The document discusses various respiratory conditions that can cause dyspnea (difficult or labored breathing). It describes hyperventilation syndrome, which causes anxiety and dizziness due to overbreathing. Foreign body obstruction is a common cause of pediatric airway issues and can cause sudden dyspnea in adults. Pharyngeal edema, epiglottitis, and croup can cause upper airway swelling and obstruction. Asthma is a reversible obstructive lung disease often caused by allergens or irritants. Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema from long-term smoking. Pulmonary edema and pulmonary embolism can cause fluid or clots in the lungs resulting in

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