Airway emergencies

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dallas.dawn
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174776
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Airway emergencies
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2012-10-01 16:29:15
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EMT airway
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chapter 13
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  1. dyspnea 
    short of breath or difficulty breathing 
  2. upper airway 
    nose mouth jaw oral cavity pharynx and larynx 
  3. respiration
    • exchange of oxygen and carbon dioxide
    • 02 is provided to the blood and co2 is taken out takes place rapidly at the alceoli 
    • if co2 rises above normal the person breathes more rapidly and more deeply 
  4. pathophysiology 
    • refers to  condition under which body processes are not working as they should and as a result, interfere with normal respiration. 
    • abnormal or pathologic conditions in the anatomy of the airway, disease processes, and tramatic conditions can prevent the proper exchange of oxygen and co2
    • in addition the pulmonary blood vessels themselves may have abnormailies that interfere with blood flow and thus with the transfer of gases 
  5. carbon dioxide retention 
    a condition characterized by a chronically high blood level of carbon dioxide win which the respiratory center no longer responds to high blood levels of carbon dioxide 
  6. hypoxic drive 
    • back up system to control respirations when oxygen levels fall 
    • the low blood oxygen level causes the resp center to respond and stimulate resp. 
    • people with chronic lung diseases frequently have a chronicall high level of carbon dioxide in teh bool. giving too much oxygen to them may actually stop resp. 
  7. hypoxia 
    condition in which the body cells and tissues are deprived of oxygen 
  8. patients often have breathing difficulty and or hypoxia with :
    • upper or lowere airway infection 
    • acute pulmonary edema 
    • copd 
    • asthma 
    • hay fever 
    • anaphylaxis 
    • spontaneous pneumothroax 
    • pleural effusion 
    • pronlonged seizures 
    • obstruction of the airway 
    • pulmonary embolism 
    • hyperventilation syndrome 
    • environmental exposure 
    • carbon monoxide posioning 
    • infectious diseases 
  9. one or more of teh following situations most likely exist
    • gas exchange between teh alveoli and pulmonary circulation is obstructed by fluid in the lung, infection or collapsed alveoli(atelectasis)
    • the alveoli are damaged and cannot transport gases properly across their own walls 
    • the air passages are obstucted by muscle spasm, mucus or weakend floppy airway walls 
    • blood lfow to the lungs is obstucted by blood clots 
    • the pleural space is filled with air or excess fluid so the lungs cannot properly expand 
  10. pulmonary edema
    • a buildup of fluid in the lungs, uaually as a result of congestive heart failure
    • the left side of the heart cannot remove blood from the lungs as fast as the right side delivers . as a result fluid biulds up withing the alvioli and in the lung tissure 
    • patient expirenences dyspnea with rapid, shallow respirations ...frothy pink sputum at the nose and mouth 
    • causes: poisioning inhaling large amounts of smoke, tramatic injuries  exposure to high altitudes 
  11. chronic bronchitis
    • irritation of the major lung passageways from infectious diseae or irritants such as smoke
    • excess mucus is constantly porduced, obstucting small airways and alveoli. 
    • protective celss and lung mechanism that remove foreign particles are destoryed, further weaking the airways. 
    • pneumonia develops easily when the air passages are persistently obstructed
  12. COPD chronic obstructive pulmonary disease
    • slow porcess of dilation and disruption of the airways and alveoli caused by chronic bronchial obsturction 
    • 4th leading cause of death 
    • result of direct lung and airway damages from repeated infections most often results from cigarette smoking
  13. emphysema 
    • is a loss of teh elastic material around the air spaces as a result of chronic streching of the alveoli when inflamed airways obstruct easy expulsion of gases. 
    • air is no longer expelled rapidly 
    • disease of the lungs in which there is extreme dilation and eventual destruction of the pulmonary alveoli with poor exchange of oxygen and carbon dioxide 
  14. COPD vs CHF 

