Respiratory Care Issues in Disasters
Prepared by: CPT A. Amin, RRT, RCP and CPT W. Williams, RRT, RCP
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• Objectives - at the end of this review, the TMR should be able to demonstrate an understanding of
• Common Environmental problems found in disasters that affect the Respiratory System
• Common Injuries affecting Respiratory System• Common Respiratory problems found in disasters• Common Respiratory Equipment likely to be found
in residences - clues to problems
Respiratory Care Issues in Disasters
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What is a chronic illness?
A chronic illness is a medical problem that lasts a year or longer, limits what a person can do, and calls for ongoing care. Examples of common chronic illnesses include:
Diabetes Chronic Obstructive Pulmonary Disease (COPD) Heart disease Chronic pain syndromes Inflammatory diseases, such as rheumatoid arthritis *More than 90 million Americans live with some form of chronic illness.
Respiratory Care Issues in Disasters
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Surviving a natural or man-made disaster is no small feat, especially for those who have a chronic illness. During a disaster access to health care, personal support and medication are lessened.
This leaves people with chronic medical conditions at risk for serious medical complications—even to the point of death.
Background:
Respiratory Care Issues in Disasters
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Data collected by the Children's Health Fund and the Columbia University Mailman School of Public Health, post Hurricane Katrina revealed the usual minor injuries, skin conditions and vaccination adminstrations.
However it also revealed high incidences of:• Diabetes • Hypertension• Asthma • CHF• COPD
Background:
Respiratory Care Issues in Disasters
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The most frequent diagnoses in those individuals who had at least one diagnosis documented were:
•Respiratory:•URI•Asthma •COPD
•Circulatory:•Hypertension•CHF
•Minor injury and Skin conditions
Background:
Respiratory Care Issues in Disasters
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Background:
During a disaster, access to healthcare, personal support and medication may be limited. Many
problems post disaster include:
• Lost medications
• Loss of electrical power
• Home care equipment damage/misplaced
As disaster responders, these are potential medical problems/issues that may occur and should be planned for.
Respiratory Care Issues in Disasters
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As disaster medical responders, life support skills are essential. For the patient with respiratory problems, these skills include:
• Physical and Environmental Assessment
• Airway management
• Ventilatory support.
Background:
Respiratory Care Issues in Disasters
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As disaster medical responders, we will more than likely contribute significantly to:
• Stabilization and monitoring efforts
• Assessment, treatment and consultation throughout the entire medical response
continuum
Background:
Respiratory Care Issues in Disasters
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Respiratory Care Issues in Disasters
Environmental Issues
Common Diseases of the Lung
Common Injuries affecting the Respiratory Systems
Common Equipment found in the residence of the patient with Pulmonary
disease
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• Environmental Issues
• Water - drowning or near drowning
• Dust and other airborne particulates
• Humidity (too much or too little)
• Mold and fungi
Respiratory Care Issues in Disasters
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• Common Diseases of the Lung• Asthma (small airways and secretions)
• Emphysema - COPD (deformed air sacks (air trapping) and secretions)
• Bronchitis (large airways and secretions)
Respiratory Care Issues in Disasters
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• Asthma – a chronic inflammatory
disorder involving many cell types
– manifesting with episodes of chest tightness
– coughing– labored breathing and
wheezing– all of which are related to
bronchiole inflammation
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Respiratory Care Issues in Disasters
• Asthma – Need to keep the airway
patent (open)– Prevent collapse of the
airway when exhaling to help decrease work of breathing
– Why the straws?
