Respiratory deck Flashcards
To cover respiratory emergencies and protocols for dealing with them (101 cards)
1
Q
When the airway is partially obstructed and the patient is conscious, what is the most effective way to clear the airway?
A
Getting them to cough forcefully.
2
Q
How would you manage an unresponsive patient with partial airway obstruction due to fluids?
A
- Visually assess the oral cavity and place the patient in the 3/4 prone or lateral position and allow drainage by gravity
- If gravity doesn’t effectively clear the airway, perform a finger sweep
- If that doesn’t work, use suction for a maximum of 20s
- If the airway clears, indicated by the patient breathing normally or the mouth being clear of fluids
a) Position the patient supine
b) Open the airway
c) Assess for normally breathing - if patient is still unresponsive, not breathing normally or agonal breathing is seen, and carotid pulse is absent, then perform CPR/AED
d) Assisted ventilation if needed
e) If patient is breathing adequately but still unresponsive to verbal stimuli, attempt to insert an oral airway, apply oxygen as required, complete primary survey, and initiate rapid transport procedures - If the airway doesn’t clear and patient is not breathing normally, initiate CPR and AED procedures. Rolling the patient lateral and sweeping to clear the airway between sets of chest compressions may be necessary.
6a) If the airway doesn’t stay clear but the patient is breathing normally, the patient will have to be managed and transported in the lateral or 3/4 prone position. Assist ventilation if needed, using finger sweeps and suction to clear the airway as required
6b) If the patient is breathing adequately but still unresponsive to verbal stimuli, attempt to insert an oral airway, apply oxygen as required, complete the primary survey, and initiate rapid transport procedures - If the airway continues to be partially or completely obstructed to the point where giving one ventilation every 5s is not practical, give 2 ventilations every 10s while continuing to clear the airway. Between ventilations it may be necessary to remove and clean the oral airway, use finger sweeps and/pr suction to clear the mouth, and reinsert the oral airway.
3
Q
What is the most common cause of airway obstruction? What is the best way to manage this?
A
Blockage by the tongue.
Jaw thrust to move the tongue out of the way and insertion of an OPA. to keep the airway open
4
Q
What should you assume if the patient is unresponsive, not breathing normal or has agonal breathing, and the carotid pulse is absent? How should you manage this?
A
The patient should be assumed to be in cardiac arrest and you should perform CPR/AED immediately.
5
Q
What two concerns should you have when treating an airway emergency?
A
- Is the patient conscious?
- Is a cervical spine injury suspected?
6
Q
What approach should you take when the patient is not in cardiac arrest?
A
The look, listen, and feel approach
7
Q
What might stridor from a conscious patient indicate?
A
A partially occluded airway
8
Q
What does a conscious patient with the inability to speak indicate?
A
A completely obstructed airway
9
Q
What are some signs of a partially occluded airway?
A
Stridor
Noisy, congested, or gurgling breathing
Hoarseness may indicate injury to the vocal chords, which is also a sign of an unstable airway
Possible cyanosis
10
Q
What is the universal distress signal of a conscious person for a complete airway obstruction?
A
Clutching his/her neck between the thumb and index finger
11
Q
What are some signs of a complete airway obstruction?
A
Cyanosis
No movement of air in or out of the mouth
Chest wall does not rise with ventilation
If conscious, unable to vocalise
12
Q
What is the best most common cause of airway obstruction after the tongue? What are some examples?
A
Foreign bodies.
Loose fitting dentures, broken teeth, vomitus, and blood
13
Q
How would you manage a foreign body airway obstruction in a conscious patient sitting or standing upright?
A
Get them to cough forcefully. If this does not work, perform 5 back blows followed by 5 abdominal thrusts, repeatedly until the foreign body is removed or the patient becomes unconscious. Chest thrusts should be used for obese or pregnant patients .If partial airway obstruction persists, assist ventilation if needed.
14
Q
How would you manage an airway obstruction if the patient becomes unresponsive?
A
Update emergency health services, place them in the supine position, and start CPR (request an AED if available). After chest compressions, look in the mouth, remove anything seen, and attempt ventilation. If the chest rises when ventilated but the patient does not begin to breathe spontaneously, venitate again and if the patient is not breathing normally or agonal breathing is seen, and the carotid pulse is absent, then initiate CPR/AED.
If unable to ventilate, recheck the jaw thrust/head-tilt position and attempt to ventilate again.
