1. Chapter 27 Shortness of Breath

2. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Anatomy Review  Physiology Review  Normal Breathing  Respiratory Distress  Causes of Shortness of Breath

3. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Anatomy Review  Respiratory system is made up of: –Airways –Lungs –Blood vessels

4. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 Anatomy Review  Upper airway –Passage of air: Nose and mouth Pharynx Trachea –Differences in pediatric patients

5. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 5 Anatomy Review  Respiratory tree –Trachea –Bronchi –Bronchioles –Alveoli

6. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 Anatomy Review  Respiratory tree –Capillaries: gas exchange

7. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Anatomy Review  Musculature –Multiple muscles involved in ventilation –Ventilation is the movement of air into and out of the lungs –Ventilation is unconscious

8. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Anatomy Review  Musculature –Diaphragm A large muscle in the chest Controlled by nerves from the cervical spinal cord

9. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Anatomy Review  Musculature –Chest wall muscles Help raise the chest Called the accessory muscles of respiration

10. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10 Physiology Review  Respiratory drive –Normal person’s respiratory rate is determined by the carbon dioxide level –The higher the level, the more stimulation to breathe –COPD patients

11. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Physiology Review  Ventilation –Inhalation Diaphragm contracts and moves downward Air is pulled into the chest

12. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Physiology Review  Ventilation –Exhalation Diaphragm relaxes Passive

13. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 Physiology Review  Respiration  Ventilation

14. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Physiology Review  Respiration –Pulmonary respiration Diffusion Gas exchange Passive process

15. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Physiology Review  Respiration –Cellular respiration Process which allows the exchange of gases in the periphery Uses the same process of diffusion

16. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16

17. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Normal Breathing  Breathing normally takes minimal effort  The brain sets the breathing rate

18. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Normal Breathing  Patient appearance –Respiratory difficulty is often obvious upon looking at the patient Normal breathing Respiratory difficulty Patient may be tired from the effort of breathing

19. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Normal Breathing  Lung sounds –Wheezing –Rhonchi –Crackles

20. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Normal Breathing  Rates and patterns –Normal: 12–20 –Pediatric: 15–30 –Infants: 25–50

21. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 Normal Breathing  Vital signs –Normal breathing should be reflected in normal heart rate and blood pressure

22. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22 Normal Breathing  Mucous membrane color –Adequate gas exchange—pink –Inadequate gas exchange—bluish –Cyanosis

23. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23 Respiratory Distress  Classic signs and symptoms  The EMT must recognize them and act quickly

24. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24 Respiratory Distress  Signs and symptoms –Patient may describe own difficulty breathing –Other signs: Increased respiratory rate Increased heart rate Cyanosis –Progression of symptoms

25. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 25 Respiratory Distress  Assessment –Initial assessment Very brief Correct any threats to breathing

26. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 26 Respiratory Distress  Assessment –Focused history and physical examination Done after life threats have been managed Gather relevant history

27. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 27 Respiratory Distress  Assessment –Focused history and physical examination Responsive patient –Ask about the illness and any remedies tried

28. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 28 Respiratory Distress  Assessment –Focused history and physical examination Responsive patient –Assess lung sounds –Look for JVD –Note skin color –Assess vital signs

29. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 29

30. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 30 Respiratory Distress  Assessment –Focused history and physical examination Unresponsive patient –Complete a rapid physical examination –Obtain vital signs –Obtain history from any family or bystanders

31. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 31 Respiratory Distress  Assessment –Focused history and physical examination Rapid physical examination –After the initial assessment –Look for cause of breathing difficulty

32. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 32 Respiratory Distress  Assessment –Focused history and physical examination Vital signs –The next priority –Pulse oximetry

33. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 33 Respiratory Distress  Assessment –Focused history and physical examination History from others –When patient is unresponsive

34. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 34 Stop and Review  How would you determine if a patient was having difficulty breathing?

35. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 35 Respiratory Distress  Management –Oxygen

36. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 36 Respiratory Distress  Management –Spontaneously breathing patient Non-rebreather mask Nasal cannula

37. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 37 Respiratory Distress  Management –Assisting ventilations Bag valve mask

38. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 38 Respiratory Distress  Management –Intubation

39. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 39 Respiratory Distress  Management –Positioning Sitting up Whatever is most comfortable

40. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 40 Respiratory Distress  Prescribed medications –Patient may need help –Contact medical control

41. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 41 Respiratory Distress  Prescribed medications –Bronchodilator inhalers Inhaled directly into the airways Help relieve the spasm

42. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 42 Respiratory Distress  Transport –Initiate quickly for patients in respiratory distress –Obtain a quick history

43. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 43 Respiratory Distress  Transport –Destination decisions –Advanced life support

44. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 44 Respiratory Distress  Ongoing assessment  Reassessment

45. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 45  Airway –Foreign body obstruction Blocks oxygen from the body Heimlich maneuver Causes of Shortness of Breath

46. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 46  Airway –Epiglottitis May occlude the airway More common in pediatric patients Causes of Shortness of Breath

47. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 47  Airway –Epiglottitis Signs and symptoms –Child will be frightened –Fever, cough, difficulty breathing –Drooling Causes of Shortness of Breath

48. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 48  Airway –Epiglottitis Management –Keep patient calm –Do not examine mouth or throat –Notify receiving hospital –Use a BVM, if necessary Causes of Shortness of Breath

49. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 49  Airway –Croup Viral infection Not as aggressive as epiglottitis Causes of Shortness of Breath

50. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 50  Airway –Croup Signs and symptoms –May accompany upper respiratory infection –Bark-like cough Causes of Shortness of Breath

51. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 51  Airway –Croup Management –Keep patient calm –Cool humidified oxygen –Notify hospital Causes of Shortness of Breath

52. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 52  Breathing –Bronchospasm –Asthma Causes of Shortness of Breath

53. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 53  Breathing –Asthma Signs and symptoms –Distress –Elevated respiratory rate –Wheezing Causes of Shortness of Breath

54. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 54

55. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 55 Asthma  Watch this animation showing the effects of asthma on the airway

56. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 56 Causes of Shortness of Breath  Breathing –Asthma Management –ABCs –Assist with inhaler –High-flow oxygen –Transport to hospital

57. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 57  Breathing –Chronic obstructive pulmonary disease Emphysema and chronic bronchitis make up a majority of this group Combination of bronchospasm and inflammation Causes of Shortness of Breath

58. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 58  Breathing –Chronic obstructive pulmonary disease Signs and symptoms –Exacerbated by respiratory infection –Shortness of breath –Hypoxic drive Causes of Shortness of Breath

59. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 59  Breathing –Chronic obstructive pulmonary disease Management –ABCs –High-flow oxygen –Assist with medications –Transport to the hospital Causes of Shortness of Breath

60. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 60  Breathing –Respiratory infections –Signs and symptoms –Management Causes of Shortness of Breath

61. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 61  Breathing –Chronic lung diseases Administer oxygen Causes of Shortness of Breath

62. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 62  Circulation –Pulmonary embolus Signs and symptoms Management Causes of Shortness of Breath

63. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 63 Causes of Shortness of Breath  Circulation –Pulmonary edema Fluid in the lungs Signs and symptoms Management

64. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 64 Stop and Review  What is the prehospital management for COPD?  What is one potential pitfall an EMT needs to be mindful of in treating epiglottitis?