EMT-Basic Exam: The Basics of Medical Emergencies - Respiratory Emergencies

This section of the EMT-Basic exam covers medical emergencies related to the respiratory system. Questions in this section focus on respiratory anatomy and physiology, signs of upper and lower airway obstructions, signs of respiratory distress and failure, emergency respiratory conditions, and the use of inhalers.

1. Asthma and Inhalers
Asthma is a common respiratory illness that EMT-Basics must treat on the job. This chronic disease is characterized by inflammation of the airway and has a two-phase response. In the first phase, a leakage of fluid from the capillaries causes bronchial constriction, which results in reduced expiratory airflow. This phase usually lasts 1 to 2 hours and may be resolved with an inhaled bronchodilator. In the second phase, edema and swelling cause a further reduction in expiratory airflow. This phase usually occurs 6 to 8 hours after the initial onset. Patients at this stage of asthma no longer respond to inhaled bronchodilators and are frequently treated with anti-inflammatory medications such as corticosteroids.
Inhaled bronchodilators, which are administered via inhalers, are the most common form of treatment for asthma. Inhalers deliver bronchodilators into lung tissues and dilate the bronchioles, thus decreasing resistance inside the airways. Some inhalers, known as metered-dose inhalers, are preset to expel a specified dose of medication when activated. Common generic names for inhaler medications include isoetharine, albuterol, and metaproterenol. The trade names for these medications are Ventolin, Proventil, and Bronkometer, respectively.
To assist in the administration of an inhaler, the EMT-Basic must first receive permission from the medical direction physician. The patient must exhibit signs of a respiratory emergency before the EMT-Basic can assist in administering the patient’s physician-prescribed inhaler.
Use of a prescribed inhaler may be contraindicated in some cases. Disoriented patients who may not be able to use their inhaler correctly shouldn’t be treated with one. Patients should only use inhalers that were prescribed to them. You shouldn’t help administer an inhaler without approval from the medical direction physician. Patients who have already met or exceeded the maximum recommended dosage of inhaler medication should not be given any further doses.
Some inhalers are used with a device called a spacer, which is an attachment that is situated between the inhaler and the patient. Spacers are used to contain the medication after it has been released from the inhaler, which gives the patient more time to inhale it. These devices are most commonly used by children and patients who have difficulty taking deep breaths.

2. COPD
COPD stands for chronic obstructive pulmonary (lung) disease. This broad category includes three respiratory conditions: asthma (discussed in the previous section), emphysema, and chronic bronchitis.
Emphysema is a degenerative disease that develops as a result of consistent exposure to noxious substances such as cigarette smoke. As emphysema worsens, alveolar surface area decreases. As the alveoli are damaged, the surface area used for gas exchange also decreases. This can cause trapped air, which results in a barrel chest. Patients with emphysema will also have a prolonged expiratory phase and frequently breathe through pursed lips. An increase in red blood cell production also causes pinkish skin coloration. Because of these symptoms, these patients are often referred to as pink puffers.
Chronic bronchitis results from the excessive production of mucus in the respiratory tree. In this disease, the alveoli become obstructed by mucus plugs. Patients with chronic bronchitis often become cyanotic, which is why they are often referred to as blue bloaters.
On-scene treatment for these conditions usually includes administration of oxygen. For hypoxic patients, oxygen at the highest level of concentration is usually prescribed.

3. Upper Airway Obstruction
Upper airway obstructions are the result of blockage in the upper respiratory tract, which consists of the trachea, voice box, and throat. Common causes of upper airway obstructions include allergic reactions, infections, burns, aspiration of foreign bodies, trauma, or blockage from an unresponsive patient’s tongue.

4. Lower Airway Obstruction
Lower airway obstructions are the result of blockage in the lower respiratory tract, which includes the lower end of the trachea and the lungs. Lower airway obstructions are most commonly caused by the buildup of mucus or fluids or by inflammation. These obstructions usually develop as a result of pre-existing respiratory conditions such as emphysema or chronic bronchitis.

5. Respiratory Distress
Respiratory distress occurs when the respiratory system becomes unable to meet the body’s demand for oxygen. Difficulty breathing is a primary symptom of respiratory distress. Patients may display poor breathing rates and rhythms, as well as reduced quality or depth of breathing.
A patient who is breathing too quickly or too slowly may not be taking in enough oxygen or not exhaling enough carbon dioxide. Abnormal breathing rhythms often indicate a serious medical emergency and require a doctor’s evaluation.
Patients in respiratory distress may also exhibit poor breathing quality. Unequal or diminished breath sounds may indicate that there’s not enough air reaching one or both lungs. Unequal chest expansion may also accompany serious respiratory problems.
Patients who are breathing too deeply or too shallowly are experiencing an altered tidal volume, which affects the level of oxygen the body can receive. Some patients in respiratory distress may also experience shortness of breath.
Other signs of respiratory distress include high pulse rate, altered mental status, restlessness, changes in skin color, the use of accessory muscles, chest wall retractions, noisy breathing, and nasal flaring.

Tip: Many patients in respiratory distress will attempt to remain in an upright, seated position. This position is usually the most comfortable for these patients.

6. Respiratory Failure
Respiratory failure occurs when the lungs become unable to function normally and either can’t take in enough oxygen or can’t expel enough carbon dioxide. Airway blockages, lung damage, or weakened breathing muscles can lead to respiratory failure. Patients in respiratory failure may experience severe respiratory distress. If not treated properly, respiratory failure can be fatal.

Related Topics You Should Review:
- Respiratory anatomy
- Respiratory physiology
- Artificial ventilation