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Airway and Respiratory

Emergencies
Dr. Anna Millizia, M.Ked (An), Sp. An

Two

most important lifesaving skills:

Airway care
Rescue breathing
The

ABCs consist of:

Airway
Breathing
Circulation

Life Threats

To

maintain life, all humans must have


food, water, and oxygen.
Lack of oxygen, even for a few minutes, can
result in irreversible damage and death.

The

main purpose of the respiratory


system is to work with the circulatory
system to provide oxygen and remove
carbon dioxide via the red blood cells.

Respiratory System

Eventually

all cells will die if deprived of


oxygen. Brain and heart are the most
sensitive.

Time is Critical!

At the back of the throat are two passages:


The esophagus
The trachea
The epiglottis helps prevent food or water
from entering the airway.
The airway divides into the bronchi.
The lungs are located on either side of the
heart. The right lung has 3 lobes, the left has
2 and the heart sits slightly more towards the
left side.

Anatomy of the
Respiratory System

Other

parts of the respiratory system:


(contd)
The smaller airways that branch from the
bronchi are called bronchioles.
At the end of the bronchioles are tiny air sacs
called alveoli.
The exchange of oxygen and carbon dioxide
occurs in the alveoli.

Anatomy of the
Respiratory System

Anatomy of the
Respiratory System

Anatomy of the
Respiratory System

The

lungs consist of soft, spongy tissue with no


muscles.
Movement of air into the lungs depends on movement
of the rib cage and the diaphragm muscles.
When the diaphragm contracts during inhalation, it
flattens and moves downward, increasing the size of
the chest cavity.
Air moves in and out of the lungs because of pressure
changes, moving from high to low pressure to equalize.
On exhalation, the diaphragm relaxes and once again
becomes dome shaped, decreasing the size of the chest
cavity.

Anatomy of the
Respiratory System

Ask callers to:


Evaluate the victims
responsiveness. If
theres a response,
assume that the
patient is conscious
and has an open
airway.
If there is no
response, advise
callers to gently
shake the patients
shoulder and repeat
questions.

Check for Responsiveness

In

healthy individuals, the airway


automatically stays open.

An

injured or seriously ill person is not


able to protect the airway and it may
become blocked.
You must take steps to have callers check the
airway and correct any problems.

A Is for Airway

In

an unconscious patient lying on his or


her back, the passage of air through both
nose and mouth may be blocked by the
tongue.
The tongue is attached to the lower jaw.
A partially blocked airway often produces a
snoring sound.
The head tilt chin lift will fix the problem.

Correct the Blocked Airway

Head

tiltchin lift
maneuver
Place the patient on his
or her back.
Place one hand on the
patients forehead and
apply firm pressure
backward.
Place the tips of your
fingers under the bony
part of the lower jaw.
Lift the chin forward and
tilt the head back.

Correct the Blocked Airway

Potential

blocks include:

Secretions such as vomit, mucus, or blood


Foreign objects such as candy, food, or dirt
Dentures or false teeth
If

there is anything in the patients


mouth, remove it.
Finger sweeps can be done quickly and require
no special equipment.

Correct the Blocked Airway

If

an unconscious patient is breathing and has


not suffered trauma, place the patient in the
recovery position.
Helps keep the patients airway open
Allows secretions to drain out of the mouth
Uses gravity to help keep the patients tongue
and lower jaw from blocking the airway

Recovery Position

Use

the look, listen, and feel technique.

Look for the rise and fall of the patients chest.


Listen for the sounds of air passing into and
out of the patients nose or mouth.
Feel the air moving on the side of your face.

Adults have a normal breathing rate of 12


to 20 breaths per minute, children 15 to
30 and infants 25 to 50.

B is for Breathing

Causes

of respiratory arrest

Heart attacks
Mechanical blockage or obstruction caused by the
tongue
Vomitus, particularly in a patient weakened by a
condition such as a stroke
Foreign objects
Illness or disease
Drug overdose
Poisoning
Severe loss of blood
Electrocution by electrical current or lightning

No Breathing.. Start CPR

30 compressions in the center of the chest,


2 inches deep. Pushing hard and fast, 100
times per minute.
As you perform breathing, keep the patients
airway open. (head-tilt)
Pinch the nose, take a deep breath, and blow
slowly into the mouth for 1 second.
Remove your mouth and let the lungs deflate.
Breathe for the patient a second time.
Alternate 30:2 compressions and breaths, until the
patient responds or experienced help takes over.

CA-B

The

most common airway obstruction is


the tongue.
If the tongue is blocking the airway, the head
tiltchin lift maneuver will clear the patch for
air movement.

Food

is the most common foreign object


that causes an airway obstruction.
If a foreign body is lodged in the air passage,
you must use other techniques to remove it.

Causes of Airway Obstruction

If conscious:Ask the patient, Are you


choking?
If the patient can reply, the airway is not
completely blocked.
If the patient cannot speak or cough, the airway is
completely blocked.

Mild

airway obstruction

The patient coughs and gags.


The patient may be able to speak, but with
difficulty. Encourage the patient to cough.

Are You Choking?

Severe

airway obstruction

The patient is unable to breathe in or out and


speech is impossible.
Other symptoms may include:
Poor air exchange
Increased breathing difficulty
A silent cough
Loss of consciousness in 3 to 4 minutes
Treatment involves abdominal thrusts.

Are You Choking?

Airway

obstruction in an adult or child

If the patient is conscious, stand behind him


or her and perform abdominal thrusts.
Perform CPR on a patient who has become
unresponsive.

Are You Choking?

