Emt dyspnea
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Emt dyspnea Presentation Transcript

  • 1. Dyspnea Temple College EMS Professions
  • 2. Dyspnea
    • Subjective sensation of:
      • Difficult, labored breathing or
      • Shortness of breath
  • 3. Hyperventilation Syndrome
    • Response to stress, anxiety
    • Patient exhales CO 2 faster than metabolism produces it
    • Blood vessels in brain constrict
    • Anxiety, dizziness, lightheadedness
    • Seizures, unconsciousness
  • 4. Hyperventilation Syndrome
    • Chest pains, dyspnea
    • Numbness, tingling of fingers, toes, area around mouth, nose
    • Carpopedal spasms of hands, feet
  • 5. Hyperventilation Syndrome
    • Treatment
      • Obtain thorough history
      • Avoiding misdiagnosis is critical
      • Try to “talk patient down”
      • Re-breathe CO 2 from face mask with oxygen flowing at 1 to 2 liters/minute
  • 6. Upper Airway
    • Foreign Body Obstruction
    • Pharyngeal Edema
    • Croup
    • Epiglottitis
  • 7. Foreign Body Obstruction
    • Partial or complete
    • Most common cause of pediatric airway obstruction
  • 8. Foreign Body Obstruction
    • Suspect in any child with
      • Sudden onset of dyspnea
      • Decreased LOC
    • Suspect in any adult who develops dyspnea or loses consciousness while eating
  • 9. Foreign Body Obstruction
    • Management
      • Partial with good air exchange
      • Partial with poor air exchange
      • Complete
  • 10. Pharyngeal Edema
    • Swelling of soft tissues of throat
    • Allergic reactions, upper airway burns
    • Hoarseness, stridor, drooling
  • 11. Pharyngeal Edema
    • Management
      • Position of comfort
      • Oxygen
      • Assist breathing as needed
      • Consider ALS intercept for invasive airway management
  • 12. Epiglottitis
    • Bacterial infection
    • Causes edema of epiglottis
    • Children age 4-7 years
    • Increasingly common in adults
    • Rapid onset, high fever, stridor, sore throat , drooling
  • 13. Epiglottitis
    • Can progress to complete obstruction
    • Do not look in throat
    • Do not use obstructed airway maneuver
  • 14. Croup
    • Laryngotracheobronchitis
    • Viral infection
    • Causes edema of larynx/trachea
    • Children ages 6 months to 4 years
  • 15. Croup
    • Slow onset, hoarseness, brassy cough, nightime stridor, dyspnea
    • When in doubt, manage as epiglottitis
  • 16. Croup/Epiglottitis
    • Management
      • Oxygen
      • Assist ventilations as needed
      • Do not excite patient
      • Do not look in throat
      • Consider ALS intercept
  • 17. Lower Airway
    • Asthma
    • Chronic Obstructive Pulmonary Disease
      • Chronic bronchitis
      • Emphysema
  • 18. Asthma
    • Reversible obstructive pulmonary disease
    • Younger person’s disease (80% have first episode before age 30)
    • Lower airway hypersensitive to allergens, emotional stress, irritants, infection
  • 19. Asthma
    • Bronchospasm
    • Bronchial edema
    • Increased mucus production, plugging
    Resistance to airflow, work of breathing increase
  • 20. Asthma
    • Airway narrowing interferes with exhalation
    • Air trapped in chest interferes with gas exchange
    • Wheezing, coughing, respiratory distress
  • 21. Asthma
    • All that wheezes is not asthma
    • Other possibilities
      • Pulmonary edema
      • Pulmonary embolism
      • Anaphalaxis (severe allergic reaction)
      • Foreign body aspiration
      • Pneumonia
  • 22. Asthma
    • Treatment
      • High concentration O 2 , humidified
      • Position of comfort
      • Assist ventilation as needed
      • Bronchodilators via small volume nebulizer
      • Calm patient, reassure
  • 23. Chronic Obstructive Pulmonary Disease
    • Chronic Bronchitis
    • Emphysema
  • 24. Chronic Bronchitis
    • Chronic lower airway inflammation
      • Increased bronchial mucus production
      • Productive cough
    • Urban male smokers > 30 years old
  • 25. Chronic Bronchitis
    • Mucus, swelling interfere with ventilation
    • Increased CO 2 , decreased 0 2
    • Cyanosis occurs early in disease
    • Lung disease overworks right ventricle
    • Right heart failure occurs
    • RHF produces peripheral edema
    Blue Bloater
  • 26. Emphysema
    • Loss of elasticity in small airways
    • Destruction of alveolar walls
    • Urban male smokers > 40-50 years old
  • 27. Emphysema
    • Lungs lose elastic recoil
    • Retain CO 2 , maintain near normal O 2
    • Cyanosis occurs late in disease
    • Barrel chest (increased AP diameter)
    • Thin, wasted
    • Prolonged exhalation through pursed lips
    Pink Puffer
  • 28. COPD
    • Prone to periods of “decompensation”
    • Triggered by respiratory infections, chest trauma
    • Signs/Symptoms
      • Respiratory distress
      • Tachypnea
      • Cough productive of green, yellow sputum
  • 29. COPD Management
    • Oxygen
      • Monitor carefully
      • Some COPD patients may experience respiratory depression on high concentration oxygen
    • Assist ventilations as needed
  • 30. COPD Management
    • If wheezing present, nebulized bronchodilators via SVN
  • 31. Alveolar Function Problems
  • 32. Pulmonary Edema
    • Fluid in/around alveoli, small airways
    • Causes
      • Left heart failure
      • Toxic inhalants
      • Aspiration
      • Drowning
      • Trauma
  • 33. Pulmonary Edema
    • Signs/Symptoms
      • Labored breathing
      • Coughing
      • Rales, rhonchi
      • Wheezes
      • Pink, frothy sputum
  • 34. Pulmonary Edema
    • Signs/Symptoms
      • Sit up
      • High concentration O 2
      • Assist ventilation
  • 35. Pulmonary Embolism
    • Clot from venous circulation
    • Passes through right heart
    • Lodges in pulmonary circulation
    • Shuts off blood flow past part of alveoli
  • 36. Pulmonary Embolism
    • Associated with:
      • Prolonged bed rest or immobilization
      • Casts or orthopedic traction
      • Pelvic or lower extremity surgery
      • Phlebitis
      • Use of BCPs
  • 37. Pulmonary Embolism
    • Signs/Symptoms
      • Dyspnea
      • Chest pain
      • Tachycardia
      • Tachypnea
      • Hemoptysis
    Sudden Dyspnea + No Readily Identifiable Cause = Pulmonary Embolism
  • 38. Pulmonary Embolism
    • Management
      • Oxygen
      • Assisted ventilation
      • Transport