    COPD 
    • disease of the lung characterized by shortness of breath and wheezing 
    • home oxygen, broncholdilators, and steriods used for treatmetn 
    • breathing progressively worse over time 
    • usually in long term smokers 
    • shortness of breath mostly on exertion 
    • chronic coughing 
    • sputum may be thick 
    • no jugular vein distenion or dependent edema 
    • patient usually then with a barrel chest 
  15. COPD VS CHF 
    CHF 
    • a disease of the heart characterized by shorness of breath edema and weakness 
    • diuretics prescribed to help promote cardiac function and to reduce fluid loads on the heart 
    • sudden onset of shortness of breath 
    • patient may or may not smoke 
    • shortness of  breath all of the time 
    • coughing 
    • sputum may be pink and frothy 
    • jugular vein distention and dependent edema 
    • may have distended abs 
  16. asthma
    • an acute spasm of the smaller air passages called bronchioles, associated with exessive mucus production and with sweeling of the mucous lining of the respiratory passages
    • wheezing--indicates of partial lower airway obsturction 
    • may be caused by an allergic response to specific foods or some other allergen substance that causes allergic response 
  17. hay fever 
    • allergic response usually to outdoor airborne allergens such as pollen or somethimes indoor allergens such as dust mites also called allergic rhinitis 
    • causes cold like symptoms
  18. anaphylactic reactions
    • an extreme life threatening systemic allergic reaction that may include shock and respiratory failure 
    • airway swelling and dilation of blood vessesl all over teh body, which may lower bp 
    • widespread itching and signs and syptoms similar to astma 
    • airway may swell so much that breathing problems can progress form extreme difficulty in breathing to total airway obstruction in a few minutes 

    • epinephrine is the treatment of choice
    • oxygen and antihistamines are usuful 
  19. pneumothroax 
    a partial or complete accumulation of air in the pleural space 

    • caused by tramua 
    • lung ruptures by a hard cough 
    • becomes dyspneic and might complain of pleurtic chest pain sharp stabbing pain on one side that is worse during inspiration and expiration or with certain movement of teh chest wall, 
    • listening to chest--detect absent or decreased breath sounds on the affected sides 
  20. plural effusion 
    • collection of fluid outside the lung on the one or both sides of teh chest 
    • compresses the lun or lungs and causes dyspnea this fluid may collect in large volumes in response to to any irritaiotn infection CHF or cancer 
    • you will hear decreaed breath sounds over teh region of the chest where fluid has moved the lung away from the chest wall 
  21. prolonged seizures 
    • a seizure is caused by a disruption in the electrical activity in teh brain 
    • typical the seizure lastsonly minutes and the patient reagain consciousness 
    • epilipticus- seizures longer than 20 min 
    • sizure taht lasts one to three min the patients will have some impairment in his or her ability to breath 
    • prolonged seizure-unconscious patient has no control over teh airway constant muscle contractions will interfere with ability of teh chest to expand and the patient will hypoventialate and become hypoxic could be apneic 
    • hyperthermia dehydration and hypoglyciema 
  22. obstuction of the airway 
    • semiconscious and unconscious ind the obstuction may be the result of aspiration of vomitus or a foreign object 
    • always consider upper airway obstuction from a foreign body first in patiens who were just eating 
  23. Pulmonary embolism 
    embouls--a blood clot or other substance in teh circulatory system that travels to a blood vessel where it causes a blockage 

    • a blood clot that breaks off from a large vein and travels to the blood vessesl of the lung, causing obstruction of blood flow 
    • symptoms and signs include: dyspnea, acute chest pain, hemoptysis(coughing up blood), cyanosis, tachypnea , and carying degress of hypoxia 
  24. hyperventilation 
    • rapid or deep breathing that lowers teh blood carbon dioxide level below normal (bodies attempt to stay alive)--indicatior of a life threating illness 
    • body is trying to compensate for acidosis--build up of excess acid in the blood or body tissues that results from the illness 
    • blood acidity can be diminshed by excessive breathing because it blows off too much co2 the result is a relative lack of acids. alkalosis-- the build up of excess base (lack of acid) in the body fluids
  25. hyperventilation syndrome 
    alkalosis causes it
    • occurs in the absense of other physical problesms. the presirations of a person who is expericning hyperventilation sydnrome maybe be as high as 40 sahallow breaths or low as only 20 very deep ventalations
    • anxiety dizziness, numbness tingling of hands and feet 

