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Management of Acute Respiratory

Problems

Paul Swinton
Paramedic Lecturer Practitioner
Staffordshire University
Foundation Degree – Professional Development
In Paramedic Science
Objectives
Review the skills associated with management of
the acute respiratory emergency

Review the drugs associated with the
management of the acute respiratory emergency

Identity/review the protocols associated with
management of the acute respiratory emergency
Definitions

Hyperventilating – a fast & deep breathing pattern

Hypoventilating – a fast & shallow breathing pattern (why?) or obviously
a slow & shallow breathing pattern

Dyspnoea – difficulty with the actual act of breathing

Cheyne Stokes Respiration – Arises from a variety of neurological &
metabolic disorders. Periods of rapid irregular breaths becoming deeper
then shallow, alternating with periods of apnoea.
Cycle repeats every 30 seconds to 2 mins with 5 to 30 second periods
of apnoea

Kussmauls Respiration – Term applied to diabetic patient in ketoacidosis.
Characterised by hyperpnoea & tachypnoea
Cardinal Signs of Respiratory Distress

• Tachypnoea
• Anxiety
• Flaring of the Nostrils
• Use of accessory muscles in the neck & abdomen
•Tugging of the trachea
• Retraction of the intercostal muscles and suprasternal
species during inhalation
• Cyanosis
• Change in mental Alertness or Speech

(Caroline 2007)
The Airway

Oxygen is essential for life; irreversible brain damage will
begin to occur 3 to 4 minutes of the brain being deprived of oxygen.
Without Oxygen, death will occur very quickly.

It is essential that you quickly assess, establish and maintain the
patient’s airway.

Prompt & Regular
Basic Manoeuvres
Assessment
Foreign Body Airway Obstruction

An uncommon but potentially treatable
cause of death

Commonest cause of FBAO in adults is food, usually fish, meat or poultr

The signs & symptoms vary depending on the degree of airway
obstruction

(JRCALC 2006)
Foreign Body Airway Obstruction
GENERAL SIGNS OF FOREIGN BODY
AIRWAY OBSTRUCTION
Attack usually occurs while eating
Patient may clutch his neck

Signs of mild airway Signs of severe airway
obstruction obstruction
Response to question Response to question
"Are you choking?" "Are you choking?"
Patient speaks and answers "Yes" Patient unable to speak
Patient may respond by nodding
Other signs Other signs
Patient is able to: ● Patient unable to breathe
● speak ● Breathing sounds wheezy
● cough ● Attempts at coughing are silent
● breathe ● Patient may be unconscious

(JRCALC Version4 2006)
FBAO

(Resuscitation Council (UK) 2008)
Foreign Body Airway Obstruction

5
Back
Cough! Slaps
5
Abdominal
Thrusts

(JRCALC 2006; Caroline 2007)
FBAO – Unconscious Adult Summary

Resuscitation
30 to 2 • Give 30 chest compressions,
then 2 rescue breaths.
• Continue giving cycles of 30
compressions to 2 rescue
breaths.
• Only stop to recheck the
patient if they start breathing
normally
– otherwise do not interrupt
resuscitation.
• If there is more than one
rescuer, change over every 2
minutes to prevent fatigue.
(JRCALC Version4 2006)
FBAO – Key Points

Chest thrusts / compressions generate a higher airway pressure than
back blows and finger sweeps

Avoid blind finger sweeps. Manually remove solid material that can be
seen from the airway

Check after each manoeuvre to see if obstruction is relieved

Patients following successful treatment with a persistent cough, difficulty
n swallowing or the sensation of an object being suck must be
in
assessed further

Abdominal thrusts can cause serious injury, therefore all patients so
treated must be assessed for injury at hospital
(JRCALC Version4 2006)
FBAO – Management
Attempt to
visualise the
cords with a
Laryngoscope

If the Airway Remove any
Remains Obstructed:- visible
foreign
material
using forceps
or suction

If this fails or is
not possible,
consider
Needle
Cricothyrotom
(JRCALC Version4 2006) y
Asthma in Adults
Introduction
Commonest of all Medical Emergencies

Caused by a chronic inflammation of the
bronchi, making them narrower.
The muscles around the bronchi become
irritated and contract, causing sudden
worsening of the symptoms