If the patient is breathing normally but is still unresponsive to verbal stimuli, attempt to insert an oral airway, assist ventilations, complete the primary survery, and initiate rapid transport procedures.
15
Q
How would you open the airway of the unresponsive patient with no possibility of c-spine injury vs. the patient with potential c-spine injury?
A
For the unresponsive patient with no possibility of c-spine injury, I would perform a head-tilt, chin lift.
For the patient with potential c-spine injury, I would perform a jaw-thrust
16
Q
When should chest compression be used in airway obstruction?
A
In all supine patients (conscious or unconscious) with a suspected foreign-body obstruction of the airway. They are not effective for partial or complete airway obstruction due to swelling, secretions, or bleeding eg. smoke inhalation, or blunt neck or facial trauma
17
Q
How do you measure an OPA?
A
The correct size can be estimated by matching the distance from the corner of the mouth to the angle of the jaw with the curved part of the oral airway.
18
Q
How should you manage patients with profuse bleeding of the mouth or nose, or who are actively vomiting?
A
In the lateral or 3/4 prone position. More often than not, the material is too thick to drain away from gravity alone.
19
Q
How do you set up and use a suction device?
A
- Attach a clean suction tip and tubing to the machine
- If the suction tip has a venting hole, it must be covered by thumb or finger to ensure adequate suction at the tip.
- Turn the device on and test it. With fingers off the venting hole, insert the suction into the mouth and activate the suction by sealing the venting hole with a finger
- Turn the suction on to ensure that the device works
- In the present of profuse bleeding or vomit, the large-calibre suction tubing may have to be used directly without a suction tip to clear the oral cavity
20
Q
What do you do if you’re performing CPR/AED procedures for an airway obstruction and the obstruction is relieved?
A
- Give two breaths and watch for the chest to rest
2a) If the patient is not breathing normally, check the carotid pulse for up to 5s (if patient is hypothermic, check for up to 30s). If the patient is unresponsive, not breathing normally or with agonal breathing, and the carotid pulse is absent, assume the patient is in cardiac arrest and perform CPR/AED protocols
2b) If the patient is breathing normally, assist ventilation if needed
2c) If the patient is breathing adequately but still unresponsive to verbal stimuli, attempt to insert an oral airway, apply oxygen as required, complete the primary survey, and initiate rapid transport procedures.
21
Q
What transport criteria are patients with partial or complete airway obstruction in?
A
RTC
22
Q
What is the criteria for assisted ventilations?
A
- Presence of cyanosis
- Shallow and ineffective respiration
- Severe respiratory distress
23
Q
Describe the protocol for using a pocket mask for assisting ventilation.
A
- Stabilise the head and neck in the neutral position if the MOI suggests spinal trauma. Alternatively, you may get a helper to manually stablise the head and neck while you hold the pocket mask in the proper position.
- Place the mask in the proper position over the patient’s nose and mouth and establish a good seal. Use 2 hands and the jaw thrust position. Do not tilt the head of a patient with suspected c-spine injury during ventilation.
- Ventilate the patient once every 5s, ensuring chest wall rises with each ventilation. If at any time the chest does not rise, do the following:
a) Open the airway with a jaw thrust
b) Reposition the pocket mask to ensure a good seal
c) Insert an oral airway
d) clear the airway of foreign bodies or debris - Train a helper to take over the assisted ventilation using a pocket mask
- If the patient is unresponsive t verbal stimuli, insert an oral airway
- Open the oxygen cylinder, set the flow rate to 10 Lpm, and connect the tubing to the inlet valve on the pocket mask. An adequate level of oxygen can still be delivered with the pocket mask if supplemental oxygen isn’t available.
- If a helper is unavailable or is unable to take over the assisted ventilation, the oral airway may be inserted and oxygen applied between ventilations.
- When ventilating an unresponsive patient, it may become necessary to stop assisted ventilations to begin CPR/AED
24
Q
What are 4 reasons that you may not see the chest rise during assisted ventilation?
A
- Jaw thrust is not properly maintained
- Pocket mask does not have a good seal
- Airway is not clear - may require an OPA
- Foreign bodies or debris in the airway
25
How can you train a helper to take over assisted ventilation using a pocket ask?