    • verbalize to slow down breathing 
    • give oxygen 
  26. carbon monoxide
    • an odorless highly poisonous gas that results from incomplete oxidation of carbon in combustion 
    • blood coming from the airway onminous sign

    • poisoning--flu like symptoms 
    • all patients have similar syptoms 
  27. MRSA 
    Methicillin resistant Staphlococcus aureus 
    bacterium that can cause infections in differentr parts of the body, it is transmitted by differnt routes including the respiratory routh and is particularly dangerous because of the resistance to methicillin 
  28. Tuberculosis 
    • a disease that can lay dormit in a persons lungs fordecades then reactivate many strains are resistant to many anitbiotics spread by cough 
    • fever coughing fatigue night sweats and weight loss 
    • more severe:shortness of breath , coughing, productive sputu, bloddy sputum and chest pain 
  29. Patient assesment 
    • scene safety
    • mechanism of injury/nature of illness 

    • from a general impression 
    • airway and breathing 
    • circulation
    • transport desision 
    • history taking 
    • secondary assement 
  30. vesicular breath sounds 
    normal breath sounds made by air moving in and out of th alveoli 
  31. bronchial breath sounds 
    normal breath sounds made by air moving through the bronchi 
  32. adventitious breath sounds 
    abnormal breath sounds such as wheezes, rhochi and rales 
  33. wheezing
    • high pitched whistiling breath sounds, characterisically heard on expiration in patients with astma or copd
    • asthma 
    • copd
    • chf
    • pnemonia 
    • bronchitis 
    • anaphylaxix 
  34. rales
    • crackling rattling breath sounds signaling fluid in the air spaces of the lungs
    • chf
    • pneumonia 
    • bronchitis
  35. rhonchi
    course breath sounds heard in patients with chronic mucus in the airways low pitched
  36. stridor 
    • a harsh high ptiched barking inspiratory sound often heard in acute laryngeal upper airway obstruction 
    • croup 
    • epiglottis 
  37. life threating 
    • problems with abcs 
    • poor initial general impression 
    • unresponsiveness 
    • potential hypoperfusion or shock 
    • chest pain assc with low bp 
    • severe pain anywhere 
    • excessive bleeding 
  38. metered dose inhaler(MDI)
    a miniture spray canister used to direct medications through the mouth and into the lungs 
  39. small volume nebulizer 
    a respiratory device that holds liquid medicine that is turned into a fine mist thie patient inhales the medication into the airways and lungs as a treatmetn for conditions like asthma 

    • and MDI contact medical control 
    • contradictions- patients is unable to help coordinate inhalation with depression of teh trigger 
    • the mdi is not prescribed for the patient 
    • you didn't obtain permission from medical control 
    • patient has already met teh maximum prescirbed dose before you came 
    • other contraindictions specific to the medicine 
    • actions--used to relax the muscles that surround the air passages in the lungs easier movement of air 
    • side effect--increaesed pulse rate, nervousness, and muscle tremors 
    • medication from and inhaler is delivered thorugh the respiratory tract to the lung 
  40. upper or lower airway infection
    • admisnister humidified oxygen 
    • do not attempt to suction the airway or pace an oropharyngeal with suspected eptiglottis 
    • allow patient to sit in the postiion that is most comfortable 
  41. acute pulmonary edema 
    • administer 100% oxygen 
    • carfully suction any secretions from teh airway. postion easiet to breath 
    • CPAP 
    • hurry to hosptial 
  42. COPD 
    • assist with patients prescribed inhaler 
    • transport fast allow them to sit upright 
  43. astma hay fever and anaphylaxis 
    • give oxygen assist with inhaler suction no longer than 15 sec 
    • hay fever --shouldn't need emergency care 
    • ana--remove offending agent , maintain the airwaygie oxugen early transport assist breathing as neeeded 
    • epinephrene 
  44. spontaneous pneumothroax 
    • provide supplamental oxygen and provide prompt transport to hosptial 
    • monitor carefully 
    • be ready to support the airway asisst respirations 
  45. pleural effusion 
    provide oxygen 
  46. prolonged seizures 
    • als needs to get there quick 
    • aggressive airway management 
    • rapid transport
  47. obsturction of airway 
    upper can be partial or complete ..talking and breathing give supplamental oxygen 

