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EMT - chapter 16

Terms in this set (49)

List the structures and functions of the upper and lower airways, lungs, and accessory structures of the respiratory system. (pp 628-629)
upper airways
- nose
- pharynx
-mouth
- epiglottis


larynx (voice box)

lower airway
- trachea
-bronchioles
- main bronchi
- alveoli (pulmonary capillaries)
dyspnea
Shortness of breath or difficulty breathing.
Explain the physiology of respiration; include the signs of normal breathing. (pp 629-631)
O2 binds with hemoglobin in red blood cells carried to heart
- brainstem senses CO2 levels in arterial blood and tells body nerves in cervical spin to direct diaphragm to breath fast or slower
Discuss the pathophysiology of respiration, including examples of the common signs and symptoms a patient with inadequate breathing may present with in an emergency situation. (pp 631-633)
- pathophysiology of respiration = conditions under which the body processes are not working as they should and then infers with normal respiration.
chronic Carbon dioxide retention
the failure of respiratory centers to respond normally to a rise in arterial levels of carbon dioxide (pH level in blood + cerebrospinal fluid)
hypoxic drive
- chronically low levels of oxygen (NOT CO2) in the blood stimulate the respiratory drive, seen in patients with chronic lung diseases. end stage of COPD.
Explain the special patient assessment and care considerations that are required for geriatric patients who are experiencing respiratory distress. (pp 633, 636-637, 665-667)
- begin oxygen therapy early in assessment and treatment process
asthma
- 25 million Americans have it
- 5-17 years olds especially
- can be triggered by emotional stress, exercise and respiratory infections.
- can result in anaphylaxis
- wheezing on inspiration/expiration
- bronchospasm -swelling of mucous lining
- excessive mucus profuction
- wheezing, cyanosis
anaphylaxis - shock - severe allergic reaction characterized by swelling of airway and dilation of blood vessels all over the body which can lower bp

EPINEPHRINE - adernalin - epipen
flushed skin or hives (urticaria)
generalized edema
hypotension
laryngeal edema with dyspnea
wheezing or stridor
- signs of shock
signs/symptoms of asthma
- can cause total airway obstruction in minutes.
Bronchiolitis
- shortness of breath
- wheezing
- coughing
- fever
- dehydration
- tachypnea
- tachycardia

caused by RSV infection = severe inflammation of the bronchioles = swell + mucus
Bronchitis
- chronic cough (sputum production)
- wheezing
- cyanosis
- tachypnea
Acute Pulmonary Edema
- high bp and low cardiac output can trigger this to and patients are drowning in own fluid.
dyspnea, rapid, shallow respirations, feeling of suffocation, cold sweats and tachycardia, cyanotic skin, crackles or wheezing.
- frothy pink sputum at nose + mouth
- triggered by failure to take medication, eats foods too salty or has a stressful illness, new heart attack or abnormal heart rhythm.
- toxic chemicals can also trigger.
left side cannot remove blood from lungs as fast as right so there is a build up of fluid.
- accumulation of fluid in the lungs between the alveoli and pulmonary capillary vessels.
- result of CHF
Congestive heart failure
- dependent (lower extremity) edema
- Crackles (pulmonary edema)
- Orthopnea (dyspnea lying down but relieved sitting up)
- Paroxysmal nocturnal dyspnea - shortness of breath at night after reclining, sit up to breathe

- late stage heart failure: pinky frothy sputum from left side of heart
Common cold
cough
runny or stuffy nose
sore throat
COVID-19 - bats to human in meat market in Wuhan, China 2019.

