Chapter 13A - Respiratory Emergencies

Question 0

List signs/symptoms of respiratory distress

Answer 0

Tachypnea, tachycardia
dyspnea (labored breathing), shortness of breath (SOB)
accessory muscle use it – suprasternal retraction
noisy breathing (wheezes, Strider, crackers, Rhonchi), grunting in kids
nasal flaring
tripod position
ALOC = agitation/anxiety/restlessness, confusion, lethargy
Abnormal skin signs = pale, cool, clammy, and/or cyanotic

Question 1

OPQRST for shortness of breath

Answer 1

Onset – when did the problem or symptoms start?
Provoking factor – what were you doing when it started?
Quality – what does it feel like? Is it more difficult to breath in or out?
Recurrence - has this happened before? Does it feel the same? What caused it that time?
Severity - how much distress is the patient in? Mild? Moderate? Severe?
Time - how long did it last?

Question 2

Defined the significance of breathing only with the diaphragm

Answer 2

Breathing where the only movement is the epigastric area may indicate normal breathing at rest

Question 3

Describe the significance of Chest wall movement while breathing

Answer 3

If the rib cage is moving when breathing, it indicates that there is an increased need for oxygen – at least monitor this – consider oxygen

Question 4

Describe the significance of accessory muscle use while breathing

Answer 4

If the accessory muscles are being used, the patient is in severe distress immediate action is necessary – give oxygen, support breathing, transport RLS

Question 5

Status asthmaticus - pathophysiology

Answer 5

Status asthmaticus indicates that something is very different about this attack and it is very life threatening

Question 6

Status asthmaticus – signs/symptoms

Answer 6

– Anxiety
– wheezing (especially on exhalation it due to bronchospasm and mucous plug in)
– tachypnea
– tachycardia
– dyspnea, possible chest discomfort or tightness but usually no pain
– accessory muscle use (a severe respiratory distress)
– Prolonged expiratory phase (forcing each breath)
– Pursed lip breathing
– coughing

Question 7

Acute asthma attack – pathophysiology

Answer 7

An allergic or stress related onset of acute respiratory distress, with bronchospasm in excess mucus production with mucous plug in (of your narrowed airways)

– and expiratory obstruction does can also be caused by stress, overexertion or exposure to severe cold and some people

Question 8

Acute asthma attack – signs/symptoms

Answer 8

– Anxiety
– wheezing (especially on exhalation it due to bronchospasm and mucous plug in)
– tachypnea
– tachycardia
– dyspnea, possible chest discomfort or tightness but usually no pain
– accessory muscle use (a severe respiratory distress)
– Prolonged expiratory phase (forcing each breath)
– Pursed lip breathing
– coughing

Question 9

COPD (emphysema or chronic bronchitis) – pathophysiology

Answer 9

A decades long destruction of lung tissue and membranes in the lungs with resultant scar tissue formation – usually due to environmental pollutants, such as cigarette smoke. There is a loss of usable surface area of gas exchange, loss of electricity and trapping of air in the lungs – with increased that space where there is no gas exchange. The patient has great difficulty getting enough oxygen to survive. Often here is hypersecretion of mucus.

In healthy people respiratory drive is driven by increased carbon dioxide levels and to a lesser extent, low oxygen levels. In the emphysema and their chronic trapped air leads to higher CO2 levels. So may only use hypoxic drive

Question 10

COPD (emphysema or chronic bronchitis) – signs/symptoms

Answer 10

– Anxiety, may tripod
– dyspnea (has trouble getting air in – accessory muscle use)
– pursed lip breathing or = puffing
– prolonged expiratory phase (trouble forcing each breath out
– abnormal breath sounds= Rhonchi or possibly wheezes
– cyanosis or ruddiness
– barrel chest = fully expanded

Question 11

Pulmonary edema – pathophysiology

Answer 11

Watery fluid (serum, not mucus) in the alveoli or smaller airways – due to many causes, such as congestive heart failure, drowning, toxic gas inhalation, excessive work at high altitude (greater than 10,000 feet), some drug overdoses, lung contusion to due to trauma (a seatbelt), infection (sepsis), pulmonary edema or after severe shock from trauma, especially cause injuries = ARDS = adult respiratory distress syndrome

Question 12

Pulmonary Edema – signs/symptoms

Answer 12

– Typically starts as mild or pronounce agitation
– tachycardia (sometimes < 140 at rest)
– pale, cool, clammy skin
– persistent cough, usually nonproductive (possibly some wheezes)
– crackles (especially in the lung bases)
– Severe dyspnea, especially if they try to lie down, tremendous respiratory effort
– eventually develop cyanosis
– productive cough develops, and possibly foam appearing at the mouth

