Hi, we’re gonna be talking about how to approach respiratory distress
in the emergency department.
So, whenever we think about respiratory distress,
we’re thinking about a patient who comes into the emergency department,
who’s having a very hard time breathing.
So, when we’re thinking about someone who is critically ill
and is having a hard time breathing,
we wanna make sure we go back to the basics
and the basics in the emergency department, we go back to our –
at the beginning of our alphabet and we think about the ABC’s.
When we’re talking about the ABC’s, first, we’re gonna start with the airway.
So, when thinking about the airway, we want to say is the airway patent?
Does the patient have anything occluding their airway?
Do they have a lot of swelling in their airway?
And an easy way for us to do that is to ask the patient to speak.
So, generally, patients who are able to speak have a patent airway.
The other thing we think about is, is the airway –
is the patient able to protect their airway?
So, what does that mean?
That means that if the patient were to vomit or have a lot of secretions,
would they be able to handle those secretions?
The next thing we think about is breathing
and we wanna make sure we’re assessing the work of breathing for our patient.
This is something that can be done using a couple of parameters.
So, one of the first things we want to do is assess the pulse oximetry.
So, we want to see if the patient has hypoxia? Is their oxygenation okay?
And the other thing that we can do when we’re thinking about this
is just looking at our patient and talking to our patient.
So, when looking at the patient, are they using accessory muscles?
Is their respiratory rate elevated?
Do you see them using their sternocleidomastoids to help them breathe?
Are they using their abdominal muscles to help them breathe?
And along with this, it’s also talking to your patient like I said.
So, can your patient speak?
In order to speak, you need to be able to breathe.
So, patients who come in who are screaming at the top of their lungs
and saying they’re having a hard time breathing, most likely,
they’re not necessarily having as much of a hard time breathing.
So, you wanna see are they able to speak one word sentences,
are they able to speak longer paragraphs and longer sentences along the way.
And then circulation is the last part of this here.
So, you wanna check the blood pressure,
you wanna check peripheral pulses in the extremities,
and along with this, you want to feel is the patient’s skin cool?
Is their skin warm? Are they clammy?
All of that kind of goes into the circulation component.
So, before we can move on to anything else,
we wanna make sure we’re starting with our ABC’s.
If we detect a problem in any of these components,
if we detect a problem with airway, with breathing, with circulation,
we always say we have to stop and fix that problem before we can move on.
So, if we detect an airway problem, we stop at A,
we fix it with potentially intubation, and then we don’t move on
until we’ve fixed all of the problems here before we move on to the rest of our process.