What happens with oxygen and carbon dioxide during the process of pulmonary respiration EMT?

Inadequate breathing is breathing that is insufficient to support life or normal, healthy function of the body.

Inhaltsverzeichnis Show

Artificial Ventilation
Patient Care
Respiratory Diseases

Respiratory conditions are the leading cause of death in infants and children. The structure of the respiratory system in infants and children are different from adults primarily as follows:

Airway: Infant and children airways are smaller than adults and more easily obstructed.
Tongue: Infant's and children's tongues are proportionately larger and take up a greater percent of the space in the mouth than adults.
Trachea: The trachea is smaller, softer, and more flexible in infants and children than in adults. The cricoid cartilage is less developed and less rigid also.
Diaphragm: Since the chest wall is softer in infants and children than in adults, they depend more heavily on the diaphragm to breathe. This is the reason that they exhibit more "seesaw" breathing.

Artificial Ventilation

The adequate rate for artificial ventilation in adults is 12 breaths/minute and 20 breaths/minute for infants and children.

When adults experience a decrease in oxygen in the bloodstream (hypoxia), their pulse increases. With infants and children, they may initially experience a slight increase in pulse but, the pulse will usually drop significantly. Bradycardia, or slow pulse, in infants and children usually means a respiratory emergency! Adequate airway management is the most important aspect of patient care in infants and children.

Whenever the chest does not rise and fall with each artificial ventilation, the force of ventilation must be increased. If this still does not produce chest movement, head-tilt/chin-lift or jaw thrust must be checked andperformed. If necessary, use an oropharyngeal or nasopharyngeal airway as needed to prevent the tongue from obstructing the airway.

Do not put anything in the mouth and transport as quickly as possible if any of the following signs of lower respiratory problems are noted:

wheezing
increased breathing effort on exhalation
rapid breathing without stridor ( a harsh, high-pitched sound)

Signs of difficulty breathing include:

increased pulse rate
decreased pulse rate
pale, cyanotic, or flushed skin
noisy breathing (wheezing, gurgling, snoring, crowing, stridor)
inability to speak full sentences due to breathing difficulty
use of accessory muscles to breathe
retractions
altered mental status
coughing
flared nostrils, pursed lips
patient positioning (tripod- patient leans forward with hand on knee or other object; sits with feet dangling and leans forward)
unusual anatomy (barrel chest)

The focused history and physical exam includes appropriate interview and examination of the chest and respiratory structures. The EMT should use OPQRST to guide the questions.

Patient Care

When a patient is suffering from breathing difficulty, the following care should be provided:

assessment of airway and assist respiration with artificial ventilation.
oxygen is the main treatment for respiratory difficulty. Use a nonrebreather mask at 12-15 liters per minute if patient is breathing adequately. Supplemental oxygen should be provided along with artificial ventilations if the patient has inadequate breathing. Use a nasal cannula only if the patient cannot tolerate the mask.
position the patient in the most comfortable position which is usually sitting up. With inadequate breathing, the patient must be supine to receive artificial ventilations.
prescribed inhalers may be used if the patient has one with them. The patient may be assisted in using this after consultation with medical direction.

Respiratory Diseases

Chronic obstructive pulmonary disease (COPD) include diseases such as emphysema, bronchitis, and black lung disease. They are usually caused by cigarette smoking but, may be caused by chemical pollutants, air pollution, chemicals, or frequent infections. A common feature is the breakdown of the alveoli which greatly reduces the surface area for respiratory exchange.

Sometimes, COPD patients develop a hypoxic drive to trigger respirations. Some COPD patients develop a tolerance to increased levels of carbon dioxide which causes the brain to rely on oxygen levels as the trigger to breathe instead. The higher levels of oxygen administration, in rare cases, may lead to a decrease in respiratory effort or even respiratory arrest.

Asthma is an episodic disease and is not classified as a COPD. It is not continual as is emphysema or bronchitis and does not produce a hypoxic drive. Asthma attacks may be triggered by allergic reactions to something injected, inhaled, or swallowed by the patient. Attacks may be precipitated by insect stings, air pollutants, infection, strenuous exercise, or emotional stress.

Prescribed inhalers are often prescribed for patients with respiratory problems that lead to bronchoconstriction. The medicine in these inhalers are called bronchodilators which dilate the bronchi and air passageways to make breathing easier.

