Care of the person with Care of the person with functional needs in disaster functional needs in disaster situations: The respiratory situations: The respiratory

systemsystem

Rachel K. Vanek, RN, BS, BSN, Rachel K. Vanek, RN, BS, BSN, MSNMSN

Acute Care Nurse Practitioner Acute Care Nurse Practitioner Medical Intensive Care UnitMedical Intensive Care Unit

University/Case Medical CenterUniversity/Case Medical Center

Great Dismal Swamp Fire Great Dismal Swamp Fire

Apartment FireApartment Fire

• Large apartment complex caught fireLarge apartment complex caught fire

• >100 elderly and poor evacuated>100 elderly and poor evacuated

• Many had respiratory and other Many had respiratory and other illnesses making them vulnerable in illnesses making them vulnerable in emergency situationsemergency situations

• Evacuated to hospitals and nursing Evacuated to hospitals and nursing homes for care/access to medical homes for care/access to medical suppliessupplies

Heat WavesHeat Waves

Cold SnapsCold Snaps

FloodsFloods

WeatherWeather

Illness outbreaksIllness outbreaks

• FluFlu

• Cold seasonCold season

• Water-borne illnessWater-borne illness

• Crowded living situationsCrowded living situations

Dust/Environmental Dust/Environmental DisastersDisasters

• Dust stormsDust storms

• Toxic chemical leaksToxic chemical leaks

• Santa Anna windsSanta Anna winds

• Other exposures that may require Other exposures that may require evacuation or special treatmentevacuation or special treatment

PurposePurpose

• Learn a bit about normal respiratory Learn a bit about normal respiratory functionsfunctions

• Determine strategies to plan for the Determine strategies to plan for the management vulnerable persons in management vulnerable persons in the event of an emergencythe event of an emergency

• Answer YOUR questions Answer YOUR questions

Respiratory Anatomy and Respiratory Anatomy and Physiology Physiology

• Respiratory system comprised of Respiratory system comprised of conducting system and gas conducting system and gas exchange systemexchange system

• Upper airway filters and warms airUpper airway filters and warms air

• Gas exchange occurs at the level of Gas exchange occurs at the level of the alveolithe alveoli

Functions of Respiratory Functions of Respiratory SystemSystem

• Warm and humidify airWarm and humidify air

• Provide oxygenProvide oxygen

• Remove carbon dioxideRemove carbon dioxide

• Cough and sneeze reflex to clear foreign Cough and sneeze reflex to clear foreign materialmaterial

• Filters blood of small material in the Filters blood of small material in the circulationcirculation

• Release and convert special hormonesRelease and convert special hormones

Respiratory DisordersRespiratory Disorders

• COPDCOPD

• AsthmaAsthma

• Heart FailureHeart Failure

• Pulmonary Pulmonary HypertensionHypertension

• PneumoniaPneumonia

• Pulmonary Pulmonary embolismembolism

• PneumoniaPneumonia

• Sleep apneaSleep apnea

• Lung CancerLung Cancer

• Fibrosis Fibrosis

• Cystic fibrosisCystic fibrosis

Medical TechnologiesMedical Technologies

• Enabling many people with severe Enabling many people with severe disease to live longer, better livesdisease to live longer, better lives

• Patient is dependent on technology Patient is dependent on technology to survive to survive

• May be simple to complexMay be simple to complex

• Most are fairly compact and portable Most are fairly compact and portable nownow

MedicationsMedications

• Always have a supply on handAlways have a supply on hand

• Always carry a list of medications Always carry a list of medications and allergiesand allergies

• Have name and number of pharmacyHave name and number of pharmacy

Intravenous MedicationsIntravenous Medications

• Some medications are infused into Some medications are infused into veinsveins

• Insulin pumps infuse subcutaneouslyInsulin pumps infuse subcutaneously

• Flolan pumps require cassettes and Flolan pumps require cassettes and special handling and infuse into special handling and infuse into central linecentral line

IV medication safetyIV medication safety

• Running out of insulin or medication Running out of insulin or medication for pulmonary hypertension is an for pulmonary hypertension is an emergencyemergency

• Patients have premixed supplyPatients have premixed supply

• Needs refrigerationNeeds refrigeration

• Needs special handling to prevent Needs special handling to prevent overdose or infectionoverdose or infection

• Friends, family or aides to assistFriends, family or aides to assist

Medication SafetyMedication Safety

• Child proof capsChild proof caps

• Never mix different medicines in one Never mix different medicines in one containercontainer

• Never share or take someone else’s Never share or take someone else’s medicationsmedications

• Expiration dates should be on the bottleExpiration dates should be on the bottle

• Never alter medication unless Never alter medication unless instructed to do soinstructed to do so