primarly killed elderly patients and those with weakened immune systems.
can kill young and healthy
cough
fever
dyspnea
chest pain
anosmia (inability to smell)
Croup
fever
seal-barking cough
stridor
mostly seen in pediatric patients

caused by: inflammation and swelling of the pharynx, larynx and trachea

typically seen in children 6months - 3 years
late fall + winter

- responds to humidified O2
** bronchodilators could worsen a patients symptoms
Diphtheria
difficulty breathing and swallowing
-sore throat
-thick, gray buildup in throat or nose
-fever
Emphysema- loss of elastic material in the lungs that occurs when alveolar air spaces are chronically stretched due to inflammed airways and obstruction of airflow out of the lungs.
- result of smoking bc affects elasticity of alveoli to be sponges and absorb.
barrel chest
- pursued lip breathing
- dyspnea on exertion
- cyanosis
-wheezing/decreased breath sounds
-mostly seen in older patients
- sputum production
- can have crackles, ronchi, wheezes or diminished breath sounds.
asthma, hay fever, anaphylaxis
result of allergic reaction to inhaled, ingested or injected substance.
- sometimes no identifiable allergen
Hay fever (allergic rhinitis)
cold like symptoms, runny nose, sneezing, congestion
- caused by allergic response to outdoor airborne allergens such as pollen or indoor allergens such as dust mites or pet dander.
- worst in spirng/summer for some
- chance for anaphylaxis
Epiglottitis
-dyspnea
-high fever
-stridor
drooling
difficulty swallowing
- severe sore throat
- tripod or sniffing position
- mostly seen in pediatric patients

caused: inflammatory disease of epiglottis, small flap of tissue at the back of the throat that protects the larynx and trachea
** bacterila infection typically

** can obstruct airway.
usually occurs in children
Influenza - animal respiratory disease that has mutated to infect humans
- influenza type A from H1N1 strain became a pandemic in 2009 and made chronic medical conditions worse
cough
fever
sore throat
fatigue

can lead to pneumonia or dehydration
pertussis (whooping cough)
- coughing spells
- whooping sound on inspiration after coughing attack
-fever

bacterial infection - airborne droplets affects primarily children under 6 years
- coughing spells last more than 1 minute, child may turn red or purple
- can vomit.
trouble breathing, sleeping and eating
- in geriatric patients coughing can lead to cracked ribs
Pneumonia = infection of the lungs impairs o2 + co2 exchange

** results after upper airway tract infection from a cold or sore throat.

upper airway - grunting wheezing, 02 impaired, blue/gray color fingernails

lower airway - abdominal pain, vomiting > over dyspnea
- dyspnea
- chills, fever
- cough
- green, red or rust-colored sputum
-localized wheezing or crackles

** affects chronically/terminally ill
- nursing homes + long-term care facilities
- recent hospitalizations
-chronic disease process ex. requiring dialysis
- immune system compromises (ex. chemotherapy)
- history of COPD

** children rapid or labored breathing characterized by breathing
spontaneous Pneumothorax - normally vacuum pressure keeps lung inflated however when the surface of the lung is disrupted air escapes the pleural cavity and results in a loss negative vacuum pressure.
- natural elasticity lung tissue causes lung to collapse.
- air leaks into pleural space from opening in chest wall or surface of the lung.
- sudden sharp stabbing chest pain on one side with dyspnea
- decreased breath sounds on affected side
- subcutaneous emphysema

people at risk: asthma, emphysema, tall thin men.
alkalosis
too much O2 not enough Co2 often from hyperventilation syndrome - anxiety, dizziness, numbness, tingling of hands and feet and painful spasms of hands or feet. feeling of cannto catch breath.
- if its a panic attack or life threatening illness should not be made outside of hospital.
Pulmonary embolus / embolism
* clot in lungs
results: from damage of the lining of vessels, blood clots, slow blood flow in lower extremity.
- surgery in legs/pelvis increases risk
dyspnea sudden
ocassionally will have acute sharp chest pain
sudden onset
tachycardia
tachypnea
hypoxia
cyanosis
clear breath sounds
hemoptysis (coughing up blood)
decreased circulation = life threatening condition.
emboli - fragments of blood clots in artery/vein that break off and travel
tension pneumothorax
severe shortness of breath
diminished or absent breath sounds on one side
decreased/altered level of consciousness
neck vein distention
tracheal deviation (late sign)
hypotension - signs of shock
respiratory syncytial virus (RSV)
- cough
-wheezing
- fever
- dehydration (refuse liquids)

in young children

caused by: infection in lungs + breathing passages can lead to other serious illness such as bronchiolitis and pneumonia + heart/lung problems

- highly contagious
* yes to humidified oxygen
TB - bacterial infection caused by Mycobacterium tuberculosis.
- can be dangerous because there are strains resistant to antibiotics.
- commonly affects the lungs but can affect any organ of the body.
- if someone is a weakened state of immunity, TB can be active again after being dormant for many years.
cough
fever
fatigue
productive/bloody sputum
- night sweats
weight loss
- dyspnea
bloody sputum and chest pain.

