Chapter 16: Respiratory Emergencies - Emergency Care and Transportation of the Sick and Injured (12th Edition)

Overview

• Focus: Respiratory emergencies in infants, children, and adults.
• Goals:
  • Understand anatomy and physiology of the respiratory system.
  • Comprehend pathophysiology and symptoms of respiratory diseases.
  • Learn assessment and management in pre-hospital settings.

Key Concepts

Dyspnea

• Definition: Difficulty breathing.
• Causes: Various conditions; diagnosis can be challenging.
• EMTS can save lives even if the exact cause is unknown.

Respiratory Anatomy

• Structures involved in breathing: Diaphragm, chest wall muscles, accessory muscles, nerves.
• Upper Airway Components: Nose, mouth, jaw, oral cavity, pharynx, larynx.
• Lower Airway Components: Trachea, bronchi, bronchioles, alveoli.
  • Function of Lungs: Exchange of oxygen and carbon dioxide.

Physiology of Respiration

• Processes: Inspiration and Expiration.
  • Oxygen is provided to blood, carbon dioxide is removed.
• Role of Alveoli: Sites of gas exchange with pulmonary capillaries.
• Brain Stem: Senses CO2 levels, regulates breathing rate.

Pathophysiology of Respiratory Issues

• Abnormal conditions can impair gas exchange.
• Conditions include airway blockages, disease processes, trauma.
• Carbon Dioxide Retention: Can occur in COPD patients, leading to hypoxic drive.

Causes of Dyspnea

• Medical Conditions: Pulmonary edema, hay fever, pleural effusion, airway obstruction, hyperventilation, carbon monoxide poisoning, drug overdose.
• Situations in Dyspnic Patients: Fast breathing, obstructed gas exchange, damaged alveoli, blocked air passages, obstructed blood flow.

Respiratory Diseases and Symptoms

Upper and Lower Airway Infections

• Common Infections: Croup, epiglottitis, RSV, bronchiolitis, pneumonia, pertussis, influenza, COVID-19, tuberculosis.
• Infection Symptoms: Cough, fever, wheezing, stridor.

Chronic Conditions

• Pulmonary Edema: Fluid accumulates in alveoli.
• COPD: Chronic obstruction includes emphysema and bronchitis.
  • Symptoms: Tightness, fatigue, barrel chest, accessory muscle use.

Allergic Reactions

• Conditions: Hay fever, asthma, anaphylaxis.
  • Asthma: Spasm of bronchioles, wheezing.
  • Anaphylaxis: Severe airway swelling, requires epinephrine.

Other Conditions

• Spontaneous Pneumothorax: Air in pleural space.
• Pleural Effusion: Fluid in lungs compresses lung.
• Pulmonary Embolism: Blood clot obstructs pulmonary artery.
• Hyperventilation: Over-breathing, leads to low CO2 levels.

Assessment and Management

Scene Size-Up

• Use Personal Protective Equipment (PPE).
• Assess potential for hazardous materials if multiple people are dyspneic.

Primary Assessment

• General impression, level of distress, age, position.
• ABCs: Airway, Breathing, Circulation.
• Lung sounds: Wheezing, rails, rhonchi, stridor.

History Taking

• Chief complaint.
• Use SAMPLE for patient history.
• OPQRST for respiratory distress.
• PASTE for shortness of breath.

Treatment and Interventions

• Oxygen Administration: Immediate, high-flow.
• Medications: Use inhalers, nebulizers.
• Positioning: Comfortable, usually seated.
• Transport: Prompt, based on severity.

Specific Conditions and Treatments

• Upper/Lower Airway Infections: Humidified oxygen, avoid suction in epiglottitis.
• Pulmonary Edema: Oxygen, suction if necessary, CPAP.
• COPD: Assist with inhalers, monitor side effects.
• Asthma/Anaphylaxis: Aggressive airway management, epinephrine.
• Pneumothorax/Pleural Effusion: Oxygen, transport.
• Obstruction: Clear if complete obstruction.
• Pulmonary Embolism: Oxygen, position comfortably.

Review Questions

• Respiration: Exchange of gases.
• Asthma: Causes lower airway obstruction.
• Tuberculosis: Drug-resistant, bacterial.
• Dyspnea Causes: Acute conditions such as asthma, pneumothorax, pulmonary emboli.

These notes provide a comprehensive review of Chapter 16, focusing on understanding and managing respiratory emergencies effectively.