The Respiratory System

Emergency Medical Technician - Basic

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 Respiratory System Purpose
Takes in oxygen
Disposes of wastes O2 + Glucose

Carbon dioxide
Excess water

The Cell

CO2 + H2O

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Respiratory System Anatomy

Nasopharynx
Oropharynx
Epiglottis
Larynx
Trachea
Carina
Bronchi
Bronchioles

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 Respiratory System Anatomy

Lung
Right lung 3 lobes
Left lung 2 lobes

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 Respiratory System Anatomy

Bronchioles
Smallest airways
Walls consist entirely of
smooth muscle (no
cartilage present)
Constriction increases
resistance to airflow
Dilation reduces
resistance to airflow

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 Respiratory System Anatomy

Alveoli
Air sacs
Site of oxygen
and carbon
dioxide exchange
with blood

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Respiratory System Anatomy

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 Respiratory System Anatomy
Diaphragm

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 Respiratory System Anatomy
Pleura
Double-walled
membrane
Visceral layer covers
lung
Parietal layer lines
inside of chest wall,
diaphragm

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 Respiratory System Physiology

Inspiration
Active process
Chest cavity expands
Intrathoracic pressure falls
Air flows in until pressure
equalizes
Expiration
Passive process
Chest cavity size decreases
Intrathoracic pressure rises
Air flows out until pressure
equalizes
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 Respiratory System Physiology

Automatic Function
Primary drive: increase in arterial CO2
Secondary (hypoxic) drive: decrease in
arterial O2

Normally we breathe to remove CO2 from the

body, NOT to get oxygen in

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 Respiratory Pathophysiology
Airway (Obstruction)
Tongue Aspiration
Foreign body airway Asthma
obstruction Chronic Obstructive
Anaphylaxis/angioedema Airway Disease
Upper airway burn Emphysema
Maxillofacial/laryngeal/ Chronic bronchitis
tracheobronchial trauma
Epiglottitis
Croup

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 Respiratory Pathophysiology
Gas Exchange Surface (Blood Flow or Gas Diffusion)
Pulmonary Edema
Left-sided heart failure
Toxic inhalations
Near drowning
Pneumonia
Pulmonary Embolism
Blood clots
Amniotic fluid
Fat embolism

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 Respiratory Pathophysiology
Thoracic Bellows (Ventilation)
Chest Trauma Pleural effusion
Simple rib fractures Spinal cord trauma
Flail chest (High C-spine lesion)
Pneumothorax Morbid obesity
Hemothorax Neurological/neuro-
Sucking chest wound muscular disease
Poliomyelitis
Diaphragmatic hernia
Myasthenia gravis
Muscular dystrophy
Guillian-Barre
syndrome

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 Respiratory Pathophysiology

Control System (Decreased Respiratory

Drive)
Head trauma
CVA
Depressant drug toxicity
Narcotics
Sedative-hypnotics
Ethyl alcohol

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 Respiratory Assessment
Initial Assessment (A, B, C, D)
Manage life threats
Complete focused history and physical

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 Initial Assessment

Airway
Listen to patient breathe, talk
Noisy breathing is obstructed breathing
But all obstructed breathing is not noisy
Snoring = Tongue blocking airway
Stridor = Tight upper airway from partial obstruction

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 Initial Assessment
Airway
Anticipate airway problems with
Decreased LOC
Head trauma
Maxillofacial trauma
Neck trauma
Chest trauma

OPENCLEARMAINTAIN
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 Initial Assessment
Breathing
Is patient moving air?
Is air moving adequately?
Is the patients blood being oxygenated?

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 Initial Assessment
Breathing
LOOK FEEL
Symmetry of chest Air movement at
expansion mouth, nose
Increased respiratory Symmetry of chest
effort expansion
Changes in skin color RATE
LISTEN Tachypnea
Air movement at mouth, Bradypnea
nose
Air Movement in
POSITIONING
peripheral lung fields Orthopnea
Tripod position

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 Initial Assessment
Breathing
Signs of respiratory distress
Nasal flaring
Tracheal tugging
Retractions
Neck, pectoral muscle use on inhalation
Abdominal muscle use on exhalation
Skin Color
Pale, cool moist skin (Early sign of hypoxia)
Cyanosis (Late, unreliable sign of hypoxia)

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 Initial Assessment
Breathing
If trauma patient has compromised breathing,
bare chest, assess for:
Open pneumothorax
Flail chest
Tension pneumothorax

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 Respiratory Assessment
Circulation
Is heart beating?
Is there major external hemorrhage?
Is patient perfusing?
Effects of hypoxia:
Adults (early): tachycardia
Adults (late): bradycardia
Children: bradycardia