The Respiratory System
The respiratory system is comprised of several structures that enable ventilation and oxygenation. Inhalation moves oxygen into the bloodstream. Blood cells pick up carbon dioxide, which is then excreted through exhalation. We’ll discuss the actual respiration process while reviewing the structures themselves.

The Upper Airway
The upper airway starts at the nose and mouth, and extends to the cricoid cartilage, the ring-shaped structure that forms the lower portion of the “voice box,” or larynx. Air entering the nostrils is warmed, moistened and filtered before it continues through the nasopharynx, the area directly posterior to the nose. Air also enters the mouth and through the oropharynx, the area directly posterior to the mouth. Together, the nasopharynx and oropharynx are called the pharynx, or the throat. (See Figure 1.)

A small, leaf-shaped flap of tissue at the top of the trachea – the epiglottis – opens to allow breathing and closes during swallowing to prevent food and fluids from entering the trachea.

At the lower portion of the pharynx, just below the thyroid cartilage (also known as the “Adam’s apple”) and the cricoid cartilage, are the trachea, which is the passageway for air to the lungs, and the esophagus, through which food and water travel to the stomach. A small, leaf-shaped flap of tissue at the top of the trachea, called the epiglottis, opens to allow breathing and closes during swallowing to prevent food and fluids from entering the trachea. It also helps keep air from entering the stomach through the esophagus. If the epiglottis fails to close, food, fluids, vomit, blood, secretions or a foreign object can enter the larynx and trachea, cause an obstruction and force a person to choke. Anything but air that reaches the lungs can also cause an infection.

The Lower Airway

The lower airway starts at the cricoid cartilage and extends to the alveoli in the lungs. The trachea, or windpipe, extends from the larynx tothe carina, the point at which it divides (bifurcates) into its to major branches, the right and left mainstem bronchi. These cartilaginous bronchi extend into the lungs, like tree branches, splitting into increasingly smaller sections called bronchioles. Lined with smooth muscle and mucus membranes, the bronchioles can contract. When the mucus membrane becomes irritated and swollen – as in asthma – it can lead to narrowing or constriction of the bronchiole and increased airway resistance that makes moving air in and out of the alveoli more difficult. Work of breathing (WOB) as a result of increased airway resistance can lead to fatigue and respiratory failure. At the end of the bronchioles are thousands of tiny air sacs called alveoli, where the gas exchange – oxygen and carbon dioxide – occurs with the bloodstream. Made of elastic tissue, the lungs expand and recoil. The right lung is divided into three lobes; the left lung into two lobes. Surrounding the lungs are two layers of connective tissue called the pleura. The visceral pleura is the moist, innermost membrane that adheres to the lung tissue. The parietal pleura is the moist, thicker, more-elastic membrane that adheres to the chest (thoracic) wall, diaphragm and mediastinum, the central compartment of the thoracic cavity. Between these two layers is the pleural space, which contains serous fluid that acts as a lubricant when the layers rub against each other. The diaphragm is a large muscle that separates the thoracic and abdominal cavities. During inhalation, the rib cage muscles (intercostal muscles) and the diaphragm contract. The diaphragm lowers and the ribs move upward and outward. This expands the size of the chest and creates negative pressure inside the chest cavity, pulling air into the lungs. During exhalation, the diaphragm and intercostal muscles relax. The ribs move downward and inward, and the diaphragm rises. With this, the chest becomes smaller and positive pressure builds inside the chest cavity, pushing air out of the lungs. During inhalation, air moves through the airway into the alveoli, where the gas and carbon dioxide are exchanged with the pulmonary capillariesthat surround each alveolus. This is called ventilation. Oxygenated blood moves from the lungs to the heart, which pumps it into the body’s circulatory system. The blood travels through the arteries to, eventually, capillaries. Oxygen that was carried by the blood from the lungs istransferred through the capillary walls into the cells. Carbon dioxide moves into the capillaries, then to the veins, which return to the heart and lungs, and the process begins anew. The process of moving gases and other nutrients between cells and the blood is called respiration. Breathing (inhaling and exhaling air) is either adequate – sufficient to support life – or inadequate. The EMT’s assessment involves not only counting patient respirations (not guessing a number), but also evaluating the patient’s breathing effort and chest movement. In addition, knowing normal respiratory rates. END

From the Gold Cross Magazine CEU Education Series, Fall 2015 edition, "Lung Diseases: When It Could Be Your Patient's Last Gasp" by Sylvie Mulvaney and Louis A. Sforza.