dyspnea temple college ems professions. dyspnea b subjective sensation of: difficult, labored...
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DyspneaDyspnea
Temple CollegeTemple College
EMS ProfessionsEMS Professions
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DyspneaDyspnea
Subjective sensation of: Subjective sensation of: • Difficult, labored breathing orDifficult, labored breathing or
• Shortness of breathShortness of breath
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Hyperventilation Hyperventilation SyndromeSyndrome
Response to stress, anxietyResponse to stress, anxiety Patient exhales COPatient exhales CO2 2 faster than faster than
metabolism produces itmetabolism produces it Blood vessels in brain constrictBlood vessels in brain constrict Anxiety, dizziness, lightheadednessAnxiety, dizziness, lightheadedness Seizures, unconsciousnessSeizures, unconsciousness
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Hyperventilation Hyperventilation SyndromeSyndrome
Chest pains, dyspneaChest pains, dyspnea Numbness, tingling of fingers, toes, Numbness, tingling of fingers, toes,
area around mouth, nose area around mouth, nose Carpopedal spasms of hands, feetCarpopedal spasms of hands, feet
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Hyperventilation Hyperventilation SyndromeSyndrome
TreatmentTreatment• Obtain thorough historyObtain thorough history• Avoiding misdiagnosis is Avoiding misdiagnosis is criticalcritical• Try to “talk patient down”Try to “talk patient down”
• Re-breathe CORe-breathe CO22 from face mask with from face mask with
oxygen flowing at 1 to 2 liters/minuteoxygen flowing at 1 to 2 liters/minute
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Upper AirwayUpper Airway
Foreign Body ObstructionForeign Body Obstruction Pharyngeal EdemaPharyngeal Edema CroupCroup EpiglottitisEpiglottitis
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Foreign Body Foreign Body ObstructionObstruction
Partial or completePartial or completeMost common cause of pediatric Most common cause of pediatric
airway obstructionairway obstruction
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Foreign Body Foreign Body ObstructionObstruction
Suspect in any child with Suspect in any child with • Sudden onset of dyspneaSudden onset of dyspnea• Decreased LOCDecreased LOC
Suspect in any adult who develops Suspect in any adult who develops dyspnea or loses consciousness while dyspnea or loses consciousness while eatingeating
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Foreign Body Foreign Body ObstructionObstruction
ManagementManagement• Partial with good air exchangePartial with good air exchange
• Partial with poor air exchangePartial with poor air exchange
• CompleteComplete
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Pharyngeal EdemaPharyngeal Edema
Swelling of soft tissues of throatSwelling of soft tissues of throat Allergic reactions, upper airway burnsAllergic reactions, upper airway burns Hoarseness, stridor, droolingHoarseness, stridor, drooling
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Pharyngeal EdemaPharyngeal Edema
ManagementManagement• Position of comfortPosition of comfort• OxygenOxygen• Assist breathing as neededAssist breathing as needed• Consider ALS intercept for invasive airway Consider ALS intercept for invasive airway
managementmanagement
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EpiglottitisEpiglottitis
Bacterial infection Bacterial infection Causes edema of epiglottisCauses edema of epiglottis Children age 4-7 years Children age 4-7 years Increasingly common in adultsIncreasingly common in adults Rapid onset, high fever, stridor, Rapid onset, high fever, stridor, sore sore
throatthroat, , droolingdrooling
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EpiglottitisEpiglottitis
Can progress to complete obstructionCan progress to complete obstruction Do Do notnot look in throat look in throat Do Do notnot use obstructed airway maneuver use obstructed airway maneuver
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CroupCroup
LaryngotracheobronchitisLaryngotracheobronchitis Viral infectionViral infection Causes edema of larynx/tracheaCauses edema of larynx/trachea Children ages 6 months to 4 yearsChildren ages 6 months to 4 years
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CroupCroup
Slow onset, hoarseness, brassy cough, Slow onset, hoarseness, brassy cough, nightime stridor, dyspneanightime stridor, dyspnea
When in doubt, manage as epiglottitisWhen in doubt, manage as epiglottitis
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Croup/Epiglottitis Croup/Epiglottitis
ManagementManagement• OxygenOxygen
• Assist ventilations as neededAssist ventilations as needed
• Do Do notnot excite patient excite patient
• Do Do notnot look in throat look in throat
• Consider ALS interceptConsider ALS intercept
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Lower AirwayLower Airway
AsthmaAsthma Chronic Obstructive Pulmonary DiseaseChronic Obstructive Pulmonary Disease
• Chronic bronchitisChronic bronchitis• EmphysemaEmphysema
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AsthmaAsthma
Reversible obstructive pulmonary Reversible obstructive pulmonary diseasedisease
Younger person’s disease (80% have Younger person’s disease (80% have first episode before age 30)first episode before age 30)
Lower airway hypersensitive to Lower airway hypersensitive to allergens, emotional stress, irritants, allergens, emotional stress, irritants, infectioninfection
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AsthmaAsthma
BronchospasmBronchospasm Bronchial edemaBronchial edema Increased mucus production, pluggingIncreased mucus production, plugging
Resistance to airflow, work of breathing increase
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AsthmaAsthma
