Chapter 19: Respiratory Emergencies
Topics
● Respirations
● Breathing Difficulty
● Respiratory Conditions
● The Prescribed Inhaler
● The Small-Volume Nebulizer
Respiration
Respiratory Anatomy and Physiology
● To move air, the respiratory system changes pressure within the chest cavity.
○ Negative pressure is used to move air in and positive pressure is used to move
air out
○ These changes in pressure are generated by contraction and relaxation of the
respiratory system muscles
● Inspiration
○ Active process
■ Uses muscle contraction to increase size of chest cavity
○ Intercostal muscles and diaphragm contract
○ Diaphragm lowers; ribs move upward and outward
○ Air is pulled into lungs
● Expiration
○ Passive process
○ Rib muscles and diaphragm relax
○ Size of chest cavity decreases
○ Air flows out of the lungs
Adequate Breathing
● Breathing sufficient to support life
● Signs
○ Generally normal mental status and moving air when breathing
○ Ability to speak relatively normally without having to catch their breath
○ Normal color and oxygen saturation typically in normal range
● May be determined by observing rate, rhythm, quality
○ 12 to 20 breaths/minute for adult
○ 18 to 30 breaths/minute for school-age child
○ 30 to 60 breaths/minute for infant
○ Rhythm usually regular
○ Breath sounds normally present and equal
Inadequate Breathing
● Breathing not sufficient to support life
● Signs
○ Rate out of normal range
, ■ Too fast
■ Slowing and irregular
○ Inability to speak
○ Silent chest
● Signs
○ Low oxygen saturation despite supplemental oxygen
○ Agonal respirations
○ Irregular rhythm
○ Diminished or absent lung sounds
○ Poor tidal volume
Pediatric Note
● Structure of an infant’s and child’s airway differs from that of an adult.
○ Smaller airway easily obstructed
○ Proportionately larger tongues
○ Smaller, softer, more flexible trachea
○ Less developed, less rigid cricoid cartilage
○ Heavy dependence on diaphragm for respiration
● Signs of inadequate breathing in infants and children
○ Nasal flaring
○ Grunting
○ Seesaw breathing
○ Retractions
Patient Care
● Inadequate breathing
○ Assisted ventilation with supplemental oxygen
■ Pocket face mask with supplemental oxygen
■ Two-rescuer bag-valve mask with supplemental oxygen
■ One-rescuer bag-valve mask with supplemental oxygen
Adequate and Inadequate Artificial Ventilation
● Chest rise and fall should be visible with each breath
● Adequate artificial ventilation rates
○ 10 to 12 breaths per minute for adults
○ 12 to 20 breaths per minute for infants and children
● Increasing pulse rates can indicate inadequate artificial ventilation in adults.
● Decreasing pulse rates can indicate inadequate artificial ventilation in pediatric patients.
Breathing Difficulty
● Patient’s subjective perception
● Feeling of labored or difficult breathing
● Amount of distress felt may or may not reflect actual severity of condition
● Onset
Topics
● Respirations
● Breathing Difficulty
● Respiratory Conditions
● The Prescribed Inhaler
● The Small-Volume Nebulizer
Respiration
Respiratory Anatomy and Physiology
● To move air, the respiratory system changes pressure within the chest cavity.
○ Negative pressure is used to move air in and positive pressure is used to move
air out
○ These changes in pressure are generated by contraction and relaxation of the
respiratory system muscles
● Inspiration
○ Active process
■ Uses muscle contraction to increase size of chest cavity
○ Intercostal muscles and diaphragm contract
○ Diaphragm lowers; ribs move upward and outward
○ Air is pulled into lungs
● Expiration
○ Passive process
○ Rib muscles and diaphragm relax
○ Size of chest cavity decreases
○ Air flows out of the lungs
Adequate Breathing
● Breathing sufficient to support life
● Signs
○ Generally normal mental status and moving air when breathing
○ Ability to speak relatively normally without having to catch their breath
○ Normal color and oxygen saturation typically in normal range
● May be determined by observing rate, rhythm, quality
○ 12 to 20 breaths/minute for adult
○ 18 to 30 breaths/minute for school-age child
○ 30 to 60 breaths/minute for infant
○ Rhythm usually regular
○ Breath sounds normally present and equal
Inadequate Breathing
● Breathing not sufficient to support life
● Signs
○ Rate out of normal range
, ■ Too fast
■ Slowing and irregular
○ Inability to speak
○ Silent chest
● Signs
○ Low oxygen saturation despite supplemental oxygen
○ Agonal respirations
○ Irregular rhythm
○ Diminished or absent lung sounds
○ Poor tidal volume
Pediatric Note
● Structure of an infant’s and child’s airway differs from that of an adult.
○ Smaller airway easily obstructed
○ Proportionately larger tongues
○ Smaller, softer, more flexible trachea
○ Less developed, less rigid cricoid cartilage
○ Heavy dependence on diaphragm for respiration
● Signs of inadequate breathing in infants and children
○ Nasal flaring
○ Grunting
○ Seesaw breathing
○ Retractions
Patient Care
● Inadequate breathing
○ Assisted ventilation with supplemental oxygen
■ Pocket face mask with supplemental oxygen
■ Two-rescuer bag-valve mask with supplemental oxygen
■ One-rescuer bag-valve mask with supplemental oxygen
Adequate and Inadequate Artificial Ventilation
● Chest rise and fall should be visible with each breath
● Adequate artificial ventilation rates
○ 10 to 12 breaths per minute for adults
○ 12 to 20 breaths per minute for infants and children
● Increasing pulse rates can indicate inadequate artificial ventilation in adults.
● Decreasing pulse rates can indicate inadequate artificial ventilation in pediatric patients.
Breathing Difficulty
● Patient’s subjective perception
● Feeling of labored or difficult breathing
● Amount of distress felt may or may not reflect actual severity of condition
● Onset
