Medical Emergencies - • Facial swelling • Risk for airway compromise

1 Medical Emergencies Airway Angioedema • Allergic reaction • Facial swelling • Risk for airway compromise • Administer epinephrine IM immediately • Side effect of ace inhibitor Myxedema Coma • Severe hypothyroidism • Decreased level of consciousness may progress to coma and respiratory failure • Provide respiratory support (ventilation with a bag-valve mask) • Prepare to assist with intubation Epiglottitis • Inflamed epiglottis (flap of cartilage that covers trachea when swallowing) • 3–7-year-old child with acute respiratory distress • Sitting up, leaning forward and drooling • Managed with endotracheal intubation • Prepare for possible tracheostomy

• RED FLAG: stridor

Asthma Crisis • Rapid, labored respirations using accessory muscles • Severe obstruction wheezing sounds are not heard due to lack of airflow (status asthmaticus) “silent chest” • Oxygen to maintain saturation above 90 • High dose inhaled short acting beta agonist (albuterol) and anticholinergic agent (ipratropium) every 20 minutes • Systemic corticosteroids to control underlying inflammation Drowning/ Choking • Aspiration = hypoxemia • Bluish pale appearance • Stridor

• Choking: CPR

• Drowning: remove wet clothes, warming

intervention to prevent hypothermia Smoke Inhalation • Occurs when noxious stimuli interact with respiratory system • Initially no signs of trauma to airway • Delayed presentation 24-48 hours after • Close observation • Oxygen supplementation • Elevate HOB

Breathing Air embolism • Small pulmonary capillaries obstruct blood circulation • Central venous catheter leaks air rapidly at 100 mL/second • Complications cardiac arrest • Clamp catheter • Position left lateral • Administer oxygen • Notify HCP Pulmonary embolism • Blood clot, fat or air embolus, or tissue (tumor) travels through venous system into pulmonary circulation and obstructs blood flow into the lungs.• Usually caused by DVT • Pleuritic chest pain • Dyspnea and hypoxemia • Tachypnea and cough • Tachycardia

• Prioritize: rapid symptom identification,

assessment of oxygen, notify HCP Pneumothorax

• Caused by trauma
• Air rushes through wound with each

inspiration

Tip: hoarseness of voice or noisy lung sounds

= emergency 1 / 2

2

• Creates sucking sound and fills pleural

place

• Lungs cannot expand so client develops

respiratory distress and air hunger

• Tachycardia and hypotension results

from impaired venous return

- Priority: apply sterile occlusive dressing

taped on three sides, preventing inward air flow while allowing air to escape pleural space Flail chest (rib cage fracture)

• Broken ribs
• Causes paradoxical movement (chest

wall flailing back and forth in opposite directions)

• Difficulty breathing
• Stabilize the flail chest by using a pillow

to put pressure on the flail segment

• Oxygen through face mask, intubation,

mechanical ventilation, pain control Severe croup

• Upper airway infection
• Barking cough, stridor
• Result of swelling around the voice box

(larynx)

• Noisy breathing
• Cool mist vaporizer
• Treat symptoms

Acute respiratory distress syndrome (ARDS)

• Progressive form of acute respiratory

failure – high mortality rate

• Refractory hypoxemia – inability to

improve oxygenation with increased oxygenation concentration

• Pulmonary edema
• Lungs become stiff and noncompliant
• Shortness of breath, labored breathing
• Trat underlying cause
• Mechanical ventilation, sedation

Severe pneumonia (desaturating)

• Decreased gas exchange
• Blocked alveoli impair ventilation
• Hypoxia and respiratory distress
• Position right lateral with unaffected

(good) lung down

• Crackles, fever, chills, productive

cough, dyspnea, and pleuritic chest pain

• Chest physiotherapy, huff coughing
• Fluids
• fowler’s position

Respiratory failure

- causes: over sedation, sleep apnea,

anesthesia, drug overdose

• leads to alveolar hypoventilation
• carbon dioxide retention and

respiratory acidosis

• hypoxemia and altered mental status
• Frequent suctioning and adequate

oxygen administration

• Obtain and evaluate ABGs
• Prepare for intubation if necessary
• Oral care, cluster care

Myasthenia gravis crisis

• Autoimmune disorder
• Drooping eyes (ptosis), Double vision

(diplopia)

• Difficulty chewing and swallowing

risk for aspiration

• Deep breathing and oxygen

administration

• Anticholinesterase drugs before meals,

easily chewed food, pyridostigmine, prednisone, immunosuppressants (cyclosporin)

• Infection, undermedication, and stress

can lead to crisis (oropharyngeal and respiratory muscle weakness and respiratory failure) Guillain barre syndrome

• Autoimmune disease – acute

inflammation of spinal and cranial nerves

• Symmetrical motor weakness and

absent or diminished reflexes

• Muscle weakness starting from lower

extremities progresses towards upper extremities

• Monitor for respiratory failure and

ability to swallow

• Assess pulmonary function by serial

spirometry

• Measurement of forced vital capacity is

gold standard for assessing ventilation ALS crisis

• Loss of motor neurons
• Progressive weakness
• Fatigue, muscle weakness progresses to

paralysis, dysphagia, difficulty speaking, and respiratory failure.

• Survives 3-5 years
• Riluzole – only medication approved for

ALS treatment slows neuron degeneration

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