1. Ask the helper to watch what you are doing to ensure they understand the timing of the breathing, give one breath every 5s
2. Between breaths, explain and show the helper how to hold the mask; put their hands over yours
3. When the helper has understood the instructions, without interrupting the assisted breathing, ask them to take over
4. Watch the helper give a few breaths to ensure they are assisted appropriately - continue to coach them if necessary
26
Describe how to use a bag valve mask
1. The patient's head and neck must be stabilised in a neutral position if the MOI suggests spinal trauma. A simple technique is for the OFA attendant to stabilise the patient's head and neck between his or her knees while kneeling. This method frees up both hands to seal the mask to the patient's face. Alternatively, an assistant can hold the head and neck in the neutral position while the OFA attendant holds the mask with both hands and another assistant ventilates the patient.
2. Transfer the oxygen tubing from the pocket mask to the bag valve mask and increase oxygen flow to 15lpm if a reservoir is being used with the BVM
3. Place the mask in the proper position on the patient's face with the apex over the bridge of the nose and the base below the lower lip against the chin. Maintain a goo seal bu holding the mask snugly against the patients' face with two hands on either side of then mask
4. An assistant should be asked to compress the bag while the OFA attendant holds the mask with both hands and maintains the seal. Ensure the bag is compressed with just enough force to see the chest rise with each ventilation.
5. Do not tilt the head of a trauma patient with suspected c-spine injury during ventilation
6. Ventilate patient once every 5s, time with patient's inhalation if possible. If the responsive patient is breathing at less than 10 breaths/min, add additional ventilations between patient's own breaths to a combined 12 breaths/min
7. Ensure that the chest wall rises with each ventilation
8. If ventilation isn't effective, return to ventilating patient with a pocket mask
27
What are the 2 most common reasons for inadequate ventilation with a BVM? How do you correct this?
1. Failure to maintain an effective seal
2. Failure to maintain a proper jaw position
These are corrected by pulling up the mandible and repositioning the mask and ensuring two hands are used to hold it in place.
28
What are the causes of dypsnea?
- May be inadequate oxygen in the air breathed
- May be an obstruction to the flow of air in the upper airway, trachea, or bronchi
- Air may not pass easily in or out of the air sacs in the lungs
- Injury to the chest wall
- A lung may be collapsed and unable to expand
- Lung tissue may have been damaged directly
- Lung tissue may lose its elasticity and no longer respond to normal motions of breathing eg. emphysema
- Lungs may be filled with fluid because the heart muscle has failed and is no longer able to circulate blood properly eg. heart failure
- Lung tissue may be infected eg. pneumonia
29
What are the signs and symptoms of chest injury?
- Pain at the injury site
- Pleuritic pain (pain that's aggravated by breathing but not produced by direct pressure on the chest wall at the site of injury)
- Dyspnea
- Failure of one or both sides of the chest to expand normally
- Coughing up blood
- Rapid and weak pulse
- Cool and/or moist skin
- Cyanosis (blue coloured lips, fingernails, or earlobes)
- Subcutaneous emphysema (air under skin tissues)
- Anxiety and fear
30
Describe the 2 types of chest injuries:
1. Closed - The skin is intact in a closed chest injury; therefore, the danger of such injuries may be underestimated. Even when a wound isn't open, the heart, blood vessels, and lungs may have lacerations and contusions. Blunt trauma and crush injuries cause closed chest injuries.
2. Open chest injuries are those in which the chest wall has been penetrated, as by a knife, a bullet, or a sharp object on which the patient has fallen. Open chest injuries may also be associated with severe rib fractures, where the broken end of the rib has lacerated the chest wall and the skin. As with closed chest injuries, there may also be contusions or lacerations of the heart, lungs, or major blood vessels. To avoid aggravating existing injuries, protruding objects must not be removed from the wound.
31
What is the most important thing to remember when treating an open chest wound?
It should never be sealed. It should be covered with a permeable dressing.
32
What are the potential causes of rib fractures?
Usually caused y direct blows or compression injuries of the chest. The trauma victim with rib fractures may have associated injuries included pneumothorax, hemothorax, and/or lung contusions.
33
What associated injuries might upper rib fractures be associated with?
Upper ribs are fractured less often than lower ribs because they are protected by the shoulder girdle. However, these rib injuries may be associated with other internal injuries in the mediastinum.
34
What associated injuries might lower rib fractures be associated with?
Lower rib fractures may be associated with underlying injuries to the liver, spleen, or kidney
35
What are the signs and symptoms of rib fractures?
