SWAST EMD Training Pack Refresher Section A: Part 5
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| Abnormal Chest Sounds: Inspiratory Stridor | Stridor is a noisy or high-pitched snoring sound with breathing. It is a sign that the upper airway is partially blocked. It may involve the nose, mouth, sinuses, voice box (larynx), or windpipe (trachea).
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| Abnormal Chest Sounds: Expiratory Wheeze | High-pitched whistle-like sound heard during exhalation as air moves through a narrow or obstructed airway. A wheeze may also be lower-pitched, having a snoring or moaning quality in which they are referred to as rhonchi.
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| Abnormal Chest Sounds: Gurgling | A sound like bubbling or splashing water. E.g. when you gargle mouthwash.
Gurgling is due to liquid or semi-solid material in the airway.
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| Abnormal Chest Sounds: Snoring | Hoarse / harsh sound that occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe. Occurs due to partial occlusion by the tongue.
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| C.O.P.D C.O.A.D | Chronic Obstructive Pulmonary Disease
Chronic Obstructive Airway Disease
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| Effect of COPD | Airways have generally become narrowed due to chronic deterioration of the lung tissue making it difficult to get in and out of the lungs.
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| The term "chronic" | Indicates a long term problem that is generally incurable and progressive in nature.
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| Patients with mild COPD | Tend to only have breathing problems in winter due to chest infections which make every day activities more difficult
Others may require long term low flow oxygen (nasal cannula and small portable oxygen container).
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| Common types of COPD | Asthma
Chronic Bronchitis
Chronic Emphysema
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| Chronic Asthma; Asthma attack | An attack occurs when the smaller airways (bronchioles) of the lower airways, narrow (bronchoconstriction):
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| Why bronchoconstriction occurs (asthma attack) | Spasms of small muscles in the airway structure,
Oedema (swelling) of the lower airway structure,
Obstruction due to mucous build up.
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| Patients with asthma and the ambulance service | Patients are likely to have a history and previous diagnosis of asthma. Patients with asthma are likely to have exhausted options available to them as a means to manage their condition before seeking assistance.
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| Asthma: relevant medical history questions | Ask the patient:
How are they normally affected when they have an asthma attack,
How severe are the asthma attacks,
How are the asthma attacks usually managed and have these actions been completed already?
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| Internal Factors which can trigger an asthma attack | Stress, anxiety, exercise, cold (etc.)
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| External Factors which can trigger an asthma attack | Smoke, spores, dander, pollen, food, medications, dust (etc.)
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| ABC Signs and Symptoms of Asthma: Airway | - Narrowing of the lower airway
- Cough
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| ABC Signs and Symptoms of Asthma: Breathing | - Hyperventilation
- Wheeze
- Inspiratory & Expiratory
- Silent Chest ( insufficient air movement to cause a wheeze - life threatening)
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| ABC Signs and Symptoms of Asthma: Circulation | - Pale, cold, clammy skin
- Cyanosis (blue) lips, nailbed
- decreasing level of consciousness
- Rapid pulse rate
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| ABC Signs and Symptoms of Asthma: Other | - Difficulty speaking between breaths
- Use of accessory muscles
- Tripod position (see image on right)
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| Special considerations: Asthma patients | The patient may declare a previous diagnosis listed below. These are high risk patients and you should have a low threshold for calling 999.
Brittle Asthma
Status Asthmatics
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| Brittle Asthma | Unstable or unpredictable, it can suddenly develop into a life-threatening attack & tends to be resistant to the usual treatments.
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| Status Asthmatics | does not respond to standard treatments of bronchodilators and steroids.
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| Management of asthma (conscious patient) | Consider the severity of the patients condition and whether the patient is coping with their condition. If the patients condition is worsening despite the use of medication this is an indication for seeking intervention and making a 999 call.
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| DRcABC with Asthma | Danger (safe?)
Response (patient alert?)
-catastrophic bleeding (stop bleeding)
Airway (open / clear?)
