Respiratory emergencies: Difference between revisions
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===Neurologic impairments to respiration=== | ===Neurologic impairments to respiration=== | ||
===Tension pneumothorax=== | ===Tension pneumothorax=== | ||
===Acute Respiratory Distress Syndrome=== | |||
===Severe aspiration into the respiratory tract==== | ===Severe aspiration into the respiratory tract==== | ||
===Severe pulmonary edema=== | ===Severe pulmonary edema=== | ||
Revision as of 18:17, 24 October 2008
Template:TOC-right In emergency medicine, ensuring the airway is not obstructed is usually the first priority in assessment and immediate measures. [1] The mnemonic "ABCD" gives the immediate priorities:
- Airway: There must be a clear path from the nose or mouth to the lungs. Even if the patient is incapable of active breathing, air can be supplied externally, but if there is no way to oxygenate the blood, the brain will be irreparably damaged in 4-5 minutes at normal body temperature
- Breathing: If the patient is making no respiratory effort, oxygen can be supplied externally, initially by mouth-to-mouth artificial respiration, manual bag-valve-mask device, or a mechanical ventilator. When the patient is breathing ineffficiently, supplemental oxygen may be adequate, or it may be necessary to paralyze the respiratory muscles and take over mechanical ventilation.
- C:irculation. Blood needs to move, through regular or artificial heartbeat, or interventions to restore circulation.
Whenever there is even mild respiratory distress, emergency personnel must plan for contingencies; some conditions, such as anaphylactic shock can progress from itching and wheezing, to complete airway obstruction, in minutes.
If there is active respiratory distress or a strong index of suspicion that it is imminent, other supportive steps should be taken. A breathing patient should be put on oxygen. Establish at least two large-bore intravenous lines, draw several tubes of venous blood according to the local protocol, and attach the patient to a cardiac monitor-defibrillator. Attach a pulse oximeter, and, when available, a pulse capnomenter. Take vital signs. Position the patient to assist respiration.
Immediate airway management
Intubation
Preparation
- Rapid sequence intubation
Nonsurgical airways
Invasive airways
Managing intubated patients in the ER
Other immediate threats to life
Upper airway obstruction
Neurologic impairments to respiration
Tension pneumothorax
Acute Respiratory Distress Syndrome
Severe aspiration into the respiratory tract=
Severe pulmonary edema
Severe asthma
Laryngospasm
Severe chronic obstructive pulmonary disease
Pulmonary fibrosis
Urgent threats to life
Chest wall defects
Lung collapse or mechanical problem
Insufficient lung parenchymal function
Airway disease
Pulmonary vascular disease
Neurogenic respiratory distress
Metabolically induced respiratory distress
Pleurisy
References
- ↑ The only intervention, assuming the patient is in a physically safe space, which will take priority is defibrillation for a witnessed cardiac arrest. Of course, if the patient is in a burning car or similar situation, extrication is an even higher priority.