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Respiratory Care Issues in Disasters
• Bronchitis & Emphysema– Walls between the air sacs
are destroyed (no longer grape clusters)
– Airways inflamed & thickened
– Copious amounts of secretions
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Respiratory Care Issues in Disasters
• Typical injuries that can be sustained in traumatic disasters affecting respiration: Head injuries
• Loss of consciousness• Upper airway injuries
– facial fractures– neck injuries
Respiratory Care Issues in Disasters
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• Facial Fractures– Nose
• bridge
– Jaw / mouth • displacement of jaw• inflammation of the
tongue (airway closure)
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Respiratory Care Issues in Disasters
• Neck injuries– Cervical injuries
• paralysis
– Wounds • soft tissue of neck
– swollen tongue
• Loss of upper airway– need to establish viable
airway (trach or endotube)
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Respiratory Care Issues in Disasters
• Typical injuries that can be sustained in traumatic disasters affecting respiration:– Chest injuries
• flail chest (multiple broken ribs on one / both sides of thorax)
• pneumothroax - chest wounds the penetrate the lung• abdominal injuries affecting diaphragm movement
Respiratory Care Issues in Disasters
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• Chest injuries– Broken ribs (one or
both sides of chest)– May or may not
puncture the lung(s)
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Respiratory Care Issues in Disasters
Broken Ribs on both sides
• Chest injuries– Pneumothorax
• lung(s) penetrated• collapse of lung(s)
– Internal organs can begin to shift (heart, diaphragm)
– Must release pressure• chest tube(s)
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Respiratory Care Issues in Disasters
Both lungs collasped
We should become familiar with at least the most commonly prescribed respiratory medications and treatments during an emergency. For example, some patients with lung disease require:
• Breathing treatments • Nebulizer• MDI
• Supplementary oxygen• Mechanical ventilation
These are usually performed by a respiratory therapist but some of these skills can be easily learned by a non therapist health professional.
Respiratory Care Issues in Disasters
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• Common Equipment found in the residence of the patient with Pulmonary disease
• Clues there may be an impending patient care issue
Respiratory Care Issues in Disasters
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• Nasal Cannula– Low flow device (2 to 6
lpm) Oxygen % varies from breath to breath.
– Approximate O2% range = 24 to ~ 40 %
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Common Respiratory Equipment
• Venti Mask - Total Gas Flow to Patient is determined by variable orifice venturi at varying liter flows (draws in air to combine with Oxygen to give approximate O2 %)
• Setting Suggested Oxygen Flow Total Gas Flow
• 24% 3 LPM 79 LPM• 26% 3 LPM 47 LPM• 28% 6 LPM 68 LPM• 30% 6 LPM 53 LPM• 35% 9 LPM 50 LPM• 40% 12 LPM 50 LPM• 50% 15 LPM 41 LPM
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Common Respiratory Equipment
• (Non)Rebreather Mask– Moderate to High O2
concentrations (60% +)– Bag holds additional
Oxygen - flows with each breath
– Bag movement is important
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Common Respiratory Equipment
• Trach(eostomy) Collar– Requires high flows – Produces high humidity– Usually find an “H”
cylinder of Oxygen– Unable to verbalize*
Common Respiratory Equipment
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• Oxygen Cylinders– Oxygen Therapy
• cannula• mask
– Different sizes are used• D, E or H size
– Support combustion -things that burn, burn hotter and faster
Common Respiratory Equipment
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• Liquid Oxygen Systems– Dewars
• Liquid that vaporizes to a gas
– Depending on size of vessel, can be equivalent of several “H” cylinders
– Extreme freeze burns• loss of limb(s)
Common Respiratory Equipment
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• Medication Nebulizer– Metered Dose Inhaler
• Bronchodilator• Steroid
– Some are rescue meds• Fast acting
– Others are maintenance meds – do not use during breathing / airway emergency
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Common Respiratory Equipment
• Medication Nebulizer– Fixed, Low flow device (6 to 8
lpm) – Generally 21% Oxygen
• unless run from alternate Oxygen source
– Electrically powered– Aerosolizes liquid medications
into small particles that are inhaled into lung
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Common Respiratory Equipment
• Home care ventilator– Pt unable to breathe
without assistance – May / May not require
O2 – Usually find an “H”
cylinder of Oxygen– Unable to verbalize*
Common Respiratory Equipment
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• Home care ventilator– Various models and
types– Most require use of
electricity • check for backup power
source
– Some are pneumatic• look for cylinders or
compressor
Common Respiratory Equipment
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• Home care ventilator– May / May not require
O2 • Look for cylinder gases• Be aware of cylinder
safety – fire hazards
– electrical hazards
Common Respiratory Equipment
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• Observe situation and surroundings– findings may lead you to seek possible
problems
• Assess patient and ask questions– current or previous respiratory health issues
• Provide care – arrange care by appropriate provider
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Final Thoughts - Recommendations