- History of a blow or compression injury to the chest
- Pain at the fracture site or localised tenderness upon palpation
- Increased pain at the fracture site when breathing deeply, coughing, or moving
- The patient leaning toward the injured side, holding the affected area to keep it stabilised
- The patient wanting to remain still
- A rib deformity and/or chest wall bruising or laceration
It might be more serious if they display:
- Moderate to severe respiratory distress
- Cyanosis
- Hemoptysis (coughing up blood)
- Shock
36
How would you manage rib fractures as an OFA attendant?
Follow the priority action approach and regularly assess the patient to ensure vitals are stable. Simple rib fractures are not wrapped, strapped, or taped. If there are no associated injuries, then the patient should be packaged for position of maximal comfort for transport to hospital.
37
What is a sternal fracture and how would you manage0dm it?
It's a rare condition and usually indicates severe trauma to the anterior chest. Sternal injuries may be associated with injuries to the chest, neck, lungs, heart, or other mediastinal structures. Patients with sternal injuries are in the RTC, and should be treated the same as a patient with a rib fracture.
38
What is a flail chest?
When 2 or more consecutive ribs are fractured in two or more places, or detached from the sternum, a segment of the chest wall may become disconnected from the rest of the bony thorax. This segment of the chest wall floating between fractures is called the 'flail' segment.
There may be movement of the flail area opposite to the remainder of the chest. When the patient inhales, the flail doesn't expand; when they exhale, it protrudes while the rest of the chest wall contracts.
This is a very serious injury and the severity of respiratory distress can vary from normal breathing to severely short of breath, depending on the size of flail chest and the magnitude of internal injuries. It can also vary due to the presence of shock.
If there is evidence of flail chest, the OFA attendant should always assume that there are more serious internal injuries.
39
What are the signs and symptoms of flail chest?
- History of blunt trauma to the chest
- Paradoxical movement or deformity, visible on observing bare chest
- Marked shortness of breath and/or respiratory distress
- Pain in the fracture area
If the lungs are damaged, the patient may:
- Cough up blood or frothy, bloody sputum
- Collapse or show signs of shock
- Show signs of tension pneumothorax
40
What is the specific treatment of flail chest aimed at?
1. Providing optimal oxygenation
2. Restoring and maintaining stability of the chest wall
41
How would you manage a flail chest as an OFA attendant?
1. In the absence of a decreased LOC, neck injury, or shock, position the patient for ease of breathing, usually semi-sitting
2. If necessary, you must provide assisted ventilation every 5s
3. Support flail segment by
a) holding the hand firmly over the segment to help control movement.
b) If there is obvious paradoxical movement or instability, it may be necessary to provide further stabilisation once en route
c) Padding can be used to stabilise the flail segment, depending upon the size and location of the flail segment and the presence of associated injuries
d) For fail segments located on the anterior and anterolateral chest wall, a pad large enough to cover the flail segment and no larger should be taped over the segment firmly enough to stop the paradoxical movement.
4. Place the pad when the flail segment is sucked into its lowest point, when the chest is in full inspiration.
5. Adhesive tape 7.5 or 10cm wide should be applied over a thick, firmly rolled pad, a towel,or similar available material of the size ad shape of the flail segment. The taping should be horizontal and vertical and applied generously so that it is anchored to the stable chest wall. Don't delay transportation for the purpose of taping a pad in place, as this can be done en route.
42
What is a closed pneumothorax and what mainly causes it?
A closed pneumothorax occurs when lung tissue is torn and air leaks from the lung into the pleural space. Air is therefore contained within the thoracic cavity but outside the lung. When the lung collapses, its volume is reduced, thereby diminishing the amount of air that can be inhaled, leading to respiratory distress and shock.
It's usually caused by rib fracture(s).
43
What are the signs and symptoms of a closed pneumothorax?
A patient with closed pneumothorax may have some or all of the general signs and symptoms of chest injury.
Specific signs and symptoms include
- history of chest trauma
- pain at the site of injury
- increased pain upon inspiration (pleuritic pain)
- difficulty breathing
- cyanosis
- rapid, weak pulse
- subcutaneous emphysema at site of injury, over the chest, or in the neck
44
How would you manage a closed pneumothorax?
It should follow the Priority Action Approach to the injured patient and the general principles of management of chest injuries. The patient meets the RTC criteria.
45
What is an open pneumothorax and what mainly causes it?
An open pneumothorax is a penetrating wound of the chest wall , whereby air enters the pleural space from outside the chest wall, and thereby collapses the lung. Air passes back and forth through the wound on inspiration and expiration, which occasionally creates a sucking sound, which is why they're sometimes called open, sucking-chest wounds. Patients with open pneumothorax can have varying degrees of respiratory distress from severe dyspnea to no dyspnea.
