Professional Documents
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Respi Emer
Respi Emer
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.
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.
Affective Objectives
4-2.11 Defend EMT-B treatment regimens for various respiratory emergencies. 4-2.12 Explain the rationale for administering an inhaler.
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.
Respiratory System
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Pale or cyanotic skin Cool, damp (clammy) skin Shallow or irregular respirations Pursed lips 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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Asthma
Common but serious disease
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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.
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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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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
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You are the Provider You and your EMT-B partner 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 patients coworker. He tells you that the patient has had breathing problems before, but hes never seen it this bad.
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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, cant breathe. You hear audible wheezes.
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Scene Size-UP
How significant is the persons 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
Check pulse.
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You You arrange to rendezvous with(continued) ALS. are the Provider 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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You are Provider (continued) What can youthe do before you meet 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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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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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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Medications in MDI
Trade names Proventil Ventolin Alupent Metaprel Brethine Generic names Albuterol Metaproterenol Terbutaline
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Prescribed Inhalers
Actions
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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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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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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Suction secretions.
Transport in position of comfort.
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Spontaneous Pneumothorax
Administer oxygen.
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Asthma
Obtain history.
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Pleural Effusion
Definitive treatment is performed in a hospital. Administer oxygen and support measures.
Transport promptly.
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Administer oxygen.
Transport promptly.
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Pulmonary Embolism
Administer oxygen.
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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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