11: Respiratory Emergencies

Cognitive Objectives (1 of 3)

4-2.1 List the structure and functions of the respiratory

system.
4-2.2 State the signs and symptoms of a patient with
difficulty breathing.
4-2.3 Describe the emergency medical care of the
patient with breathing difficulty.
4-2.4 Recognize the need for medical direction to assist
in the emergency medical care of the patient with
breathing difficulty.

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 Cognitive Objectives (2 of 3)
4-2.5 Describe the care of a patient with breathing
distress.
4-2.6 Establish the relationship between airway
management and breathing difficulty.
4-2.7 List signs of adequate air exchange.

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 Cognitive Objectives (3 of 3)

4-2.8 State the generic name, forms, dose,

administration, actions, indications, and
contraindications for the prescribed inhaler.
4-2.9 Distinguish between the emergency medical care
of the infant, child, and adult patient with breathing
difficulty.
4-2.10 Differentiate between upper airway obstruction
and lower airway disease in the infant and child
patient.

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 Affective Objectives
4-2.11 Defend EMT-B treatment regimens for various
respiratory emergencies.
4-2.12 Explain the rationale for administering an
inhaler.

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 Psychomotor Objectives
4-2.13 Demonstrate the emergency medical care for
breathing difficulty.
4-2.14 Perform the steps in facilitating the use of an
inhaler.

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Respiratory System

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 Anatomy
and Function
of the Lung

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 Characteristics of
Adequate Breathing
• Normal rate and depth
• Regular breathing pattern
• Good breath sounds on both sides
of the chest
• Equal rise and fall of chest
• Pink, warm, dry skin

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 Characteristics of
Inadequate Breathing
• Pulmonary vessels become obstructed.
• Alveoli are damaged.
• Air passages are obstructed.
• Blood flow to the lungs is obstructed.
• Pleural space is filled.

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 Signs of
Inadequate Breathing
• Slower than 12 • Pale or cyanotic skin
breaths/min or faster than • Cool, damp (clammy)
20 breaths/min skin
• Unequal chest expansion • Shallow or irregular
respirations
• Decreased breath sounds
• Pursed lips
• Muscle retractions
• Nasal flaring

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 Dyspnea
• Shortness of breath or difficulty breathing
• Patient may not be alert enough to complain
of shortness of breath.

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Upper or Lower Airway Infection
• Infectious diseases may affect all parts of the
airway.
• The problem is some form of obstruction to the air
flow or the exchange of gases.

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Acute Pulmonary Edema
• Fluid build-up in the lungs
• Signs and symptoms
– Dyspnea
– Frothy pink sputum
• History of chronic congestive heart
failure
• Recurrence high

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Chronic Obstructive Pulmonary
Disease (COPD)
• COPD is the result of direct lung and airway
damage from repeated infections or inhalation
of toxic agents.
• Bronchitis and emphysema are two common
types of COPD.
• Abnormal breath sounds may be present.
– Rhonchi and wheezes

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 Asthma
• Common but serious disease
• Asthma is an acute spasm of the bronchioles.
• Wheezing may be audible without a
stethoscope.

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 Spontaneous Pneumothorax
• Accumulation of air in the
pleural space
• Caused by trauma or
some medical conditions
• Dyspnea and sharp chest
pain on one side
• Absent or decreased
breath sounds on one
side

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 Anaphylactic Reactions
• An allergen can trigger an asthma attack.
• Asthma and anaphylactic (allergic) reactions can
be similar.
• Hay fever is a seasonal response to allergens.

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 Pleural Effusion
• Collection of fluid outside
lung
• Causes dyspnea
• Caused by irritation,
infection, or cancer
• Decreased breath sounds
over region of the chest
where fluid has moved the
lung away from the chest
wall
• Eased if patient is sitting up
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 Mechanical Obstruction
of the Airway
• Be prepared to treat quickly.
• Obstruction may result from the position of head, the
tongue, aspiration of vomitus, or a foreign body.
• Opening the airway with the head tilt-chin lift
maneuver may solve the problem.

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 Pulmonary Embolism
• A blood clot that breaks off and
circulates through the venous
system
• Signs and symptoms
– Dyspnea
– Acute pleuritic pain
– Hemoptysis
– Cyanosis
– Tachypnea
– Varying degrees of hypoxia

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 Hyperventilation
• Overbreathing resulting in a decrease in the
level of carbon dioxide
• Signs and symptoms
– Anxiety
– Numbness
– A sense of dyspnea despite rapid breathing
– Dizziness
– Tingling in hands and feet

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• You andYou yourare thepartner
EMT-B Provider
are dispatched to
1465 Dalles Military Rd for a 33-year-old woman
with difficulty breathing.
• You arrive at the office building and an upset man
identifies himself as the patient’s coworker.
• He tells you that the patient has had breathing
problems before, but he’s never seen it this bad.

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 You are the Provider (continued)
• He leads you to a woman who is standing with her
arms outstretched on the desk with a metered-dose
inhaler in hand.
• She acknowledges your presence with a nod.
When you ask her what is wrong, she answers with
a two-word response, “can’t breathe.”
• You hear audible wheezes.

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 Scene Size-UP

• How significant is the person’s response to your

question and why?
• What should you do next? Should you transport
this patient or wait for ALS to arrive on scene?

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 Initial Assessment

• Perform initial assessment.