Open, sucking-chest wounds can be cause be any objects or mechanism that leads to penetration of the chest wall.
46
What are the signs and symptoms of an open pneumothorax?
A patient with open pneumothorax may have some or all of the general signs and symptoms of chest injury.
Specific signs and symptoms include:
- history of trauma to the chest
- an open chest wound
- a sucking sound as air passes throug the opening in the chest wall
- blood or blood-stained bubbles expelled from the wound on exhalation
- coughing up blood
- possible exit wound
47
How should you manage an open pneumothorax/open-sucking, chest wound
Follow the Priority Action Approach and the general principles of chest injuries, ensuring they receive rapid transport. You should use a permeable dressing to not occlude the wound as this may cause a tension pneumothorax.
48
What is the specific treatment of an open pneumothorax?
1. Control any external bleeding
2. Do not allow the wound to seal
3. Do not use an occlusive dressing on the wound as this could make the condition worse by creating a tension pneumothorax
4. If there is bleeding from the wound, apply pressure with gauze. It should not impede air escaping from the wound
49
What is a tension pneumothorax and what mainly causes them?
Tension pneumothorax is the accumulation of air in the pleural space under pressure. The air under tension collapses the lung on the side of the injury and then displaces the mediastinum away from the air-filled pleural space.
This can occur from either penetrating or blunt chest trauma when the injury creates a one-way valve so that air can enter but not leave the pleural space. In blunt trauma, the lung may be torn (most commonly by a rib fracture). The site of lung injury acts as a one-way valve, allowing air into the pleural space during inspiration but prevents its return to the lung during expiration. Air under increasing pressure consequently collects in the pleural space; collapsing the lung and increasing the pressure on the heart, blood vessels, and unaffected lung, which can cause severe dyspnea and shock. The increased pressure on one side of the chest can cause the neck structures to shift to one side.
50
What are the signs and symptoms of tension pneumothorax?
A patient with tension pneumothorax may have some or all of the general signs and symptoms of chest injury.
Specific signs and symptoms include:
- severe progressive respiratory distress
- distended neck veins due to an obstruction of the superior vena cava
- marked overexpansion on the affected side of the chest
- subcutaneous emphysema
51
Describe the management of tension pneumothorax
It should follow the Priority Action Approach to the injured patient and the general principles of management of chest injuries. The patient meets the RTC criteria.
52
What is the specific treatment for tension pneumothorax?
The patient requires immediate transport to a hospital. Management must include assisted ventilation and oxygen, if needed. These injuries are not limited to closed-chest pneumothorax, as occlusive dressing on open, sucking-chest injuries can lead to tension pneumothorax. If this occurs, roll the pateint and remove the occlusive dressing, releasing the built up air pressure inside the chest cavity.
High pressure ventilation may worsen a tension pneumothorax. The OFA attendant may provide low-pressure assisted ventilation with oxygen as needed.
53
What is a spontaneous pneumothorax?
A pneumothorax that develops without injury. Lungs can develop a weak area on their surface, either from a developmental birth defect or because of underlying disease (eg. emphysema/COPD). The weak area ruptures and air leaks into the chest cavity, causing the pneumothorax. As the effected lung collapses, symptoms of dyspnea may appear.
54
Describe the signs and symptoms of spontaneous pneumothorax?
When a patient has no apparent chest injury or airway obstruction but is obviously in respiratory distress, spontaneous pneumothorax should be considered. The patient experiences a sudden sharp pleuritic chest pain with varying degrees of dyspnea.
55
Describe the management of spontaneous pneumothorax?
It should follow the Priority Action Approach to the injured patient and the general principles of management of chest injuries. The patient meets the RTC criteria. Management should include oxygen at 10 Lpm by mask if indicated. Transport the patient to hospital in the most comfortable position (usually sitting).
56
What is hemothorax?
Hemothorax occurs when blood collects within the pleural space. It may be caused by open or closed chest injuries, and is frequently associated with pneumothorax. The bleeding may come from lacerated vessels in the chest wall, from lacerated major vessels within the chest cavity itself, or from a lacerated lung. Bleeding within the thoracic cavity to accommodate large volumes of blood, the patient may exhibit signs of shock from blood loss.
57
What are the signs and symptoms of hemothorax? How can it be managed?
