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Incidence : Incidence 3-5% of adults 7-10% of children Most have periodic wheezing attacks separated by symptom-free periods Some have chronic shortness of breath with episodes of increased shortness of breath attacks can last minutes to days, and can become dangerous if the airflow becomes severely restricted Mucous Plugging : Mucous Plugging Normal vs Asthmatic : Normal vs Asthmatic General Treatment for Respiratory Distress : Assess the airway and ventilation Administer oxygen Request ALS (for severe respiratory distress) Monitor breathing Do not permit physical activity Place in fowler’s or semi-fowlers General Treatment for Respiratory Distress Assess for the following : Assess for the following Vital signs Patient’s ability to speak in sentences In this caseSilence is Not Golden : In this caseSilence is Not Golden Assess for the following : Assess for the following Vital signs Patient’s ability to speak in sentences Accessory muscle use Accessory Muscles : Accessory Muscles Assess for the following : Assess for the following Vital signs Patient’s ability to speak in sentences Accessory muscle use Lung sounds Normal Bronchovesicular : Normal Bronchovesicular Normal sounds heard in the periphery of all lung fields. Normal Bronchial : Normal Bronchial Normal sounds heard toward the center of the chest over the larger airways. Wheezes : Wheezes “Musical” sounds heard when there is a constriction of the bronchioles. In general the higher the pitch the tighter the bronchioles. A “quiet” chest is the worst case scenario “All that wheezes is not asthma” : “All that wheezes is not asthma” --Chevalier Jackson, MD (1865-1958). Boston Medical Quarterly, 16:86,1965 Other Causes of Wheezing : Other Causes of Wheezing Aspiration Certain drugs Chronic obstructive pulmonary disease Endobronchial tumors Endotracheal tumors Inhaled irritants Tracheal stenosis Viral tracheobronchitis Vocal cord dysfunction Pulmonary edema (CHF) Suspect CHF : Suspect CHF Elderly Severe hypertension Digoxin, Lasix, K+ Dependent edema Atrial fibrillation Diaphoresis Rales Crackles (rales) : Crackles (rales) Assess for the following : Assess for the following Vital signs Patient’s ability to speak in sentences Accessory muscle use Lung sounds Oxygen saturation Record SpO2 : > 95% is normal 88-95% mild hypoxia 84-88% moderate hypoxia < 84% severe hypoxia Inaccurate readings Poor peripheral circulation Nail polish Bright light Toxins (CO, nitrates) Record SpO2 For patients age 1 to 65 with an attack of previously diagnosed asthma : For patients age 1 to 65 with an attack of previously diagnosed asthma Albuterol may be indicated Assess for the following : Assess for the following Vital signs Patient’s ability to speak in sentences Accessory muscle use Lung sounds Oxygen saturation Assessment of severity Peak flow, Borg scale Borg Scale : Figure 1. Modified Borg scale. Figure 1. Modified Borg Scale. (Note: The word "breathlessness" was added in our version of the scale for clarification.) (From Burdon JGW, Juniper EF, Killian KJ, Hargrave FE, Campbell EJM. The perception of breathlessness in asthma. Am Rev Respir Dis 1982;126:825-8. Official Journal of the American Thoracic Society. © by the American Lung Association.) Borg Scale Slide 31: Begin transport Administer Albuterol, 2.5 mg/3cc Normal saline via nebulizer. Do not delay transport to complete medication administration. Albuterol : Albuterol Sympathetic Drug Selective ß2 agonist Bronchodilator Minimal cardiovascular effects Indications : Indications Relief of bronchospasm Cautions : Cautions Patients with pertinent cardiac history Contact medical control first if there is a history of: : Contact medical control first if there is a history of: Angina Myocardial infarction Arrhythmia Congestive heart failure Contraindications : Contraindications Known hypersensitivity to drug Five “Rights” of Drug Administration : Five “Rights” of Drug Administration Time Patient Drug Dose Route Exacerbation of asthma 1 – 65 yrs, Hx of asthma Albuterol 2.5 mg/3ml dilution Nebulizer Before using any drug : Before using any drug Checklist Correct medication and dose Color Expiration date Some patients have home nebulizers : Some patients have home nebulizers Slide 43: Gather supplies needed, including: medication nebulizer set (nebulizer cup, mouthpiece or mask, tubing Put the medication into the nebulizer cup and screw the cap on securely. Connect the other end of the tubing to the nebulizer cup. Connect the mouthpiece or face mask to the nebulizer cup. Connect the tubing to the oxygen regulator. Set oxygen flow to 6-10 liters Check to make sure a fine mist of medication is coming through the face mask or mouthpiece. Mouthpiece: : Mouthpiece: Place the mouthpiece in the patient’s mouth with the lips sealed around the mouthpiece. Encourage your patient to take slow deep breaths in and out of their mouth. The mist should “disappear” with each breath. Slide 45: Encourage your patient to continue slow, deep breaths until all the medication in the nebulizer cup is gone. You may need to tap the sides of the nebulizer cup to ensure all medication is given. Face mask: : Face mask: Place the mask over your patient’s mouth and nose. The adjustable elastic band may be used to hold the mask in place. Encourage your patient to take deep breaths in and out for the duration of the treatment. Slide 47: If symptoms persist, treatment may be repeated once, after 10 minutes, for a total of two (2) doses Reassess patient after each treatment and prior to transfer of care Report treatment and response to ED staff : Report treatment and response to ED staff You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.