those airways so bronchial dilation usually but you do have some side effects of those so you can it increases the pulse and increases nervousness and it increases muscle tremors so medication from an inhaler is delivered through the respiratory tract to the lung we need to follow skill drills okay so that's 16-1 to help a patient self-administer medicine and then follow the steps uh in skilled row 16-2 to help the patient self-administer medication from a small volume nebulizer okay so those skill drills are in your book all right so now let's talk about treating specific conditions okay so just as i kind of talked about it earlier there's the upper or the lower airway infection all right so administer we want to administer humidified oxygen we do not attempt to suction an airway or place in an op in a patient with some type of suspected epiglottitis remember their epiglottis is swollen so we don't want to push anything in that we could harm the patient so we're going to position them comfortably and transport properly all right so treatment specifically with pulmonary edema and remember pulmonary edema is the fluid in the lungs we're going to provide 100 oxygen we need the suction if necessary okay so only if necessary we want to position comfortably and usually that's in that seated position we want to provide cpap if indicated and allowed by our protocols and then we want to transport promptly all right so that was congestive heart failure this is going to be copd and we just talked we talked about it earlier chronic obstructive pulmonary disease we're going to assist with an inhaler but we need to watch for signs of of overuse okay so we need to watch for those side effects transition uh position comfortably and transport promptly with the copd patients that's how we treat them asthma hay fever or anaphylaxis so asthma we need to be prepared to suction um we will be ready to assist the patient if they have that inhaler and then provide aggressive airway management oxygen and prompt transport okay hay fever is usually not emergency and we can manage the airway and give oxygen depending on the level of distress hay fever right so that's like a common allergy maybe to pollen or dust right but anaphylaxis on the other hand that is a true emergency so that's an allergic reaction with airway involvement that is anaphylaxis so we're going to remove the offending agent we need to provide aggressive airway management oxygen and prompt transport and then administer epi if allowed by your local protocol okay then there's spontaneous pneumonia pneumo we just we need to provide um oxygen and get them to the hospital and we need to monitor them very carefully right and they need um uh help right help okay so pleural effusions of course fluid removal must be done at the hospital um just like treatment of that pneumo and so we're going to provide oxygen and transport promptly and then of course obstruction so a partial obstruction of the airway we are just providing supplemental oxygen okay complete obstruction however we need to clear the obstruction and then administer oxygen so um so partial we're providing we're not clearing but only when it's a complete obstruction okay we need to transport rapidly to an emergency department for emboli we need to get supplemental oxygen that's mandatory we're going to position them comfortably and if they're coughing up blood we need to clear the airway immediately and of course prompt transport prompt transport all right hyperventilation we're going to complete primary assessment and gather that history we're never going to have the patient breathe in the paper bag we need to reassure the patient and provide oxygen if necessary and then prompt transport some type of environmental or industrial exposure we need to ensure that patients are decontaminated we need to treat with oxygen and adjuncts if we need to and suction based on presentation foreign body airway obstruction perform the appropriate airway clearing technique specific for the age so provide oxygen and transport if there's some type of tracheostomy dysfunction okay so a tracheostomy dysfunction we need to position them comfortably provides suctioning to clear the obstruction all right and then once the obstruction is clear oxygenate the patient asthma so for children we're going to give them blow by by holding a mask in front of their face and use meter dose inhalers as we would with older patients and as with any chronic disease asthma may be life-threatening in an older person okay so let's talk a little bit about cystic fibrosis that's a genetic disorder that affects the lungs and digestive system and so it predisposes children to repeated lung infections and so symptoms range from sinus congestion to wheezing and asthma like complaints so we need to suction and oxygenate these patients okay so that concludes the lecture portion we're going to go through the review questions and so we'll see how much we've learned this chapter okay so the process in which oxygen and carbonation or carbon dioxide are exchanged in the lungs is called do you guys remember what that is called respiration and so respiration is that exchange of oxygen of gases between the body and its environment okay you're right so which of the following respiratory diseases causes obstruction of the lower airway all right so we know group is upper epiglottitis is upper uh and remember the larynx an infection in the larynx is upper so what do we know asthma asthma is going to be lower the rest are upper so asthma is that lower airway disease it's uh bronchioles right okay which of the following diseases is potentially drug resistant okay and is caused by coughing can be transmitted so it's tuberculosis so why tuberculosis is such an a scary kind of disease is because it is antibiotic resistant drug resistant so tuberculosis is that bacterial infection it's dangerous very dangerous resistant the antibiotics and all of the following are causes of acute dipsnia except all right so look cute remember fast onset and so what they're looking for probably is asthma um pneumo and pulmonary emboli those are all acute emphysema on the other hand that's that long chronic respiratory disease okay so that's the correct answer okay bronchiospasm is the most often associated with bronchus spasm is um a narrowing of that airway spasming and that is asthma okay it's a reactive disease it's caused by bronchiole spasms all right a sudden onset of difficulty breathing with sharp chest pain and cyanosis that persist despite supplemental oxygen okay so we know pneumonia that is kind of a slower onset and mi heart attack yes that'll have chest pain could be chest pain right pulmonary emboli that sounds like it right pulmonary emboli is a blockage it could cause pain in that area specific so let's see yeah pulmonary emboli is that's an onset of pleurotic chest pain so albuterol it's abated to an antagonist and agonist and it's a generic name for so albuterol is a generic name for ventalin so we didn't talk about that but i'm glad we're doing these so we know ventilating or proventol is albuterol okay an acute bacterial infection that results in swelling of that flap that covers the larynx during swallowing so we know that the flap is called that's the epiglottis and then some type of swelling of that flap or infection of the flap should be epiglottitis right all right so epiglottitis yeah that's that uh life-threatening it could be potentially and it's a bacterial infection caused by that epiglottis some young man recently had a heart attack and he's complaining of some difficulty breathing especially when he's lying flat okay so that's the key thing right there if you lay him flat uh and there's fluids um he will not be able to breathe so think about a water bottle you lay the water bottle flat um and then the water is covering all surface of that lung right so you you sit him up um and then at least he'll be breathing with the basically the top lobes right so we're gonna say that this is some type of pulmonary edema and i'm pretty sure it's from some type of heart failure right so um so it's gonna be a recent heart attack we'll have that left side of the heart is damaged so it's a left-sided heart failure okay left-sided heart failure which the following patients is breathing adequately so we have the right way i'm going to look at the number of respiratory okay so 29 year old with respiration is 20 who is conscious and alert i say that that person's breathing breathing adequately okay so that concludes uh chapter 16 respiratory emergencies lecture continue to follow us so go ahead and subscribe 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