Patients may have some or all of the general signs and symptoms of chest injury. Of special concern with this condition are signs of increasing respiratory distress and/or shock.
It should follow the Priority Action Approach to the injured patient and the general principles of management of chest injuries. The patient meets the RTC criteria.
58
What is a pulmonary contusion?
It's a bruise of the lung, almost always associated with blunt injuries to the chest eg. automobile crashes/serious fals
59
What are the signs and symptoms of a patient with pulmonary contusion(s)?
The blood vessels in the lung are injured and a considerable amount of blood may be lost in the lung tissue. The patient may or may not be in respiratory distress, depending on the extent of the contusion. Patients with significant pulmonary contusions frequently cough up blood. The signs and symptoms may develop 12-24 hours after the injury.
A patient with pulmonary contusion may have some or all of the general signs and symptoms of chest injury.
60
What is the management of pulmonary contusion?
It should follow the Priority Action Approach to the injured patient and the general principles of management of chest injuries. The patient meets the RTC criteria.
61
Describe what happens to the lungs in the event of a blast injury
An explosion can create sudden extreme changes in the air pressure in the lungs. This can damage the air sacs and produce widespread bleeding. The alveoli become filled with blood, preventing the normal exchange of gases. As fluid accumulates in the lungs, it increasingly interferes with the movement of oxygen from the alveoli into the bloodstream and the patient becomes hypoxic. This process of bleeding into the lungs may occur over several hours.
Pressure waves may also strike the outside wall of the body, causing pressure changes that damage the lungs and the contents of the abdominal and cranial cavities. Heart damage is a common complication associated with blast injuries.
62
What are the signs and symptoms of a blast injury?
They can vary in severity and be fatal without any evidence of external damage to the body. Patients may have all or some of the general signs and symptoms of chest injury.
Specific signs and symptoms include:
- history of an explosion
- pain in the chest and/or abdomen
- respiratory distress
- coughing, and frothy sputum that may be blood stained
- Nause/vomitting
- Shock
- Decreased LOC
- Bloodshot eyes, minute red/blue spots on face, neck and/or upper chest caused by tiny hemorrhages
- Abdominal tenderness and/ord rectal bleeding
- Possible delayed onset of dyspnea, headache, chest pain, or shock
- Patient may be deaf from ruptured eardrum
63
How should you manage a patient with a blast injury?
You should follow the Priority Action Approach to the injured patient and the general principles of management of chest injuries. The patient meets the RTC criteria.
64
What is traumatic asphyxia? Describe what happens in the condition
Traumatic asphyxia is a rare condition, caused by a crushing trauma to the chest. An injury of this type forces the anterior chest wall back, compressing the heart against the vertebral column. This sudden compression of the hart, especially of the thin-walled right atrium, forces the blood back into the valveless veins of the upper chest, neck and head. The force is so great that multiple tiny hemorrhages occur in the minute veins of the skin and mucus membranes. The patient will often have bluish mottled skin on the head, neck, and upper thorax and may have subconjunctival hemorrhages.
65
What are the signs and symptoms of traumatic asphyxia? Describe the management of this condition:
A patient with this condition may have all or some of the general signs and symptoms of chest injury.
The specific signs and symptoms include:
- Purple face, neck, and shoulders
- Bloodshot eyes, which may bulge
- Crushed chest
- Cyanotic and swollen tongue and lips
You should follow the Priority Action Approach to the injured patient and the general principles of management of chest injuries. The patient meets the RTC criteria.
66
What are the signs and symptoms of smoke inhalation
- Sore throat, hoarseness, shortness of breath, swallowing difficulties, and pain on deep inspiration
- Cough, especially when it produces soot-tinged sputum
- Headache or dizziness, restlessness, confusion, decreased LOC, sometimes convulsions
- Respiratory distress with noisy, rapid respiration or a harsh dry cough
- Cyanotic or pale
- Facial burns, especially about the mouth and nose
66
Describe some of the causes of smoke inhalation and what happens to the respiratory system during smoke inhalation:
Respiratory injury from smoke inhalation is a major cause of death in patient with or without body-surface burns. Smoke is a combination of suspended particles and gaseous products of combustion. The particulate matter (soot) does not cause major respiratory problems as it's predominantly caused by gases from burned plastics, sulphur and nitrogen compounds, carbon monoxide, heart, and a lack of oxygen. Smoke from burning plastics contains cyanide, which prevents the body from utilising oxygen.