• Place the patient on oxygen.
• If patient is in respiratory distress, ventilate.
• Check pulse.

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Signs and Symptoms (1 of 2)
• Difficulty breathing
• Altered mental status
• Anxiety or restlessness
• Increased or decreased respirations
• Increased heart rate
• Irregular breathing
• Cyanosis

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 Signs and Symptoms (2 of 2)
• Pale conjunctivae
• Abnormal breath sounds
• Difficulty speaking
• Use of accessory muscles
• Coughing
• Tripod position
• Barrel chest

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• You
Youarrange
are theto rendezvous
Provider with(continued)
ALS.
• You apply high-flow oxygen and obtain the
following vital signs:
– Pulse: 42 breaths/min
– Pulse oximetry: 90%
• The patient indicates that she has used the inhaler
twice already.

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 Youcan
• What are
youthe Provider
do before you meet(continued)
ALS?
• Another pulse oximetry reading reveals a reading
of 72%.
• The patient is using accessory muscles to breathe.
• What do these signs indicate?

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 COPD Patients
• COPD patients cannot handle pulmonary
infections well
• Usually age 50 or older
• History of recurring lung problems
• Long-term smokers
• Tightness in chest/constant fatigue

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 Focused History and Physical Exam

• Abnormal breath sounds are symptomatic

of COPD
• Long history of dyspnea with sudden
increase in shortness of breath
• Recent chest cold with fever
• Vital signs
– Normal blood pressure
– Rapid, occasionally irregular pulse
– Respirations rapid or very slow
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 Interventions
• Treat immediate life threats
• Possible interventions
– Oxygen via nonrebreathing mask at 15 L/min
– Positive pressure ventilations
– Airway adjuncts
– Positioning
– Respiratory medications

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 Detailed Physical Exam

• Performed only once life threats are

addressed.
• May not be able to do if busy treating
airway or breathing problems.

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 Ongoing Assessment

• Carefully watch patients for shortness of

breath.
• Reassess vital signs.
• Ask patient if treatment has made a
difference.
• Check for accessory muscle use.

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 Emergency Medical Care
• Give supplemental oxygen at 10 to 15
L/min via nonrebreathing mask.
• Patients with longstanding COPD may be
started on low-flow oxygen (2 L/min).
• Assist with inhaler if available.
• Consult medical control.

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 Medications in MDI
• Trade names • Generic names
– Proventil – Albuterol
– Ventolin – Metaproterenol
– Alupent – Terbutaline
– Metaprel
– Brethine

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 Prescribed Inhalers
• Actions
– Relax the muscles surrounding the
bronchioles
– Enlarge the airways leading to
easier passage of air
• Side effects
– Increased pulse rate
– Nervousness
– Muscle tremors

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 Prior to Administration
• Read label carefully.
• Verify it has been prescribed by a physician for this
patient.
• Consult medical control.
• Make sure the medication is indicated.
• Check for contraindications.

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 Contraindications for MDI
• Patient unable to help coordinate inhalation
• Inhaler not prescribed for patient
• No permission from medical control
• Maximum dose prescribed has been taken.

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 Administration of MDI (1 of 3)
• Obtain order from medical control or local protocol.
• Check for right medication, right patient, right route.
• Make sure the patient is alert.
• Check the expiration date.
• Check how many doses have been taken.

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 Administration of MDI (2 of 3)
• Make sure inhaler is at room temperature or warmer.
• Shake inhaler.
• Stop administration of oxygen.
• Ask the patient to exhale deeply and put lips around
opening.
• If the inhaler has a spacer, use it.

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 Administration of MDI (3 of 3)
• Have the patient depress the inhaler
and inhale deeply.
• Instruct the patient to hold his or her
breath.
• Continue administration of oxygen.
• Allow the patient to breathe a few
times then repeat dose according to
protocol.

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 Reassessment
• Carefully watch for shortness of breath.
• 5 minutes after administration:
– Obtain vital signs again.
– Perform focused reassessment.
• Transport and continue to assess breathing.

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Upper or Lower Airway Infection
• Administer warm, humidified oxygen.
• Do not attempt to suction the airway or insert an
oropharyngeal airway in a patient with
suspected epiglottitis.
• Transport patient in position of comfort.

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Acute Pulmonary Edema
• Administer 100% oxygen.
• Suction secretions.
• Transport in position of comfort.

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Chronic Obstructive Pulmonary
Disease (COPD)
• Assist with prescribed inhaler if patient
has one.
• Transport promptly in position of comfort.

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Spontaneous Pneumothorax
• Administer oxygen.
• Transport in position of comfort.
• Monitor closely.

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 Asthma
• Obtain history.
• Assess vital signs.
• Assist with inhaler if patient has one.
• Administer oxygen.
• Transport promptly.

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 Pleural Effusion
• Definitive treatment is performed in a
hospital.
• Administer oxygen and support
measures.
• Transport promptly.

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Obstruction of the Airway
• Clear airway.
• Administer oxygen.
• Transport promptly.

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 Pulmonary Embolism
• Administer oxygen.
• Place patient in comfortable position,
usually sitting.
• Assist breathing as necessary.
• Keep airway clear.
• Transport promptly.

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 Hyperventilation
• Complete initial assessment and history
of the event.
• Assume underlying problems.
• Do not have patient breathe into a paper
bag.
• Give oxygen.
• Reassure patient and transport.

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