Breathing
-Severity of attack, Signs of 'ineffective breathing'? Severity of difficulty
Circulation
-Skin colour, Temprature, Pulse rate
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| Severity of breathing difficulty: Mild | Expiratory wheeze, Able to speak in sentences
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| Severity of breathing difficulty: Moderate | Inspiratory & Expiratory Wheeze, Able to speak in short sentences or phrases
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| Severity of breathing difficulty: Severe | Inspiratory & Expiratory Wheeze or silent chest, Able to get one or two words out
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| 'Cannot breathe' - From an asthmatic | Likely to indicate that the patient is in a serious condition. Asthmatics will know whether the medication is working and if their condition is improving.
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| Medications for asthma | "reliever" medication (Ventolin in a blue/grey inhaler), 1-2 puffs every 2 mins and up to 10 puffs.
Spacer devices used to improve the administration of the medication.
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| Home nebuliser: | Self-administer medication through a home nebuliser which caused liquid medication to create a mist by pushing air or oxygen through the medication.
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| Coaching breathing: | Some patients may respond to you coaching their breathing.
This may alleviate some of the underlying anxiety the patient experiences which may improve the patients condition.
It will not resolve the physiological changes which occur in an asthma attack.
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| Chronic Bronchitis (Blue Bloaters) | Inflammatory condition affecting lower airways
Diagnosed after bronchitis x3 over 2yr
Caused: smoking/ air pollution
Coughed up sputum blocks airways (excessive mucous production)
Lung damge can lead to chronic HF, pulmonary oedema & cyanosis
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| Emphysema (Pink Puffers) | Destruction of alveoli / alveolar membranes
Common in smokers
Lung tissue loses elasticity causing alveolar collapse (decreased surface area for gas exchange, which alters concentration of O2 in blood)
Hypoxia (lack O2) main respiratory stimulus
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| Response: What could cause the patient to have a lowered response level? | Lack of oxygen to the brain during an attack can lead to unconsciousness, confusion and drowsyness
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| Airway: What physiological changes occur in the lower air passages with COPD | Walls fibres of the alveoli become damaged. This makes them less elastic & unable to recoil when you exhale, making it hard to exhale CO2 out of the lungs.
If the lung airways become inflamed, this results in bronchitis with subsequent mucus production.
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| Breathing: Consider the signs and symptoms of breathing difficulty which may be evident in COPD? What position is likely to be adopted? | Tripod position
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| Circulation: Consider the signs and symptoms of circulatory compromise which could indicate the patient is in respiratory distress in COPD? What sights could indicate ineffective breathing? | Breathing rate. An increase in the number of breaths per minute may mean that a person is having trouble breathing or not getting enough oxygen.
Colour changes.
Grunting.
Nose flaring.
Retractions.
Sweating.
Wheezing.
Body position.
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| What is a Laryngectomy Stoma? | A permanent hole in windpipe made by surgeon. Lower part of the neck to breathe through it. Stoma stays open on its own. Sometimes a temporary tube used to keep open, few days after surgery (rare)
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| What is a Tracheostomy | An emergency procedure that occurs as a result from an airway obstruction, or acute condition that causes the throat to become swollen and narrowed.
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| Reasons that cause the neck to swell or narrow | Swelling after head/neck surgery, a cancerous tumour - mouth cancer, laryngeal cancer or thyroid glad cancer. Birth defects that cause the airways to narrow.
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| Chronic obstructive Airway disease that causes excessive mucous production | Bronchitis
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| Small air sacs where gaseous exchange occurs | Alveoli
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| Gas removed from the lungs in Respirtion | Carbon Dioxide
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| Large muscle involved in respiration | Diaphragm
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| Space in-between the membranes covering the lungs | pleural cavity
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| Structures which form when the trachea initially divides | Bronchi
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| Spongey organs vital in respiration | Lungs
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| Part of the upper respiratory System | Nose, Mouth
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| Part of the upper and lower respiratory system | trachea
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| Blue tinge visible on the skin due to a lack of oxygen in the blood | Cyanosis
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| Respiratory condition effecting 5% of the population | Asthma
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| Gas removed from air during respiration | Oxygen
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| Fast, rapid, breathing | Tachypnoea
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| Difficulty breathing | Dyspnoea
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| COPD involving destruction of the alveoli | Emphysema
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