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It’s a warm summer day outside, the temperatures are mild, and rain is in the forecast. You are sitting with your partner when the call comes in: “University Ambulance 2, respond to the lobby of the Maple Tree Hotel for a man with respiratory distress.”

Approximately one out of every four EMS calls is either airway or respiratory related.

 

Why is it critical to maintain a patient’s airway and ensure adequate breathing at all times?
How frequently should you assess the condition of a patient’s airway and his or her ability to breathe?
What impact will inappropriate assessment and management of a patient’s airway and breathing have on total patient care?

 

En route to the hotel, you consider the potential causes of your patient’s respiratory distress. Could it be an asthma attack or a heart attack? Could there be some sort of trauma preventing him from breathing well? You are pleased that you thoroughly checked your respiratory equipment and the oxygen cylinders before you left the station that morning. You begin putting on your gloves.

 

What are the specific causes of respiratory distress? Which are serious and which are not?
What type of equipment would you anticipate needing to treat a patient with difficulty breathing?

 

As you arrive at the hotel, you are greeted by hotel security, who report that the man was attending a conference when suddenly he began complaining of difficulty breathing and confusion. He then passed out in his chair. The security officer informs you that the ushers have carefully moved him into the aisle and are trying to keep his airway open.

As you walk into the room, you notice that the conference session is on break, so few people are around, and there are no immediate hazards. You see only one large patient who appears to be unresponsive. You ask your partner to call dispatch to send ALS.

 

How does the information given by hotel security and bystanders help you prepare for your patient?
What are some potential hazards in this situation?

 

The ushers step out of the way as you kneel beside the patient. You confirm with the ushers that the patient, in fact, did not fall off his chair but that they lifted him out carefully. You then open his airway using the head tilt-chin lift technique and listen for breathing. You hear snoring respirations that persist even after adjusting his head position. You decide to use an oropharyngeal airway to keep his airway patent.

 

What is the most appropriate method to open an unresponsive patient’s airway when you are considering a chief complaint of difficulty breathing? 

 

Several minutes after inserting the oral airway, your patient begins to gag and vomits. You immediately remove the oral airway and roll the patient to his side. When he finishes vomiting, you clean the large debris from his face and mouth. Your partner has set up the portable suction for you. As you reevaluate the patient’s breathing and airway, you now hear gurgling sounds.

You grab a rigid tipped catheter, turn on the machine, and open his mouth using a cross-finger technique. After measuring the depth of the catheter against the patient’s face, you insert the catheter into the patient’s mouth and begin counting the seconds. After about 10 seconds, the mouth appears clear of fluids and the gurgling has stopped.

 

How important is it to reevaluate the interventions you use to treat your patient?
If your suction catheter does not remove the large debris from the patient’s mouth, how would you remove it?

 

Now that you have cleared your patient’s airway by suctioning, you place the patient in the recovery position and continue with your assessment. You find his breathing to be present and adequate. A pulse is present, and there is no evidence of bleeding. Findings from your secondary assessment are normal except for a low pulse oximetry reading of 88%.

You place your patient on a nonrebreathing mask at 15 L/min and prepare the patient for transport to the hospital. Dispatch reports that the ALS unit is delayed in traffic due to construction.

 

This patient needs oxygen. What type of patients should not receive oxygen?
Earlier in your assessment you called for additional help, but now that help is delayed. How does that change your immediate decisions toward the patient’s care? 

 

Despite supplemental oxygen therapy, your patient’s condition has deteriorated. He is more cyanotic and has shallow, slow respirations. You insert a nasopharyngeal airway and begin assisting his ventilations at one breath every 5 seconds with a bag-valve mask attached to 100% supplemental oxygen.

He does not resist your attempts to ventilate, and his chest rises and falls with each ventilation. He tolerates the nasal airway. Dispatch reports that paramedics will rendezvous in 5 minutes.

 

Is an airway adjunct needed to provide assisted ventilations with a bag-valve mask? How does it help?
The patient’s condition is deteriorating and you have begun ventilations at one every 5 seconds. Is this enough? How do you know if your ventilations are effective?

 

After approximately 2 minutes of assisted ventilation, the patient’s cyanosis has resolved and his level of consciousness has improved. You continue bag-mask ventilations to maintain adequate tidal volume and rendezvous with the paramedics, who intubate the patient and assist you with transporting him to the hospital, where he is diagnosed with a stroke.

Following a 2-day stay in the hospital, the patient was discharged to an extended-care facility for continued recovery.

SCIENCE
HEALTH SCIENCE
NURSING

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