Airway

obstruction in an infant

If the infant has an audible cry, the airway is


not completely obstructed.
Use a combination of 5 back slaps and 5 chest
thrusts, if the infant is awake but not
breathing from airway obstruction.
If the infant becomes unresponsive:
Begin CPR.
Continue CPR until EMS personnel arrive.

Are You Choking?

Check

every patient for the presence of a stoma.


If you locate a stoma, keep the patients neck
straight.
Examine the stoma and clean away any mucus
in it.
Place your mouth directly over the stoma and
use the same procedures as in mouth-to-mouth
breathing.
If the patients chest does not rise, seal the
mouth and nose with one hand and then breathe
through the stoma.

Breathing for Patients With


Stomas

Occurs

when air is forced into the


stomach instead of the lungs

Increases

vomit

the chance that the patient will

Breathe

slowly into the patients mouth,


just enough to make the chest rise.

Make

sure airway is properly tilted open.

Gastric Distention

There are a variety of problems that


can cause Difficulty in Breathing
(DIB) or Shortness of Breath (SOB).
The rest of the presentation will
cover some of those conditions.

Respiratory Emergencies

Noisy respirations, wheezing, or gurgling (rales or


crackles)
http://www.easyauscultation.com/lung-sounds-reference-guide.a
spx
click on this link to listen to abnormal lung sounds

Rapid or gasping respirations


Pale or blue skin
Increased work of breathing
Talking in 1 or 2 word sentences
The most critical sign is respiratory arrest, which is
characterized by:

Lack of chest movements


Lack of breath sounds
Lack of air against the side of your face

Signs of Inadequate Breathing

Causes:

Upper or lower airway infection


Acute pulmonary edema (Fluid in lungs)
Chronic obstructive pulmonary disease (COPD)
Asthma
Hay fever
Hyperventilation syndrome
Environmental/industrial exposure
Carbon monoxide poisoning
Infectious diseases

DIB

Causes

(contd)

Anaphylaxis (Severe Allergic Reaction)


Spontaneous pneumothorax (Collapsed Lung)
Pleural effusion (Fluid around the Lung)
Prolonged seizures
Obstruction of the airway (Choking)
Pulmonary embolism (clot in Lung area)

DIB

Bronchitis

inflammation of bronchioles. Patients


will have a productive cough and wheezing.
Common Cold viral infection with swollen
mucous membranes and excess fluid production
from sinuses and nose.
TB a respiratory disease that can lay dormant
in the lungs for years. Is spread by respiratory
droplets.
Pneumonia viral or bacterial infection that can
damage lung tissue. Characterized by productive
cough, fever and congestion.
Diphtheria A highly contagious disease that
causes a layer of debris to form in the upper
airway and can causes obstruction. This is a rare
problem.

Airway Infections

Epiglottitis Bacterial infection that affects mostly school aged


children. Causes swelling of the flap above the larynx. Patients
will have Stridor (a harsh, high pitched sound) as the air moves
past the swelling. They will also have a fever, sore throat and
drooling.
Croup Viral Infection, usually seen in children under 3years old.
Causes inflammation of the airway and a seal bark type of
cough.
RSV Highly contagious infection that is spread through airborne
droplets. Affect young children and can lead to more serious lund
or heart problems.
Pertussis (Whooping Cough) Highly contagious bacterial
infection that mostly effects children under 6. Patient will have a
fever and coughing episodes where they cant catch their breath.
SARS Potentially life-threatening viral infection that starts with
flu-like symptoms and can progress to death. Spread from
person-to-person contact.

Airway Infections

Slow

process of dilation and disruption of airways


and alveoli

Caused
Fourth

by chronic bronchial obstruction

leading cause of death

Tobacco

smoke can create chronic bronchitis.

Emphysema

is another type of COPD.

Loss of elastic material around air spaces


Causes include inflamed airways, smoking.
Most

patients with COPD have elements of both


chronic bronchitis and emphysema.

Chronic Obstructive Pulmonary


Disease (COPD)

Result of allergic reaction to inhaled, ingested, or injected


substance
In some cases, allergen cannot be identified.
Asthma is acute spasm of smaller air passages
(bronchioles)
Excessive mucus production
Swelling of mucous lining of respiratory passages.
Hay fever causes cold-like symptoms.
Allergens include pollen, dust mites, pet dander.
Anaphylactic reaction can produce severe airway swelling.
Total obstruction is possible.
Reaction occurs within 30 minutes of exposure

Asthma, Hay Fever, and


Anaphylaxis

Rapid,

deep breathing to the point that arterial carbon


dioxide falls below normal
May be indicator of major illness
High blood sugar, overdose of aspirin, respiratory
infection, etc
Acidosis: buildup of excess acid in blood or body
tissues
Alkalosis: buildup of excess base in body fluids
Alkalosis can cause symptoms of panic attack,
including:
Anxiety
Dizziness
Numbness

Hyperventilation

Genetic disorder that affects lungs


and digestive system
Disrupts balance of salt and water
resulting in very thick mucus
Disposed to repeated lung
infections and malabsorption of
nutrients in intestines

Cystic Fibrosis

Cardiac

problem that causes fluid to back


up in the lungs
Risk factors include hypertension and a history
of coronary artery disease and/or atrial
fibrillation.
In most cases, patients have a history of
congestive heart failure.

Have

patient assume a comfortable


position, usually sitting up and leaning
forward.
Loosen any tight clothing.
Follow their doctors orders for any
medication administration.
If there is oxygen on scene, it is helpful in
cases of DIB.

Treatment

TERIMA KASIH