Emt dyspnea

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Emt dyspnea

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

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