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Associate Ambulance Practitioner > Respiratory conditions asthma > Flashcards

Respiratory conditions asthma Flashcards

1
Q

Medical/Respiratory Disorders affecting the Respiratory System Name conditions

A

Asthma Chronic bronchitis Emphysema Pneumonia Pulmonary embolus

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2
Q

Asthma 4 presentations

A

Mild/moderate Severe Life-threatening Near fatal

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3
Q

Asthma can be triggered by a number of factors e.g.

A

allergens (pollen, dust, foodstuffs), aspirin, infection, stress, cold air or smoke

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4
Q

Pathology of asthma

A

The initial reaction involves spasmodic contraction of the bronchi and bronchioles. Inflammation of the bronchi and bronchioles. Increased mucus secretion. Oedema may follow to further complicate the condition.

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5
Q

Adult Asthma

A

Acute Severe Asthma Unable to complete a sentence in one breath Respiratory rate >25 Heart rate >110 PEF 33% - 50% of predicted normal Life Threatening Asthma Silent chest Cyanosis Poor respiratory effort Bradycardia or hypotension Exhaustion, confusion, coma PEF <33% of predicted normal SpO2 <92%

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6
Q

Asthma in Children

A

Acute Severe Asthma SpO2 <92% on air Too breathless to talk or feed Respiratory rate >50 (2 – 5 yrs), >30 (5 – 18yrs) Heart rate >130 (2 – 5 yrs), >120 (5 – 18 yrs) PEF <50% of predicted normal Life Threatening Asthma - SpO2 <85% in air Silent chest Cyanosis Poor respiratory effort Fatigue or exhaustion Agitation or reduced conscious level PEF <33% of predicted normal

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7
Q

Management of Asthma

A
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8
Q

Management of Asthma (1)

A

Ensure ABC’s

Administer Oxygen therapy if hypoxaemic (maintain SpO2 94-98%)

Consider patient position

Commence transport

Specifically consider:

Check peak flow if practicable – note the best of 3 Administer Salbutamol

In acute severe or life threatening cases Ipratropium should be administered with the salbutamol

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9
Q

Management of Asthma (2) In cases of hypoventilation consider

A

in-line nebulisation with BVM and nebuliser

Monitor using ECG and Pulse Oximeter

Repeat doses of Salbutamol in accordance with guidelines

Exclude pneumothorax

Monitor and reassess to evaluate any change in peak flow or air entry

Consider Paramedic support to administer Hydrocortisone where there is a delay getting to hospital of >30 minutes

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10
Q

Treatment of Life Threatening Asthma

A

Adrenaline 1:1000 IM/SC – repeated after 5 minutes if necessary)

Salbutamol / Ipratropium Bromide

Paramedic support for IV access [do not delay transport]

Paramedic will administer Hydrocortisone IV (if >30 minutes to hospital)

In-line nebulisation with bag, valve, mask in cases of hypoventilation.

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11
Q

Causes of respiratory compromise

A
  • Obstruction of the air passages
  • Chest or lung trauma
  • Paralysis of respiratory nerves and muscles
  • Non – oxygen atmospheres
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12
Q

Causes of dyspnoea

A
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13
Q

Asthma

A

oCharacterised by intermittent reversible airway obstruction

oBronchi become inflamed making them smaller.

oInflammation irritates the muscles around the bronchi causing spasmodic contraction

oInflammation causes mucus glands to produce excessive sputum which further blocks the airways

o

o

oCan result in a partial or complete obstruction of the airways

oAir can become trapped in the alveoli

oLeads to Hyperinflated chest

https://www.youtube.com/watch?v=EK8nzKzdnIM acute asthma video (4 mins

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14
Q

Peak expiratory flow rate (PEFR)

A
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15
Q

oxygen

A
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16
Q

Describe the clinical features of the 4 levels of asthma

A

Mild/moderate

Severe

Life-threatening

Near fatal

17
Q

You should consider the possibility of COPD in patients:

A
  • Over 35
  • Smoker (or ex-smoker)

•

Patients displaying any of the following:

  • Exertional breathlessness
  • Chronic cough
  • Regular sputum production
  • Wheeze
18
Q

Bronchitis

A
  • Bronchoconstriction caused by inflammation of the airways and increased mucus production coupled with inhibition of the cilia leading to an accumulation of secretions.
  • Acute bronchitis (viral or bacterial) -common in young children and the elderly -is usually short lived
  • •Chronic Bronchitis is defined as where an individual has had a cough with sputum for 3 months in 2 successive years (Ross and Wilson p258)
  • •Lung damage may eventually result in right heart failure, peripheral oedema and cyanosis
  • Blue bloater’
  • Typically overweight
  • Typically cyanosed
  • •Difficult inspiration & expiration
  • •Productive cough
19
Q

Emphysema

A
  • Characterised by distension of the alveoli and destruction of their gas exchange membranes
  • Lung tissue loses elasticity
  • •The airway loses muscular integrity and collapses
  • •Air is obstructed on entrance to the alveoli

‘Pink puffer’

Typically thin

Typically maintain normal skin tone

Usually maintains normal skin colour

Use of accessory muscles

Difficult often prolonged exhalation

Pursed lips

20
Q

Pneumonia – signs and symptoms

A
  • Fever with or without rigors
  • Cough (often productive with green, blood-stained or rusty sputum)
  • Pleuritic chest pain
  • Muscle or joint pain
  • Raised RR, raised HR,
  • Crackles at base of lungs
21
Q

Pneumonia – Management

A

•Oxygen therapy as required

Salbutamol if wheeze

22
Q

PE – signs and symptoms

A
  • Raised HR, Raised RR
  • Lowered SpO2 (<92%)
  • Signs of DVT (deep vein thrombosis)

–Unilateral swelling of lower leg, warm, red, painful, tender calf

  • Dyspnoea
  • Pleuritic chest pain - often specific to one place (use of finger to identify pain)
  • Substernal chest pain
  • Apprehension
  • Cough
  • Haemoptysis
  • Syncope
23
Q

PE – Management

A
  • Oxygen therapy as required target SpO2 94-98%
  • Time critical transport with pre-alert
  • Management en-route
  • Position patient for comfort, often sitting forwards
  • Be prepared for arrest
  • 12 lead ECG and monitor obs en-route
  • Consider assisting ventilation
24
Q

Hyperventilation syndrome (HVS)

A

A DIAGNOSIS OF EXCLUSION – don’t miss a life threatening cause

Excessive breathing causes little change to oxygen levels

BUT a significant decrease in CO2 raising blood pH (alkalosis)

Alkalosis affects calcium binding and can cause tetany (commonly carpopedal spasm)

  • Tingling / numbness in hands, feet & mouth
  • Chest pain
  • Tetany / carpopedal spasm
  • Severe anxiety – feeling of suffocation
  • Syncope
25
Q

HVS – Management

A
  • Exclude life threating causes
  • Oxygen therapy as required target SpO2 94-98%
  • Coach breathing

–Remove bystanders – including friends and family

–Ensure calm quiet environment

–Eye contact and at eye level

–Calm and confident approach

–Demonstration

Continue to consider medical causes for hyperventilation

Do not leave patient until symptoms have subsided completely and remained absent for approx. 10 minutes

–Clear instructions – include hand gestures

–Explain that it will take time to adjust body chemistry

–Stay with patient

––Use CO2 rebreathing device if necessary

Associate Ambulance Practitioner (63 decks)

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