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 Initial Assessment

Circulation
Dont let respiratory failure distract you from
assessing for circulatory failure
Low oxygen or high carbon dioxide levels can
depress cardiovascular function

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 Respiratory Assessment
Disability
Restlessness, anxiety, combativeness = hypoxia
Until proven otherwise
Drowsiness, lethargy = hypercarbia
Until proven otherwise

Just because the patient stops fighting, hes

not necessarily getting better!!!
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 Initial Management
Patient Responsive/Breathing Adequate
Oxygen may be indicated
Oxygenate immediately if patient has:
Decreased level of consciousness
Possible shock
Possible severe hemorrhage
Chest pain
Chest trauma
Respiratory distress or dyspnea
History of any kind of hypoxia

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 Initial Management
Patient responsive, breathing inadequate
Open/maintain airway
Place nasopharyngeal airway
Assist ventilations
Mouth to Mask
2-person Bag-valve Mask
Manually Triggered Ventilator
1-person Bag-valve Mask

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 Initial Management
Patient unresponsive, breathing adequate
Open/maintain airway
Place nasopharyngeal or oropharyngeal airway
Suction airway as needed
Provide oxygen by non-rebreather mask
Frequently reassess

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 Initial Management
Patient unresponsive, breathing inadequate
Open/maintain airway
Place nasopharyngeal or oropharyngeal airway
Suction airway as needed
Assist ventilations
Mouth to Mask
2-person Bag-valve Mask
Manually Triggered Ventilator
1-person Bag-valve Mask
Frequently reassess
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 Initial Management
Patient not breathing
Open airway
Place nasopharyngeal or oropharyngeal airway
Ventilate patient
Mouth-to-Mask
2-Person Bag-Valve Mask
Manually Triggered Ventilator
1-Person Bag-Valve Mask
Frequently reassess

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 Initial Management

Golden Rules
If you think about giving O2, give it!!!
If you decide to give oxygen, give a lot of it!!!
If you cant tell whether a patient is breathing
adequately, he isnt !
If youre thinking about assisting a patients
breathing, you probably should be!

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 Focused History and Physical

Chief Complaint
Dyspnea
Subjective sensation that breathing is excessive,
difficult, or uncomfortable
Respiratory Distress
Objective observations that indicate breathing is
difficult or inadequate

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 Focused History and Physical
History of Present Illness (OPQRST)
Gradual or sudden onset?
What aggravates or alleviates?
How long has dyspnea been present?
Coughing? Productive cough?
What does sputum look/smell like?
Pain present? What does pain feel like? How bad? Does it
radiate? Where?

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 Focused History and Physical
Past History
If Then???
Hypertension, MI, Diabetes CHF with Pulmonary Edema

Chronic Cough , Smoking, COPD

Recurrent Flu

Allergies, Acute Episodes of SOB Asthma

Lower Extremity Trauma, Pulmonary Embolism

Recent Surgery, Immobilization

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 Focused History and Physical

Medications
If Then???
Breathing Pills, Inhalers Asthma or COPD
Albuterol Montelukast
Aminophylline Oxtriphylline
Ipratropium Cromolyn
Terbutaline Prednisone
Salbumatol
Zafirlukast

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 Focused History and Physical
Medications
If Then???
Lasix, hydrodiuril, digitalis CHF

Coumadin, BCPs Pulmonary embolism

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 Focused History and Physical Exam
Crackles (Rales) Stridor
Fine, crackling High pitched, crowing
Fluid in smaller airways, Upper airway restriction
alveoli Wheezing
Rhonchi Whistling
Coarse, rumbling Usually more pronounced on
exhalation
Fluid, mucus in larger
Generalized: narrowing,
airways spasm of the smaller airways
Localized: foreign body
aspiration

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 Mild Breathing Difficulty
May be hypoxic
Can move adequate tidal volume
Can answer questions, speak in complete
sentences, is alert
High concentration O2 by non-rebreather
mask
Consider bronchodilators if patient wheezing

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 Moderate Breathing Difficulty
May be hypoxic
May be moving adequate tidal volume
Having difficulty answering questions, speaks in
choppy sentences, is restless/irritable
High concentration O2 by non-rebreather mask
Get ready to assist ventilations if needed (patient
may resist assistance at this time)
Consider bronchodilators if patient wheezing

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 Severe Breathing Difficulty
Getting sleepy
Not speaking or speaking with very few
words
Previously wild, now seems cooperative
Assist ventilations with BVM and oxygen
Time BVM ventilation with patients
ventilatory efforts
Interpose extra ventilations if necessary

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