Emergencies may require you to assess and treat patients with malfunction of, or damage to, the respiratory system. Respiratory system conditions can also affect your treatment plan during other types of emergencies.
Here is a brief description of the most common respiratory emergencies and conditions you may encounter. Make sure you know how to identify and treat all of them. Refer to other sources, such as your textbook, for complete information.
Carbon dioxide retention can occur due to various types of lung diseases, most commonly COPD. COPD can alter the patient’s drive to breathe. Normally when carbon dioxide levels increase, it triggers a person to breathe deeper and faster. In people who have chronically high levels of carbon dioxide, the body gets used to the high levels and instead begins to base the drive to breathe on low oxygen levels. This is referred to as hypoxic drive.
Dyspnea is shortness of breath that can occur for a variety of reasons. Respiratory illnesses, such as asthma and COPD, can lead to dyspnea. Additional causes of dyspnea include pulmonary edema, airway obstruction, and anxiety. Symptoms include shallow, rapid breathing and anxiety. Treatment is often aimed at the underlying cause.
Airway infections can occur due to a variety of conditions such as croup, Respiratory Syncytial Virus (RSV), and pneumonia. An infection can affect the lower or upper airways. Symptoms may include wheezing, shortness of breath, and cough. Treatment will depend on the cause, but may include bronchodilators, steroids, and oxygen.
Pulmonary edema is excess fluid on the lungs. It can occur suddenly due to congestive heart failure. Symptoms include shortness of breath, pink, frothy sputum, and a cough. The patient may also have crackles. Oxygen and the medication Lasix (furosemide) are typical treatments.
COPD, or chronic obstructive pulmonary disease, is caused by damage to the alveoli and is often due to smoking. Symptoms may include wheezing, shortness of breath, and coughing. Treatment can include bronchodilators, steroids, and oxygen.
Asthma is a chronic condition that can cause increased mucus production, inflammation of the airways, and airway constriction. Symptoms may include wheezing, cough, and dyspnea. Hay fever is an allergic reaction to an allergen. Symptoms may include sneezing, cough, and runny nose. Asthma may be treated with bronchodilators and steroids. Hay fever may be treated with antihistamines and decongestants.
Anaphylaxis is a severe allergic reaction to an allergen. The condition can be life-threatening, since it can lead to airway swelling and a drop in blood pressure. Symptoms can include trouble breathing, stridor, and hives. Treatment includes epinephrine and airway management.
A pneumothorax involves air in the pleural space. It can occur spontaneously due to a lung infection or for unknown reasons. Symptoms include chest pain, dyspnea, and decreased breath sounds over the affected area. Treatment includes inserting a chest tube to remove the air.
A pleural effusion involves an accumulation of fluid outside the lungs in the pleural space. It can occur due to an infection, congestive heart failure, and cancer. Symptoms include shortness of breath and decreased breath sounds over the affected area. Treatment involves removal of the fluid in a procedure that must be performed at the hospital. Prehospital management involves keeping the patient comfortable and administering supplemental oxygen, if the patient is hypoxic.
A pulmonary embolism is a blood clot in the lung. The clot usually travels from another part of the body, such as the legs. It can restrict blood flow to the lungs, decrease oxygen levels in the body, and be life-threatening. Symptoms can include dyspnea, tachycardia, and hypoxia. Administration of blood thinners at the hospital is the usual treatment.
Hyperventilation is an abnormally high respiratory rate. Causes may include pain, anxiety, and fever. Treatment involves addressing the underlying cause.
Environmental and industrial contaminants can involve the inhalation of various chemicals, substances, and gases that irritate the airway, such as carbon monoxide. Symptoms can include coughing, dyspnea, and an altered level of consciousness. Treatment includes administration of supplemental oxygen and airway management.
Foreign body aspiration is the inhalation of something, such as food or an object. Symptoms include shortness of breath and stridor. Treatment may involve removing the foreign body at the hospital. Prehospital treatment includes airway management and supportive care.
Patients who have a tracheostomy tube can experience various complications, such as mucus plugs blocking the airway, bleeding, and dislodgment of the tube. Symptoms can include a blocked airway, cyanosis, and hypoxia. Treatment depends on the complication. For example, an airway obstruction due to a mucus plug can be treated by suctioning the tube and changing the inner cannula of the trach.
Cystic fibrosis is a chronic disease that is inherited. It affects the digestive system and the lungs. Symptoms include excessive mucus production, wheezing, and dyspnea. Treatment by the prehospital provider includes medication to loosen mucus, suctioning, and oxygen.
Terms/Concepts to Know: chronic obstructive pulmonary disease, status asthmaticus, bronchodilators, croup, epiglottitis, emphysema, allergen, RSV, bronchiolitis
Respiratory emergencies may require other types of treatment. Be sure you thoroughly understand the procedures and indications for use of these types of respiratory emergency equipment.
Metered-dose inhalers are small spray canisters, which can be used to deliver respiratory medications to the lungs. Bronchodilators, which open the airways, as well as steroids that decrease inflammation, can be administered via a metered-dose inhaler.
A small volume nebulizer can also be used to deliver respiratory medication through a fine mist that the patient inhales. The most common medication delivered in a small volume nebulizer is Albuterol, which is a bronchodilator used to treat conditions such as asthma and COPD.