Airway narrowing interferes with Airway narrowing interferes with exhalationexhalation
Air trapped in chest interferes with gas Air trapped in chest interferes with gas exchangeexchange
Wheezing, coughing, respiratory Wheezing, coughing, respiratory distressdistress
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AsthmaAsthma
All that wheezes is All that wheezes is notnot asthma asthma Other possibilitiesOther possibilities
• Pulmonary edemaPulmonary edema• Pulmonary embolismPulmonary embolism• Anaphalaxis (severe allergic reaction)Anaphalaxis (severe allergic reaction)• Foreign body aspirationForeign body aspiration• PneumoniaPneumonia
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AsthmaAsthma
TreatmentTreatment• High concentration OHigh concentration O22, humidified, humidified
• Position of comfortPosition of comfort
• Assist ventilation as neededAssist ventilation as needed
• Bronchodilators via small volume Bronchodilators via small volume nebulizernebulizer
• Calm patient, reassureCalm patient, reassure
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Chronic Obstructive Chronic Obstructive Pulmonary DiseasePulmonary Disease
Chronic BronchitisChronic BronchitisEmphysemaEmphysema
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Chronic BronchitisChronic Bronchitis
Chronic lower airway inflammationChronic lower airway inflammation
• Increased bronchial mucus Increased bronchial mucus productionproduction
• Productive coughProductive cough Urban male smokers > 30 years oldUrban male smokers > 30 years old
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Chronic BronchitisChronic Bronchitis
Mucus, swelling interfere with ventilationMucus, swelling interfere with ventilation Increased COIncreased CO22, decreased 0, decreased 022
CyanosisCyanosis occurs occurs earlyearly in disease in disease Lung disease overworks right ventricleLung disease overworks right ventricle Right heart failure occursRight heart failure occurs RHF produces peripheral edemaRHF produces peripheral edema
Blue Bloater
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EmphysemaEmphysema
Loss of elasticity in small airwaysLoss of elasticity in small airways Destruction of alveolar wallsDestruction of alveolar walls Urban male smokers > 40-50 years oldUrban male smokers > 40-50 years old
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EmphysemaEmphysema
Lungs lose elastic recoil Lungs lose elastic recoil Retain CORetain CO22, maintain near normal O, maintain near normal O22
CyanosisCyanosis occurs occurs latelate in disease in disease Barrel chest (increased AP diameter) Barrel chest (increased AP diameter) Thin, wastedThin, wasted Prolonged exhalation through pursed lipsProlonged exhalation through pursed lips
Pink Puffer
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COPDCOPD
Prone to periods of “decompensation”Prone to periods of “decompensation” Triggered by respiratory infections, chest Triggered by respiratory infections, chest
traumatrauma Signs/SymptomsSigns/Symptoms
• Respiratory distressRespiratory distress• TachypneaTachypnea• Cough productive of green, yellow sputumCough productive of green, yellow sputum
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COPD ManagementCOPD Management
OxygenOxygen• Monitor carefullyMonitor carefully
• Some COPD patients may Some COPD patients may experience respiratory depression on experience respiratory depression on high concentration oxygenhigh concentration oxygen
Assist ventilations as neededAssist ventilations as needed
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COPD ManagementCOPD Management
If wheezing present, nebulized If wheezing present, nebulized bronchodilators via SVNbronchodilators via SVN
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Alveolar Function Alveolar Function ProblemsProblems
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Pulmonary EdemaPulmonary Edema
Fluid in/around alveoli, small airwaysFluid in/around alveoli, small airways CausesCauses
• Left heart failureLeft heart failure• Toxic inhalantsToxic inhalants• AspirationAspiration• DrowningDrowning• TraumaTrauma
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Pulmonary EdemaPulmonary Edema
Signs/SymptomsSigns/Symptoms• Labored breathingLabored breathing
• CoughingCoughing
• Rales, rhonchiRales, rhonchi
• WheezesWheezes
• Pink, frothy sputumPink, frothy sputum
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Pulmonary EdemaPulmonary Edema
Signs/SymptomsSigns/Symptoms• Sit upSit up
• High concentration OHigh concentration O22
• Assist ventilationAssist ventilation
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Pulmonary EmbolismPulmonary Embolism
Clot from venous circulation Clot from venous circulation Passes through right heartPasses through right heart Lodges in pulmonary circulationLodges in pulmonary circulation Shuts off blood flow past part of alveoliShuts off blood flow past part of alveoli
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Pulmonary EmbolismPulmonary Embolism
Associated with:Associated with:• Prolonged bed rest or immobilizationProlonged bed rest or immobilization
• Casts or orthopedic tractionCasts or orthopedic traction
• Pelvic or lower extremity surgeryPelvic or lower extremity surgery
• PhlebitisPhlebitis
• Use of BCPsUse of BCPs
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Pulmonary EmbolismPulmonary Embolism
Signs/SymptomsSigns/Symptoms• DyspneaDyspnea• Chest painChest pain• TachycardiaTachycardia• TachypneaTachypnea• HemoptysisHemoptysis
Sudden Dyspnea + No Readily Identifiable Cause = Pulmonary Embolism
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Pulmonary EmbolismPulmonary Embolism
ManagementManagement• OxygenOxygen
• Assisted ventilationAssisted ventilation
• TransportTransport