Smoke inhalation may affect the upper airway, causing inflammation and swelling in the mouth, larynx, and trachea. It may also affect eh more distal portions of the lung, causing generalised inflammation and fluid formation (pulmonary edema) in the lower airways and alveoli.
Respiratory distress may be immediate or delayed. Upper airway obstruction from tissue fluids may not occur for several hours. Furthermore, pulmonary edema, which may be rapidly fatal, may not be evident for many hours (usually 8-36 hours after inhalation).
Some smoke inhalation patients may not have any respiratory injury but may have cyanide or carbon monoxide poisoning. Their symptoms may be entirely non-respiratory, such as neurological or cardiac.
67
What information concerning smoke inhalation should be obtained and passed onto medical aid?
1. Location of the worker when exposed to the smoke - a patient found in an enclosed space is liekly to suffer significant inhalation injury
2. Duration of exposure
3. Presence of toxic substances - alerting the OFA attendant to possible respiratory irritation
4. Decreased LOC - may be due to hypoxia, carbon monoxide, or other toxic gases
5. Any other information might be a factor, including head injury or alcohol use
68
Describe the management of smoke inhalation
During the scene assessment, you should note whether the area is safe to enter. You shouldn't enter any area with a toxic substance or inadequate oxygen content without the proper rescue breathing apparatus.
The patient should be removed from the contaminated atmosphere to fresh air before the primary survey is conducted. If available, and there are no sources of ignition present, then provide supplementary oxygen at 10 Lpm in cases of smoke inhalation. Remember, pulse oximetry readings can be misleading with toxic smoke inhalation due to false elevation by CO-bound hemoglobin.
You should follow the Priority Action Approach to the injured patient and the general principles of management of chest injuries. The patient meets the RTC criteria.
69
What is asthma?
The chief symptom of asthma is dyspnea. It's a disease characterised by attacks of narrowing of the airways that occur intermittently and may range from mild attacks of shortness of breath to profound respiratory failure and death. The asthma attacks are interspersed with symptom-free periods. It is the narrowing of the airways (bronchospasm) that produces the typical wheezing, whistling noises of breathing during an asthmatic attack.
70
Describe what happens in Asthma
In asthmatics, bronchospasm is caused by the contraction of the smooth muscles in the airway walls, leading to airway constriction and impaired ventilation. During an asthma attack, bronchial constriction is accompanied by edema in the airway mucous membranes and the production of thick, sticky secretions, which further narrow the airways and hinder ventilation, especially during expiration. This results in trapped air in the alveoli, increasing lung air volume and making breathing more laborious. As the condition worsens, both inhalation and exhalation become difficult, often causing anxiety and panic. Patients typically get enough oxygen but struggle to exhale carbon dioxide, which accumulates in the blood, leading to mental confusion and impaired respiratory drive. Eventually, this improper air exchange reduces blood oxygen levels.
71
What is the worst sign for an asthmatic?
When they are hypoxic and confused
72
What are the different factors that can cause acute asthmatic attacks?
1. Allergic reactions
2. Respiratory infections eg. from cold viruses
3. Cold air
4. Emotional distress
5. Exercise
6. Other irritants
73
What other possibility may occur if an acute asthma attack is triggered by an allergic reaction?
It may be part of a serious allergic reaction, which could lead to anaphylactic shock. It's important to find out what precipitated the attack and whether the patient has a history of recurrent attacks of a similar kind but can breathe normally in between
74
How can patients treat their asthma?
To reverse the constriction of the bronchi from the attack, many patients have their own prescription medications (bronchodilators), often in the form of inhalers. There may be oral medications used as well, which may be administered with the OFA attendant's assistance. If possible, a history of all medications and the amount used for the curretn attack should be provided to hospital staff.
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What is status asthmaticus, when does it occur, and how does it present?
Status asthmaticus is a severe, prolonged asthmatic attack that does not respond to usual medications and can last for several hours, causing exhaustion, dehydration, and minimal chest movement.
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What transport category are Status Asthmaticus patients in?
RTC
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How do you recognise an acute asthma attack?
Check for history of:
- Precipitating factors eg. cedar, dust, pollens
- Previous attacks
- Medication (inhaler or pills)
- Dyspnea
The physical findings include respiratory distress, non-productive cough, overinflated chest with prolonged expiration, wheezing, anxiety, and elevated respiratory and pulse rates.
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What is the management of the acute asthma attack?
