Mastering Respiratory System EMT Terminology: A Comprehensive Guide

Understanding the Respiratory System for EMTs

The respiratory system is responsible for oxygen exchange, a function essential to life. As an EMT, you’ll frequently encounter respiratory distress cases—from asthma attacks to airway obstructions. Quick assessment and intervention can mean the difference between life and death. Let’s dive into terminology and concepts of the respiratory system for EMT’s.

Key Structures of the Respiratory System

• Upper Airway:
  • Nasal cavity – Filters and humidifies incoming air
  • Pharynx (throat) – Divided into nasopharynx, oropharynx, and laryngopharynx
  • Epiglottis – Prevents aspiration by covering the trachea during swallowing
  • Larynx (voice box) – Contains vocal cords; site for airway obstruction
• Lower Airway:
  • Trachea (windpipe) – Allows passage of air to the lungs
  • Bronchi & Bronchioles – Branching airways leading to the alveoli
  • Alveoli – Tiny sacs where oxygen and carbon dioxide exchange occurs
• Lungs & Accessory Structures:
  • Diaphragm – Primary muscle of respiration
  • Intercostal muscles – Assist in expanding the chest cavity

Functions of the Respiratory System

• Gas Exchange: Oxygen enters the blood, and carbon dioxide is expelled
• Ventilation vs. Respiration:
  • Ventilation = Mechanical movement of air
  • Respiration = Cellular gas exchange in the lungs
• Regulation of Blood pH: Maintains acid-base balance
• Protection Against Pathogens: Mucous membranes and cilia trap debris

Common Respiratory Emergencies in EMS

1. Airway Obstruction

• Causes: Foreign bodies, swelling (anaphylaxis), tongue in unconscious patients
• EMT Intervention:
  • Use head tilt-chin lift or jaw thrust (for suspected C-spine injury)
  • Heimlich maneuver for choking
  • Consider suctioning

2. Asthma

• Causes: Bronchospasm, inflammation, mucus buildup
• Symptoms: Wheezing, dyspnea, accessory muscle use
• EMT Intervention:
  • Assist with albuterol (MDI or nebulizer, if within scope)
  • Provide oxygen therapy
  • Transport in position of comfort

3. Chronic Obstructive Pulmonary Disease (COPD)

• Causes: Long-term smoking, environmental factors
• Symptoms: Pursed-lip breathing, barrel chest, wheezing, chronic cough
• EMT Intervention:
  • Low-flow oxygen (1-2 LPM nasal cannula) to avoid hypoxic drive suppression
  • Assist with bronchodilator if prescribed
  • Monitor for respiratory failure

4. Pulmonary Edema (Fluid in Lungs)

• Causes: Congestive heart failure (CHF), toxic inhalation
• Symptoms: Crackles (rales), pink frothy sputum, severe dyspnea
• EMT Intervention:
  • High-flow oxygen
  • CPAP (if in scope)
  • Rapid transport

5. Pneumothorax (Collapsed Lung)

• Causes: Trauma, spontaneous rupture of bleb (tall, thin males at risk)
• Symptoms: Absent lung sounds on affected side, tracheal deviation (tension pneumothorax)
• EMT Intervention:
  • Occlusive dressing for open chest wounds
  • Assist with needle decompression (if in scope)

Key Respiratory Terms for EMTs

• Apnea – No breathing
• Apneustic Breathing – Prolonged inhalation with a short, ineffective exhalation; often indicates brainstem damage.
• Bradypnea – Slow breathing
• Cyanosis – Bluish skin discoloration due to oxygen deprivation
• Dyspnea – Difficulty breathing
• Hypercapnia – Increased carbon dioxide (CO₂) levels in the blood, usually due to hypoventilation. Common in COPD patients.
• Hypocapnia – Low CO₂ levels, often caused by hyperventilation (e.g., panic attacks).
• Hypoxemia – Low oxygen levels in the blood; different from hypoxia, which refers to low oxygen at the tissue level.
• Hypoxia – Low oxygen levels
• Rales (Fine Crackles) – Fluid in alveoli (pulmonary edema)
• Rhonchi (Coarse Crackles) – Coarse sounds from mucus buildup (chronic bronchitis)
• Shallow Breathing (Hypoventilation) – Ineffective, weak respirations that do not provide adequate gas exchange. May require BVM support.
• Stridor – High-pitched inspiratory sound (upper airway obstruction)
• Tachypnea – Rapid breathing
• Wheezing – Whistling sound due to narrowed bronchi (asthma, COPD)

Pharmacological Considerations

• Oxygen Therapy:
  • Nasal cannula (1-6 LPM, 24-44% O₂)
  • Non-rebreather mask (10-15 LPM, up to 90% O₂)
  • Bag-Valve Mask (BVM) (100% O₂)
• Albuterol (Beta-2 Agonist):
  • Dose: nebulizer (2.5 mg in 3 mL saline)
  • Effects: Bronchodilation (Opens airway)
  • Side effects: Tachycardia, jitteriness
• Epinephrine (For Severe Asthma):
  • Dose: 0.3 mg IM (Adult), 0.15 mg IM (Pediatric)
  • Effects: Vasoconstriction, bronchodilation

Assessing & Treating Patients with Respiratory Distress

• Primary Assessment:
  • ABC (Airway, Breathing, Circulation)
  • Look: Cyanosis, accessory muscle use, tripod positioning
  • Listen: Lung sounds (wheezing, stridor, rales)
  • Feel: Equal chest rise and fall
• Oxygenation & Ventilation:
  • Pulse oximetry (SpO₂) should be >94% for normal patients
  • For COPD, aim for 92% oxygen saturation
  • If breathing is inadequate, use BVM ventilation
• Transport Considerations:
  • Position of comfort (Usually semi-Fowler’s or high-Fowler’s)
  • Continuous monitoring (Pulse ox, respiratory rate)
  • Rapid transport if unstable

Final Takeaways for EMTs

• Early airway intervention is key – Recognize signs of obstruction or distress
• Oxygen is a drug – Use it appropriately based on patient condition
• Lung sounds matter – Differentiating wheezing from crackles can change treatment
• Respiratory distress can escalate quickly – Always be prepared for BVM support or advanced airway management