Prehospital Academy Lesson 15.5
Respiratory Emergencies: Patient Management Theory EMT, and AEMT
This lesson concludes the respiratory series for EMT and AEMT by focusing on the foundational management principles and treatment theories for respiratory patients at the EMT-Basic and AEMT levels. It emphasizes a "basics first" approach, which is the cornerstone of effective care, even for advanced providers. Mastering these fundamental interventions is critical for stabilizing patients and improving outcomes in respiratory emergencies.
Foundational Principles of Respiratory Management
Effective management of respiratory emergencies hinges on a systematic approach to ensure the patient's airway, breathing, and circulation are adequately supported. The primary goal is to correct hypoxia and improve ventilation, preventing the patient from progressing to respiratory failure and arrest.
Key tenets of this approach include:
Patient Assessment: A thorough assessment of the patient's respiratory status, including rate, rhythm, quality of breathing, lung sounds, and oxygen saturation, guides all treatment decisions.
Basics First Approach: All treatment, regardless of provider level, begins with fundamental interventions. Advanced skills are only considered once the basics are effectively managed.
Medical Control: EMS providers practice under the license of their medical director. It is crucial to follow local protocols and contact medical control for orders or when a patient's condition warrants it.
Oxygen Administration: A Primary Intervention
Supplemental oxygen is a primary treatment for patients with respiratory insufficiency or distress.
Indication: Oxygen should never be withheld from a patient who is hypoxic or in respiratory distress. The goal is to improve oxygen saturation and reverse the effects of hypoxia.
Delivery Devices: The choice of delivery device (e.g., nasal cannula, non-rebreather mask) depends on the patient's condition and oxygenation status.
Considerations: While generally safe, oxygen is a medication. Providers should be aware of specific protocols regarding oxygen administration, especially in patients with chronic respiratory conditions like COPD.
Ventilatory Support: Assisting Inadequate Breathing
When a patient is not breathing adequately (hypoventilation) or is in respiratory arrest, ventilatory support is required.
Continuous Positive Airway Pressure (CPAP)
Indications: For alert patients with moderate to severe respiratory distress, such as those with pulmonary edema or severe asthma, who are having difficulty maintaining airway patency or exchanging gas effectively.
Mechanism: CPAP delivers constant positive pressure, helping to keep alveoli open, improve gas exchange, and reduce the work of breathing.
Bag-Valve Mask (BVM)
Indications: For patients with inadequate ventilation (hypoventilation) or those in respiratory arrest.
Procedure: The BVM is used to deliver positive pressure ventilations, forcing air into the lungs to support breathing and oxygenation. A good mask seal and proper technique are essential.
Pharmacological Interventions (EMT-Basic/AEMT)
EMTs and AEMTs may assist with or administer certain medications for respiratory emergencies as per local protocols.
Metered-Dose Inhaler (MDI) and Small-Volume Nebulizer (SVN)
Medications: Typically contain bronchodilators (e.g., albuterol) that relax the smooth muscles of the bronchioles, improving airflow in conditions like asthma and COPD.
Assessment: Before assisting with a patient's prescribed inhaler, inquire about their previous use of the medication, including the number of doses taken and the time of the last dose.
Medical Control: Always follow local protocols and contact medical control to ensure the medication is indicated and to receive any necessary orders.
Critical Thinking Questions
You are treating a patient with severe respiratory distress secondary to congestive heart failure. Explain the rationale for using CPAP in this scenario and describe the key assessment findings that would support its use.
A patient with COPD is exhibiting signs of respiratory distress. What are the potential risks and benefits of administering high-flow oxygen, and what is the current best practice for oxygen administration in this patient population?
You are called to a pediatric patient with a history of asthma who is using their prescribed MDI without relief. What signs would indicate that the patient is progressing from respiratory distress to respiratory failure, and what would be your next management steps?
Explain the "basics first" approach as it applies to a patient in respiratory arrest. Detail the sequence of interventions you would perform before considering any advanced airway maneuvers.
You are assisting a patient with their bronchodilator medication. What specific information must you gather from the patient and relay to medical control before and after administering the medication?