OxygenOxygen

• Used in a variety of health situationsUsed in a variety of health situations

• May be used constantly or as needed, May be used constantly or as needed, for example with exercise for example with exercise

• Delivered via nasal cannulaDelivered via nasal cannula

• Can be used with CPAP or BiPap at Can be used with CPAP or BiPap at homehome

• Can be used with mechanical Can be used with mechanical ventilatorventilator

Oxygen Delivery Oxygen Delivery

• Nasal CannulaNasal Cannula

• Simple Mask – used for O2 and Simple Mask – used for O2 and nebulizernebulizer

• Venturi MaskVenturi Mask

• Increased O2 needs requires specialty Increased O2 needs requires specialty carecare

• May have concentrator or storage tankMay have concentrator or storage tank

Oxygen SafetyOxygen Safety

• Keep tanks 5-10 feet from heat source Keep tanks 5-10 feet from heat source or open flamesor open flames

• Secure an oxygen cylinder to a solidly Secure an oxygen cylinder to a solidly fixed objectfixed object

• No smoking in car or home when O2 No smoking in car or home when O2 in usein use

• Do not use petroleum based products Do not use petroleum based products near O2 usenear O2 use

Oxygen SafetyOxygen Safety

• Be careful when long lengths of Be careful when long lengths of tubing in use to avoid trippingtubing in use to avoid tripping

• If O2 is pressurized avoid touching If O2 is pressurized avoid touching iced areasiced areas

Oxygen concentratorsOxygen concentrators

Inhalers/NebulizersInhalers/Nebulizers• Medications delivered directly into the Medications delivered directly into the

lunglung

• Used in a variety of respiratory illnessesUsed in a variety of respiratory illnesses

• Inhalers deliver medications in aerosol Inhalers deliver medications in aerosol form to effect the airwaysform to effect the airways

• Nebulizer delivers the medication in a Nebulizer delivers the medication in a mistmist

• Drugs and method of delivery are Drugs and method of delivery are prescribedprescribed

VentilatorsVentilators

• Provides gas movement in and out of Provides gas movement in and out of lungslungs

• Replaces work of breathing for Replaces work of breathing for person who can’t breathe or can’t person who can’t breathe or can’t breathe effectivelybreathe effectively

• It is a life critical machineIt is a life critical machine

VentilatorsVentilators

• Person will have a tracheostomyPerson will have a tracheostomy

• Require specialized trainingRequire specialized training

• People on ventilators have family, People on ventilators have family, friends, or aides trained in the care friends, or aides trained in the care and managementand management

• Battery packs can last up to 8 hoursBattery packs can last up to 8 hours

Mechanical Ventilator SafetyMechanical Ventilator Safety

• Airway must be securedAirway must be secured

• Machines have alarmsMachines have alarms

• Airway requires suctioning at timesAirway requires suctioning at times

• If disconnected easy to reconnectIf disconnected easy to reconnect

• Bag valve mask can replace the Bag valve mask can replace the ventilators work in an emergencyventilators work in an emergency

• Back up power sourceBack up power source

Ventilator SafetyVentilator Safety

• Avoid loops of tubing – can be Avoid loops of tubing – can be hazardoushazardous

• Homes that have patients on Homes that have patients on ventilators have special emergency ventilators have special emergency plansplans

• Same safety precautions for oxygen Same safety precautions for oxygen if they have it as wellif they have it as well

CPAP and BPAPCPAP and BPAP

• CPAP is now a common modality for CPAP is now a common modality for the treatment of obstructive sleep the treatment of obstructive sleep apneaapnea

• BPAP is used as an adjunctive BPAP is used as an adjunctive modality to assist in ventilatory modality to assist in ventilatory supportsupport

• Machines have settings preset Machines have settings preset

• Can be attached to oxygenCan be attached to oxygen

CPAP and BPAPCPAP and BPAP

• BPAP is used to assist ventilatory BPAP is used to assist ventilatory support when sleepingsupport when sleeping

• CPAP is used to stent open airways CPAP is used to stent open airways for obstructive sleep disordersfor obstructive sleep disorders

• May have different uses in the May have different uses in the hospitalhospital

CPAP and BPAP safteyCPAP and BPAP saftey

• Never use someone else’s machineNever use someone else’s machine

• Avoid long loops of tubingAvoid long loops of tubing

• Most have built in humidity that need Most have built in humidity that need to be maintained and refilledto be maintained and refilled

• Masks and tubing can be cleaned Masks and tubing can be cleaned with soap and waterwith soap and water

Key Points Key Points

• O2 safetyO2 safety

• People with medical needs will People with medical needs will generally have the equipment they generally have the equipment they needneed

• Providing safe havenProviding safe haven

• Enlist the assistance of family and Enlist the assistance of family and friendsfriends

Thank you for your kind Thank you for your kind attentionattention

Questions????Questions????