RESPIRATORY EMERGENCY

Allen Widysanto
 VENTILATION

Movement of air in and out

 Must ventilate 500 ml
of air to get into alveoli
 DIFFUSION

Exchange of O2 and CO2

 PERFUSION

Movement of blood
MECHANISM OF BREATHING
MAJOR SYMPTOMS OF PULMONARY
DISEASE
 DEFINITION

Difficult, laboured, uncomfortable

breathing. Subjective feeling which may
DYSPNEA be associated with mild anxiety or
extreme fear

HYPERVENTILATION Rapid-deep breathing

TACHYPNEA Rapid-shallow breathing

Sensation of not being able to get

BREATHLESSNESS enough air
Look for pursed lip breathing or prolonged
expiration
Tripod position suggests distress, resting weight on
knees helps with chest expansion
Cyanosis blue discoloration
suggests hypoxia
 ETIOLOGY

LUNG HEART MUSCULOSCELETAL

DYSPNEA

METABOLIC KIDNEY BRAIN

 PULMONARY DYSPNEA

OBSTRUCTION

RESTRICTION
VENTILATION
IMPAIRMENT
IMPAIRMENT OF
OXYGEN TRANSFER
DIFFUSION
SHUNTING
PERFUSION ANEMIA
INADEQUATE
CARDIAC OUTPUT
 SIGNS AND SYMPTOMS

Depend on the causa

UPPER AIRWAY OBSTRUCTIONS ARE CHARACTERIZED BY
STRIKING INSPIRATORY STRIDOR, INSPIRATORY WHEEZING

LARYNGEAL OR
TRACHEAL
OBSTRUCTION
HOW TO DIAGNOSE?
SHORT HISTORY TAKING
PHYSICAL EXAMINATION

CONSCIOUSNESS
EFFORT OF BREATHING : torakoabdominal or abdominotorakal
VITAL SIGN :
BLOOD PRESSURE, RESPIRATORY RATE, HEART RATE
GENERAL EXAMINATION
Cyanosis,,cuping hidung, pursed lip breathing,
retraction, cold
SPECIFIC EXAMINATION
decrease vesicular, stridor, wheezing
YES OR NO
NO :
1. trigger point.
Trigger points in the muscles of the throat, neck, chest, and
back may also interfere with the control of respiration by the
nervous system.
2. Bad breathing habit
Shallow breathing

IS SHORTNESS OF BREATH REALLY HAVE

TO BE WORRIED?
YES
HAS ANOTHER SYMPTOMS RATHER THAN SOB ALONE
 Initial Assessment

Airway open,no noises

Breathing 12-20 times per minute
Circulation warm, pink, dry, strong pulses
Disability mental status clear
Vital Signs
 ONSET of BREATHLESSNESS

SUDDEN
ONSET

Pulmonary embolus A few hour

Pneumotoraks
Inhalation of a foreign body
Asthma
Over days or
Pulmonary edema weeks

Accumulation of PE GRADUAL
Partial/complete airway occlusion ONSET OVER
due to growth of lung cancer MONTHS OR YEARS

COPD
Lung fibrosis
Non-respiratory causes
(anemia, hyperthyroidism)
 Additional Symptoms

Chest pain
Fever/chills
Wheezing
Smoking history
Trauma
 Respiratory Emergencies

For each, consider

Cause/Pathology
Signs and symptoms
Management
 MANAGEMENT STRATEGIES

Decreasing the central drive to breathe

Reducing the sense of effort or improve respiratory muscle function

Altering the central perception of dyspnea

 Decreasing central drive to breathe

Oxygen
Opiates
Anxiolytics
 Reduce the sense of effort and improve
respiratory muscle function

Hyperinflation as a primary mechanism of dyspnea :

breathing techniques and changing breathing paterns
for reducing dyspnea.
The patient should be allowed to get the most
convenient position until she/he experiences the least
shortness of breath
NISV
Pursed lip breathing
Help the patient to maintain a slow, rhythmic and deep pattern of breathing
 Alter the central perception of dyspnea

When acute dyspnea persists despite optimal

treatment, care focuses on the symptom rather than
the disease.
Breathing-relaxation training
Counseling and support
Distraction with music
Acupunture /acupressure
Chest wall vibration
Neuro-electrical muscle stimulation
 COMPLICATION

RESPIRATORY
FAILURE

Inability of the respiratory system to maintain a normal state of gas exchange

from the atmosphere to the cells as required by the body = To maintain
normal arterial blood PO2, PCO2 and pH
Slow labored breathing is a sign of respiratory failure
 TREATMENT
Supplemental oxygen
Bronchodilators
Diuretics
Antibiotics
Mechanical ventilation

THE UNDERLYING DISEASE LEADING TO

RESPIRATORY FAILURE MUST BE ADDRESSED
 4 take home messages

Dyspnea = Shortness of breath is one of the major

symptoms of pulmonary disease which is giving
sensation such as uncomfortable breathing .
There are many etiologies of shortness of breath
either from the lung or the other organs.
Management of dyspnea is depend on the
underlying disease, however supplemental
oxygen is a must.
Respiratory failure ( type 1 or type 2 ) is the
complication of unmanaged shortness of breath.