    • must be removed  clear the patients upper airway . head tilt chin lift 
    • give oxygen 
    • rapid transport 
  48. pulmonary embolism 
    • place patient in comfortabe position (oxygen is not mandatory) clear airway  
    • transport fast be aware that could cause cardiac arrest 
  49. hyperventalation 
    • gather a history of the event 
    • treatment consist of reassuring teh patient in a calm professional manner supplying suppleamental oxygen and providing prompt transport to emergy 
  50. epidemic 
    occurs when new cases of disease occur in a human population ans sutantiall exceed what is expected 
  51. pandemic 
     outbreak that occurs on a global scale 
  52. influenze type A 
    virus that has crosses the animal human barrier and has infected humans recenly reaching a pandemic level with the h1n1 strain 
  53. tracheostomy dysfunction 
    • can sometimes become obstucted by secretions mucus or feorign bodies 
    • beeding leaking dislodgment and infect 
    • establish a paten airway 
    • place patient in comfortable postion suction to clear ovstruction then oxygenate 
  54. croup
    an inflammatory disease of the upper respiratory system that may cause a partail airway obsturction and is characteried by a barking cough usually in children

    administration of humidified air 
  55. epiglottitis 
    • a disease in which the epiglottis becomes inflamed and enlarged and may bause an upper airway obstruction
    • children 
    • treat teh child gently and try not to do anything that will make them cry give high flow oxygen do not put anything in their mouth 
  56. bronchiolitis 
    inflammation of teh bronchioles taht usually occurs in children younger thatn 2 year of age and is often causes by the respiratory syncytial virus 
  57. pneumonitis 
    inflamation of the lung  may cause shortness of breath and fever present gradually over a course of several weeks 
  58. respiratory syncytial virus 
    •  virus that causes an infection of teh lungs and breathing passages can lead to other serious illnesses that affect the lungs or heart such as bronchiolitis and pneumonia 
    • highly contagious and spread thorugh droplets 

    • look for signs of dehydration
    • treat airway and breathing problems  humidified o2 
  59. pneumonia 
    • infectious desease of teh lung that damages lung tissue 
    • signs:external dyspnea a produtive cough, chest discomfort and pain, wheezing , headach, nausea and comitting , musculoskeltal pain weight loss and confusion
    • will see cyanosis and pallor dry skin possible fever, decreases skin turgor and pale dry mucosa 
    • hear will be tachycardic with possible hypotension
    • diminished breath soundswheezing rales or rhonchi 
  60. pertussis
    • an airbourne bacterial infection that affects mostly children younger than 6 years, patients will be feverish and exhit a whoop sound on inspiration after a coughing attack . highly contagious through a droplet infection
    • give oxygen 
  61. cystic fibrosis 
    • genetic disorder that affects teh lungs and digestive system. disrupts the normal function of cells that make up the sewat lands in the skin and that line th lungs and the digestive system 
    • symptosm range from sinus congestion to wheezing. chronic cough that produces thick heave discolored mucus 
    • treat with suctioning and oxygen 
  62. CHF 
    • the left side of the heart cannot remove blood from teh lungs as fast as teh right side delivers it . as a result, fluid biulds up witin the alveoli adn the lung tissue between the alveoli and the pulmonary capillaries results in pumonary edema 
    • patient risk factors: hypertension and history of coronary artery diesae and or atrial fibrillation
    • signs:difficulty breathing with exertion because the heart cannot keep up with the bodys need for oxygen. may also report a sudden attack of respiratory distress taht wakes them at night when they aer in a reclining position . compain of coughing feeling suffocated cold sweats and tachycardia 
    • uses cpap

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