** higher infection rate of those who live in close contact such prision inmates, nursing homes, homeless shelters.
normal breath sounds
12-20 breaths/min adult
15-30 breaths/min = child
30-60 breaths/min = infant
- regular pattern
clear and bi lateral breath sounds
- adequate depth (tidal volume)
- unlabored, without abnormal (adventitious) breath sounds
pleural effusion
collection of fluid outside the lung on one or both sides of chest
- fluid collect from: irritation, infection, CHF, cancer over period of days and weeks.
- dyspnea sudden
- sitting up right relieves their symptoms
addition conditions with hypoxia (decrease O2 ) + dyspnea
pulmonary edema
hay fever
pleural effusion
obstruction of the airway
hyperventilation syndrome
enviromental/industrial exposure
carbon monoxide posioning
drug overdose
COPD - chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.
-16 million people +
- 4th leading cause of death in the US
- may resulted from firect lung and airway damage from toxic gases (cigs)
describes emphysema, chronic bronchitis, and emphysema +
- excess mucus obstructs alveoli from perfusion.
atelectasis
collapse of the alveolar air spaces of the lungs
Describe different respiratory conditions that cause dyspnea, including their causes, assessment findings and symptoms, complications, and specific prehospital management and transport decisions. (pp 633-634, 656-667)
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List the characteristics of infectious diseases that are frequently associated with dyspnea. (pp 634-638)
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Discuss some pandemic considerations related to the spread of influenza type A and coronavirus and strategies EMTs should employ to protect themselves from infection during a possible crisis situation. (pp 634, 637)
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Explain the special patient assessment and care considerations that are required for pediatric patients who are experiencing respiratory distress. (pp 634-638, 642, 662-667)
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albuterol
proventil, ventolin
albutero/ipratropium
combivent
MDI - metered dose inhaler
miniature spray cainister used to direct substances through the mouth into the lungs.
Small-volume nebulizer
works by providing a means for fine mist of aeroslized medicine to get deep into the patients lungs and work quickly.
exacerbation
intensify or worsen in severity
contraindications of MDI and small-volume nebulizer
- patient is unable to coordinate inhalation with MDI / volume nebulizers
- not prescribed to patient
- did not obtain permission from medical control prior
- patient has already taken maximum dose before EMS arrival
- medication is expired
Describe the assessment of a patient who is in respiratory distress and the relationship of the assessment findings to patient management and transport decisions. (pp 648-655)
-Standard precautions, PPE
-toxic substance that was inhaled, absorbed, ingested
-if multiple people with dyspnea consider possibility of airborne hazardous material release.
- NOI/MOI
Describe the primary emergency medical care of a person who is in respiratory distress. (pp 648-651, 656-662)
rapid exam to identify immediate life threats:
- is there labored breathing? cyanosis? etc.
ABCs = treat = rapid transport
- note general impression of patient
- skin parameters
- AO x4
AVPU
C/C
- is the pulse regular rhythm, strong?

Semi-fowlers position - 15 L/min via norebreather
if doing BVM ask if chest rise and fall is there? adequate breathing
List five different types of adventitious breath sounds, their signs and symptoms, and the disease process associated with each one. (p 651)
wheezing - indicates constriction and inflammation in the bronchus. exhale.

crackles (rales) - sounds of air trying to pass through the fluid on the alveoli. inspiration.
high pitched - fine crackles
low pitched - coarse crackles
**result of CHF or pulmonary edema

Rhonchi - low pitched rattling sounds caused by mucus in larger airway.

stridor - high pitched sound heard on inspiration as air tried to pass through an obstruction in upper airway
- partial obstruction indicated.
State the generic name, medication forms, dose, administration, indications, actions, and contraindications for medications that are administered via metered-dose inhalers (MDIs) and small-volume nebulizers. (pp 656-662)
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