Temple College EMS Professions 6/29/2019 Dyspnea Temple College EMS Professions Temple College EMS Professions

Dyspnea Subjective sensation of: Difficult, labored breathing or Shortness of breath

Hyperventilation Syndrome Response to stress, anxiety Patient exhales CO2 faster than metabolism produces it Blood vessels in brain constrict Anxiety, dizziness, lightheadedness Seizures, unconsciousness

Hyperventilation Syndrome Chest pains, dyspnea Numbness, tingling of fingers, toes, area around mouth, nose Carpopedal spasms of hands, feet

Hyperventilation Syndrome Treatment Obtain thorough history Avoiding misdiagnosis is critical Try to “talk patient down” Re-breathe CO2 from face mask with oxygen flowing at 1 to 2 liters/minute

Upper Airway Foreign Body Obstruction Pharyngeal Edema Croup Epiglottitis

Foreign Body Obstruction Partial or complete Most common cause of pediatric airway obstruction

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

Foreign Body Obstruction Management Partial with good air exchange Partial with poor air exchange Complete

Pharyngeal Edema Swelling of soft tissues of throat Allergic reactions, upper airway burns Hoarseness, stridor, drooling

Pharyngeal Edema Management Position of comfort Oxygen Assist breathing as needed Consider ALS intercept for invasive airway management

Epiglottitis Bacterial infection Causes edema of epiglottis Children age 4-7 years Increasingly common in adults Rapid onset, high fever, stridor, sore throat, drooling

Epiglottitis Can progress to complete obstruction Do not look in throat Do not use obstructed airway maneuver

Croup Laryngotracheobronchitis Viral infection Causes edema of larynx/trachea Children ages 6 months to 4 years

Croup Slow onset, hoarseness, brassy cough, nightime stridor, dyspnea When in doubt, manage as epiglottitis

Croup/Epiglottitis Management Oxygen Assist ventilations as needed Do not excite patient Do not look in throat Consider ALS intercept

Lower Airway Asthma Chronic Obstructive Pulmonary Disease Chronic bronchitis Emphysema

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

Resistance to airflow, work of breathing increase Asthma Bronchospasm Bronchial edema Increased mucus production, plugging Resistance to airflow, work of breathing increase

Asthma Airway narrowing interferes with exhalation Air trapped in chest interferes with gas exchange Wheezing, coughing, respiratory distress

Asthma All that wheezes is not asthma Other possibilities Pulmonary edema Pulmonary embolism Anaphalaxis (severe allergic reaction) Foreign body aspiration Pneumonia

Asthma Treatment High concentration O2, humidified Position of comfort Assist ventilation as needed Bronchodilators via small volume nebulizer Calm patient, reassure

Chronic Obstructive Pulmonary Disease Chronic Bronchitis Emphysema

Chronic Bronchitis Chronic lower airway inflammation Increased bronchial mucus production Productive cough Urban male smokers > 30 years old

Chronic Bronchitis Blue Bloater Mucus, swelling interfere with ventilation Increased CO2, decreased 02 Cyanosis occurs early in disease Lung disease overworks right ventricle Right heart failure occurs RHF produces peripheral edema Blue Bloater

Emphysema Loss of elasticity in small airways Destruction of alveolar walls Urban male smokers > 40-50 years old

Emphysema Pink Puffer Lungs lose elastic recoil Retain CO2, maintain near normal O2 Cyanosis occurs late in disease Barrel chest (increased AP diameter) Thin, wasted Prolonged exhalation through pursed lips Pink Puffer

COPD Prone to periods of “decompensation” Triggered by respiratory infections, chest trauma Signs/Symptoms Respiratory distress Tachypnea Cough productive of green, yellow sputum

COPD Management Oxygen Assist ventilations as needed Monitor carefully Some COPD patients may experience respiratory depression on high concentration oxygen Assist ventilations as needed

COPD Management If wheezing present, nebulized bronchodilators via SVN

Alveolar Function Problems

Pulmonary Edema Fluid in/around alveoli, small airways Causes Left heart failure Toxic inhalants Aspiration Drowning Trauma

Pulmonary Edema Signs/Symptoms Labored breathing Coughing Rales, rhonchi Wheezes Pink, frothy sputum

Pulmonary Edema Signs/Symptoms Sit up High concentration O2 Assist ventilation

Pulmonary Embolism Clot from venous circulation Passes through right heart Lodges in pulmonary circulation Shuts off blood flow past part of alveoli

Pulmonary Embolism Associated with: Prolonged bed rest or immobilization Casts or orthopedic traction Pelvic or lower extremity surgery Phlebitis Use of BCPs

Sudden Dyspnea + No Readily Identifiable Cause = Pulmonary Embolism Signs/Symptoms Dyspnea Chest pain Tachycardia Tachypnea Hemoptysis Sudden Dyspnea + No Readily Identifiable Cause = Pulmonary Embolism

Pulmonary Embolism Management Oxygen Assisted ventilation Transport