LECTURE 6

RESPIRATORY EMERGENCY

OBJECTIVES
1. Able to identify 7 signs and symptoms of respiratory distress
2. Able to identify 4 signs and symptoms of acute bronchitis
3. Able to identify 3 signs and symptoms of hemoptysis
4. Able to identify 3 signs and symptoms of 3 pneumothorax
5. Able identify 2 signs and symptoms of asthma and chronic obstructive pulmonary
disease (COPD)
6. Able to identify 7 signs and symptoms of inhalation trauma
7. Able to point out 6 steps of managing respiratory emergency

RESPIRATORY DISTRESS

Definition

Signs & symptoms

Etc

HEMOPTYSIS

Hemoptysis is coughing blood from the airway. It can be ranged from a few ml of
blood to massive hemoptysis. Massive hemoptysis criterias used in many centers in
Indonesia are:
 Expectoration over 600 ml/day, or
 Expectoration from 250 to 600 mL/day and hemoglobin concentration is less than
10g/dL, or
 Expectoration from 250 to 600 ml/day and hemoglobin concentration is more than
10g/dL, but bleeding is still going for 48 hours

The most common causes of hemoptysis in Indonesia are tuberculosis, bronchiectasis,

lun cancer, pulmonary abscess, pulmonary mycosis, pneumonia, blood disorders and
heart disorders. It should be remembered that every hemoptysis is a respiratory
emergency because of the potency of asphyxia and respiratory arrest,
Managing Respiratory Emergency

1. Secure the scene (in the case of inhalation of toxic gas, bring the patients as far as
possible from the scene) and use universal proctection
2. Check patient’s consciousness
3. Primary suvey :
a. Airway – Open and monitor the airway
b. Breathing – Administer oxygen by nasal canule 2-3 L/m or oxygen mask
10-15 L/m and monitor breathing adequacy
c. Circulation – Be aware of the signs of shock, if exists, begin shock
management procedures
4. DO NOT permit physical activity
5. Assist the patient to position in comfort
6. Request Advanced Life Support assistance
7. In the case of asthma exacerbation and acute exacerbation of COPD patients, ask the
patient whether they have asthma medication or bronchodilators (inhalers such as
metered dose inhaler, turbuhalers, oral medications such as salbutamol, procaterol,
theophylline, aminophylline). If available, assist them with the self administration
of inhalers or take the medication orally.
8. In the case of hemoptysis, assist the patient to cough the blood. Support the patient to
be calm, DO NOT panic. Help the patient in sitting position, so the blood will not
aspirate and block the airway. Bring the patient to the nearest hospital. Remember,
every hemoptysis is a respiratory emergency.

Note

Most asthma or bronchodilators drugs for COPD patients are inhaled using various forms
of inhalers or nebulizers. The basic devices are the metered-dose inhaler (MDI), breath-
actuated inhalers, dry powder inhalers, and nebulizers.

Metered dose inhaler (MDI) Turbuhaler

How to use metered dose inhaler (salbutamol/albuterol, fenoterol, terbutalin,
procaterol, ipratropium bromide)

1. Remove the cap from the mouthpiece; Inspect the inhaler mouthpiece for the
presence of foreign objects before each use, especially if the strap is removed
from the actuator and lost or if the cap has not been used to cover the mouthpiece.
Make sure the canister is fully and firmly inserted into the actuator.
2. Shake the inhaler before each use.
3. Breath out fully through the mouth, expelling as much air from the lungs as
possible. Place the mouthpiece fully into the mouth, holding the inhaler in the
mouthpiece down position and closing the lips around it.

4. While breathing in deeply and slowly through the mouth, fully depress the
top of the metal canister with your index finger . Immediately after the puff is
delivered, release your finger from the canister and remove the inhaler from your
mouth

How to use dry powder inhaler (turbuhaler : terbutalin, formoterol)

1. Unscrew the cap and lift off
2. Hold the Turbuhaler upright by placing the base on a flat surface and turn the coloured base
of the device anticlockwise as far as it will go, then turn it clockwise until you hear a click
3. Breathe out a little
4. Place the mouthpiece between your lips and breathe in forcefully and deeply through your
mouth
5. Breathe out gently (but not into the turbuhaler)

NON MEDICAL STRATEGIES IN MANAGING ASTHMA EXACERBATION IN

CHILDREN

Asthma triggers a vicious emotional-physical cycle:

 Breathlessness and wheezing incite a fear of suffocation and death, even in very
small children.
 This anxiety produces further constriction on the muscles surrounding the
airways, which makes breathing even more difficult.

Caregivers must first focus on alleviating their own anxiety, which can heighten a child's
own fears. The next step is to help the child relax. One method for this is as follows:

 The child sits comfortably, bending slight forward with the eyes closed.
 The hands are placed gently over the navel.

 The child is then told to pretend the stomach is a balloon.

 The "balloon" must be "blown up" by inhalation, not exhalation. The child can tell
if this working because the hands will move slightly apart.

 When the child breathes out, the "balloon" will be made flat.

This exercise both relaxes the child and discourages shallow, oxygen-poor breathing.
Massaging the child in gentle circles on the chest is relaxing and may also loosen mucus.

Other recommendations include the following:

 A child may also find relief by lying stomach-down on several pillows so that the
head is slightly lower than the chest while the caregiver gently pats the back
between the shoulder blades.
 Giving the child warm liquids, such as soup or hot cider, is effective in loosening
mucus and may also relax bronchial muscles. Cold fluids, like cold air, should be
avoided.
 Overhydration, too much liquid, can be harmful, however, so these drinks should
not be forced on the child.
 Warm, moist air from vaporizers can greatly ease and moderate asthma attacks.
 Daily massages and breathing and relaxation techniques to reduce stress can be
very helpful