STUDY - Technical - New Dacian's Medicine
Apnea
(Classical / Allopathic Medicine)
Apnea, the
cessation of spontaneous respiration, is occasionally
temporary and self-limiting, as occurs during Cheyne-Stokes
and Biot's respirations. More commonly, however, it's a
life-threatening emergency that requires immediate
intervention to prevent death.
Apnea usually
results from one or more of six pathophysiologic mechanisms,
each of which has numerous causes. Its most common causes
include trauma, cardiac arrest, neurologic disease, aspiration
of a foreign object, bronchospasm, and drug overdose.
ALERT:
If you detect apnea:
- establish and maintain a patent airway
- quickly look, listen, and feel for spontaneous respiration; if it's absent, begin artificial ventilation until it occurs or until mechanical ventilation can be initiated
- assess the patient's carotid pulse (or brachial pulse if he's an infant or a small child) immediately after you've established a patent airway. If you can't palpate a pulse, begin cardiac compressions.
When the patient's respiratory and cardiac status are stable, perform a focused assessment.
If you detect apnea:
- establish and maintain a patent airway
- quickly look, listen, and feel for spontaneous respiration; if it's absent, begin artificial ventilation until it occurs or until mechanical ventilation can be initiated
- assess the patient's carotid pulse (or brachial pulse if he's an infant or a small child) immediately after you've established a patent airway. If you can't palpate a pulse, begin cardiac compressions.
When the patient's respiratory and cardiac status are stable, perform a focused assessment.
HISTORY:
Attempt to determine the events immediately preceding the apneic event by asking someone who witnessed the episode.
When able, ask the patient about headache, chest pain, muscle weakness, sore throat, or dyspnea.
Review the patient's medical history for respiratory, cardiac, or neurologic disease.
Ask the patient about allergies and drug use.
Attempt to determine the events immediately preceding the apneic event by asking someone who witnessed the episode.
When able, ask the patient about headache, chest pain, muscle weakness, sore throat, or dyspnea.
Review the patient's medical history for respiratory, cardiac, or neurologic disease.
Ask the patient about allergies and drug use.
PHYSICAL
ASSESSMENT:
Inspect the patient's head, face, neck, and trunk for soft-tissue injury, hemorrhage, or skeletal deformity.
Auscultate the lungs for adventitious breath sounds, particularly crackles and rhonchi.
Percuss the lung fields for increased dullness or hyperresonance.
Auscultate the heart for murmurs, pericardial friction rub, and arrhythmias.
Check for cyanosis, pallor, jugular vein distention, and edema.
Inspect the patient's head, face, neck, and trunk for soft-tissue injury, hemorrhage, or skeletal deformity.
Auscultate the lungs for adventitious breath sounds, particularly crackles and rhonchi.
Percuss the lung fields for increased dullness or hyperresonance.
Auscultate the heart for murmurs, pericardial friction rub, and arrhythmias.
Check for cyanosis, pallor, jugular vein distention, and edema.
SPECIAL
CONSIDERATIONS:
Central nervous system (CNS) depressants can cause hypoventilation and apnea. Benzodiazepines can cause respiratory depression and apnea when given I.V. with other CNS depressants to elderly or acutely ill patients.
Central nervous system (CNS) depressants can cause hypoventilation and apnea. Benzodiazepines can cause respiratory depression and apnea when given I.V. with other CNS depressants to elderly or acutely ill patients.
PEDIATRIC
POINTERS:
Premature infants are especially susceptible to periodic apneic episodes because of the immaturity of their CNS (Central Nervous System).
Common causes of apnea in infants include sepsis, intraventricular or subarachnoid hemorrhage, seizures, bronchiolitis, and sudden infant death syndrome.
In toddlers and older children, the primary cause of apnea is acute airway obstruction from aspiration of a foreign object. Other causes include acute epiglottiditis, croup, asthma, and such systemic disorders as muscular dystrophy and cystic fibrosis.
Premature infants are especially susceptible to periodic apneic episodes because of the immaturity of their CNS (Central Nervous System).
Common causes of apnea in infants include sepsis, intraventricular or subarachnoid hemorrhage, seizures, bronchiolitis, and sudden infant death syndrome.
In toddlers and older children, the primary cause of apnea is acute airway obstruction from aspiration of a foreign object. Other causes include acute epiglottiditis, croup, asthma, and such systemic disorders as muscular dystrophy and cystic fibrosis.
AGING ISSUES:
In elderly patients, increased sensitivity to analgesics, sedative-hypnotics, or any combination of these drugs can produce apnea, even within normal dosage ranges.
In elderly patients, increased sensitivity to analgesics, sedative-hypnotics, or any combination of these drugs can produce apnea, even within normal dosage ranges.
PATIENT
COUNSELING:
Educate the patient about safety measures related to ingestion of drugs. Encourage cardiopulmonary resuscitation training for all adolescents and adults.
Educate the patient about safety measures related to ingestion of drugs. Encourage cardiopulmonary resuscitation training for all adolescents and adults.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)