Question 13

Pulmonary embolism – pathophysiology

Answer 13

A blood clot suddenly lodging in a pulmonary artery, blocking perfusion to an area. Clot usually from Venous stasis in the lower extremities due to prolonged immobility (airplane flights or more than five hours, or prolonged a bed rest or within 10 days after abdominal, pelvic or lower extremity surgery,), or secondary to leg trauma such as a fracture (fat emboli), or a crush/impact injury or after a SCUBA accident (air emboli)

Question 14

Pulmonary embolism – signs/symptoms

Answer 14

– Sudden and dramatic onset of agitation, apprehension

• sudden and dramatic onset of hyperventilation
• sudden and severe dyspnea, with congestion and shortness of breath
• pleuritic chest pain = sharp, stabbing, especially in inhalation
• Tachypnea
• tachycardia
• hemoptysis = coughing up bright red blood
• cyanosis
• possibly abnormal breath sounds = crackles
• calf or leg pain

Question 15

Pneumonia – pathophysiology

Answer 15

An acute infection of the lungs, either viral or bacterial, the result in production of large quantities of mucus, more than a liter per day that must be cleared by coughing

Question 16

Pneumonia – signs/symptoms

Answer 16

– History of respiratory infection 
– fever 
– productive cough (rhonchi), often with a greenish or rust colored mucus 
– possibly some wheezing 
– chest discomfort or chest pain

Question 17

Flu (influenza) type A, B, C – pathophysiology

Answer 17

The flu is an acute viral infection of the lungs, usually occurring as epidemics from December through March every year. Spread by droplets (cough or sneeze) or direct contact from shaking hands, or from touching objects (doorknobs, money, etc.)

Especially dangerous (and possible fatal) in people with chronic pulmonary diseases, or heart problems. The elderly, infants and those who already have severe illnesses

Question 18

Flu – signs/symptoms

Answer 18

Incubation period is 1-3 days (infection to symptoms)
– sudden onset of fever and chills (out of nowhere, 102-104°)
– General malaise
- 3 to 4 days of extreme fatigue and weakness – severe headache (Often with photophobia and Eye ache)
– severe muscle aches and pain (a back and legs calmly)
– cough (sometimes with the substernal burning) (can become severe enough that some victims of fracture their own rib coughing)
– worse symptoms last 3 to 7 days

Question 19

The flu and cold– differential diagnosis

Answer 19

Sore throat:
Flu - yes, gets worse on second and third day
Cold – yes, disappears in 1 to 2 days

runny, stuffy nose:
flu – sometimes/rare
cold – always

sneezing:
Flu - sometimes/rare
cold – usually

muscle aches and pain:
flu – severe/sudden onset (especially back and legs)
cold – mild/rare

Headache:
flu – severe/photophobia
cold – mild pressure

fever:
Flu- 102-104° rapid rise/chills
cold – usually none

site:
flu – mostly lower respiratory infection
Cold - URI

Cough:
flu – severe, hacking (some actually break ribs)
cold – minimal or none

occurs:
flu – December to March
cold – year round

incubation:
Flu - 2 days
Cold - 1-3 days

Diarrhea:
Flu- no
Cold - no

Nausea:
flu – no (anorexia)
cold – no (anorexia?)

Vomiting:
Flu - no (from cough, especially in kids)
Cold - no

Question 20

Hyperventilation syndrome – pathophysiology

Answer 20

Acute hyperventilation, from various causes, most commonly stress, fright, anxiety or pain. The excessively deep breathing blows of too much carbon dioxide, causing respiratory alkalosis

Question 21

Hyperventilation syndrome – signs/symptoms

Answer 21

– Usually severe agitation/anxiety/fright
– hyperventilating
– progressive signs/symptoms of alkalosis:
-– lightheadedness, dizziness
-– numbness, tingling around mouth or hands
-– a feeling of tightness in the chest, complain that they can’t get their breathing
-– muscle twitching
– carpal-pedal spasms
-– tetany
–– seizures
–– loss of consciousness

Question 22

Epiglottitis – pathophysiology

Answer 22

Infection or inflammation with edema of the epiglottis

Question 23

Epiglottis – signs/symptoms

Answer 23

– Fever 
– sore throat 
– difficulty swallowing 
– drooling dyspnea 
– accessory muscle use (respiratory distress) 
– coughing

Question 24

Why do you not want to insert an OP airway with a patient that has epiglottis?

Answer 24

Stimulation of the epiglottis can cause dramatic swelling and airway a closing