The inflammation can also cause the
mucus glands to produce excessive
sputum which further blocks the air
passages

If a patient is suffering a first episode of wheezing –
‘Asthma’ always consider a differential diagnosis e.g. FBAO
(JRCALC Version4 ; Caroline 2007)
Introduction
The obstruction & subsequent wheezing
are caused by three factors within the
bronchial tree

1. Increased production of
bronchial mucus
2. Swelling of the bronchial tree
mucosal lining cells
3. Spasm & constriction of
bronchial muscles

Because inspiration is an active process
involving muscles of respiration, the
obstruction of the airways is overcome.
Expiration occurs with muscle relaxation
and is severely delayed by the narrowing
of the airway in asthmatics. This generates the
wheezing on expiration (JRCALC 2006; Caroline2007)
Triggers

In 2002 in the UK 69,000
people were admitted to
hospital with asthma.
Over 1,400 died from the
disease

Asthmatic Patients do not
have hypoxic drive and
need high concentrations
of oxygen

(Caroline 2007)
The amount of cartilage decreases & the amount of
smooth muscle increases progressively down the bronchi.

JJR 2007
Smooth Muscle

Involuntary muscle in the walls of the bronchi controlled by the
action of the sympathetic and parasympathetic nervous systems

Smooth muscle also responds to localised stimuli such as hormones
changes in PH, O2, & CO2 levels Temperature or ion concentrations

Para sympathetic control constrict the airways; the sympathetic
control relies on the presence of adrenalin produced by the adrenal
gland to produce dilation
Assessment

Asthma usually presents to
the Ambulance Service in
one of two forms

Assess for any LTE features,
correct any A & B problems
on scene then transfer to
nearest hospital continuing
with management

Assess A, B, C, D’s
(JRCALC Version4 2006)
Management Reassess to evaluate
condition

Repeat Salbutamol
Assess A, B, C, D’s If indicated & consider hydrocortisone

100% Oxygen IV Access

Commence Transfer ECG, SP02

Check Peak Flow
if practicable In cases of Hypoventilation
Consider in-line Nebulisation / BVM

Consider Atrovent
If Indicated
Administer Salbutamol
(JRCALC Version4 2006)
If indicated
Life Threatening Asthma

A small minority of cases may not respond to oxygen and
nebulised therapy. In these cases the use of intramuscular
Epinephrine should be considered where:-

The patient
is Deterioration
Suffering Continues despite
from Oxygen and
LT Asthma continuous
Ventilation nebulised
Is salbutamol
Failing

(JRCALC Version4 2006)
Drug Therapy

This treatment should be reserved for the most serious cases and
is NOT intended to be used as a matter of routine due to its
arrhythmogenic properties

Consider
Administer Consider
Atrovent
Epinephrine Salbutamol
Hypoxic Drive

Normal stimulus to breath is altered levels of CO2 and O2 measured
in the central chemosensitive area in the medulla oblongata and the
peripheral chemoreceptors in the carotid and aortic bodies.

Patients with chronic respiratory disease other than asthma develop
a tolerance for high levels of pCO2 .

The stimulus to breath then becomes reduced levels of oxygen.
Hence High levels of oxygenation lessen the stimulus to breath,
resulting in hypercarbia
Hypoxia

Hypoxia is a reduced level of oxygen availability to the tissues and
can be classified as follows...

Hypoxic Hypoxia: Caused by Low levels of pO2 in arterial blood.
Causes such as airway obstruction, high altitude or fluid in the lungs

Anaemic Hypoxia: Caused by too little functioning haemoglobin in
the blood stream. Causes such as Haemorrhage, anaemia, failure of
haemoglobin to carry O2

Stagnant Hypoxia : Caused by the bloods inability to transport O2 to
the tissues fast enough for the tissue requirements. Causes such as
heart failure, circulatory shock

Histoxic Hypoxia: Caused by tissues being unable to utilise the
oxygen which is delivered to them. Causes such as cyanide poisoning
Group Projects
Projects

Plan & design a booklet covering the following conditions

Pulmonar
Chronic y
Obstructive Embolis
Airway Disease Pneumonia
m
Pulmonar
y
Oedema
Must Contain:-
• An introduction into the
condition (aetiology) Assessment &
Evaluation of
• General Signs & Respiratory Function
Symptoms
• Management