1. Calmly reassure the patient
2. Maintain and support the patient in the most comfortable sitting position
3. If indicated, don't delay providing oxygen unless you can quickly prove that the patient has normal oxygen saturation
4. Help patient to take his/her medication. If the cause of the attack is an allergen, and the patient uses an epinephrine auto-injector, he or she may need assistance in getting it
5. Assist ventilation with a pocket mask and oxygen if the patient is sleepy or unresponsive
6. All asthma patients in respiratory distress are in RTC. An asthma patient who is drowsy, exhausted, or dyspneic with a prolonged attack has a life-threatening medical emergency
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What is Chronic Obstructive Pulmonary Disease (COPD)?
COPD is a long-standing obstructive airway disease characterized by diffuse obstruction to airflow and dyspnea, often caused by smoking or environmental toxins.
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What is emphysema?
Emphysema is a chronic condition causing permanent destructive changes in the alveoli, leading to loss of elasticity, trapped air, and reduced respiratory function.
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What is a "silent chest" in status asthmaticus?
A "silent chest" indicates virtually no air movement through the swollen, narrowed airways and is a sign of imminent respiratory arrest.
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What are the symptoms of status asthmaticus?
Symptoms include exhaustion, dehydration, overinflated chest, minimal chest movement, lack of wheezing, sleepiness due to CO2 accumulation, decreased respiratory drive, and chest muscle fatigue.
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What are the most common forms of COPD?
The most common forms of COPD are emphysema and chronic bronchitis. They're usually caused by exposure to lung toxins, such as smoking or some chemicals/particles in the environment. Most suffers have a combination of both, and may even have superimposed astham.
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How is emphysema recognised?
It's recognised by a history of smoking, weight loss, increased dyspnea, respiratory distress, overinflated barrel chest, and use of accesory muscles for breathing.
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What is chronic bronchitis?
Chronic bronchitis is characterised by recurrent infections of the bronchial tree, often due to heavy smoking, causing inflammation, swelling, and excessive mucus.
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How is chronic bronchitis recognised?
It's recognised by a history of smoking, recurrent respiratory infections, productive cough, respiratory distress, cyanosis, wheezing, and distended neck veins.
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What is the primary cause of COPD?
Cigarette smoking
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How should patients with deteriorating COPD be managed?
Management includes calming and reassuring the patient, ensuring an adequate airway, supporting the patient in a comfortable position, administering oxygen carefully (1-2 LPM in patient with suspected advanced COPD), assisting with medications, and preparing for rapid transport
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What is pneumonia?
Pneumonia is a group of diseases affecting the lung, characterised by exudation of serum and cells into the alveolar spaces and small bronchioles, causing hypoxia and sometimes cyanosis
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How is pneumonia recognised?
It's recognised by cough, fever, chills, green-yellow sputum, pleuritic chest pain, dyspnea, tachycardia, and cyanosis in severe cases
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How should patients with pneumonia be managed?
Management includes maintaining the ABCs, assessing vital signs, providing oxygen if needed, and transporting the patient to medical aid.
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What is pulmonary edema?
Pulmonary edema is the accumulation of fluid within the alveoli, impairing oxygen flow from the alveoli into the blood and causing increased work of breathing.
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What are the common causes of pulmonary edema?
Causes include left ventricular failure, inhalation of noxious gases, smoke inhalation, acute altitude sickness, and drug overdose.
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How should patients with pulmonary edema be managed?
Management includes calming and reassuring the patient, positioning them upright, providing oxygen, suctioning secretions if needed, assisting ventilation, and rapid transport
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What is hyperventilation syndrome?
Hyperventilation syndrome is breathing at a depth or rate greater than needed to control normal CO2 levels in the blood, often caused by anxiety or stress.
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How is hyperventilation recognised?
It's recognised by marked anxiety, dizziness, feelings of depersonalisation, chest pain, numbness or tingling, and shortness of breath
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How should hyperventilation syndrome be managed?
Management includes calming and reassuring the patient, explaining their breathing situation, suggesting they slow their breathing, and transporting them to the hospital.
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What is the antidote to opioid overdose?
The antidote to opioid overdose is naloxone (Narcan), which can resotre normal breathing and consciousness during an opioid overdose
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How is narcotic ingestion recognsied?
It's recognised by drug paraphernalia, decreased respiratory effort or apnea, small pupils, sweating, variable heart rates, and possible track marks from injections.
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How should patients with suspected narcotic overdose be managed?
Management includes following the Priority Action Approach, using naloxone, and preparing to assist ventilation if necessary.
