EmtDyspnea - Dyspnea Dyspnea Temple College EMS Professions...

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Unformatted text preview: Dyspnea Dyspnea Temple College EMS Professions Dyspnea Dyspnea a Subjective Subjective sensation of: • Difficult, labored breathing or • Shortness of breath Hyperventilation Syndrome Hyperventilation Syndrome Response to stress, anxiety a Patient exhales CO2 faster than metabolism produces it metabolism a Blood vessels in brain constrict a Anxiety, dizziness, lightheadedness a Seizures, unconsciousness a Hyperventilation Syndrome Hyperventilation Syndrome Chest pains, dyspnea a Numbness, tingling of fingers, toes, Numbness, area around mouth, nose a Carpopedal spasms of hands, feet a Hyperventilation Syndrome Hyperventilation Syndrome a Treatment • • • Obtain thorough history Avoiding misdiagnosis is critical Avoiding critical Try to “talk patient down” • Re-breathe CO2 from face mask with oxygen flowing at 1 to 2 liters/minute oxygen Upper Airway Upper Airway Foreign Body Obstruction a Pharyngeal Edema a Croup a Epiglottitis a Foreign Body Obstruction Foreign Body Obstruction a Partial or complete a Most common cause of pediatric Most airway obstruction airway Foreign Body Obstruction Foreign Body Obstruction a Suspect in any child with Suspect • Sudden onset of dyspnea • Decreased LOC a Suspect in any adult who develops Suspect dyspnea or loses consciousness while eating eating Foreign Body Obstruction Foreign Body Obstruction a Management • • • Partial with good air exchange Partial with poor air exchange Complete Pharyngeal Edema Pharyngeal Edema Swelling of soft tissues of throat a Allergic reactions, upper airway burns a Hoarseness, stridor, drooling a Pharyngeal Edema Pharyngeal Edema a Management • • • • Position of comfort Oxygen Assist breathing as needed Consider ALS intercept for invasive airway Consider management management Epiglottitis Epiglottitis Bacterial infection Bacterial a Causes edema of epiglottis a Children age 4-7 years Children a Increasingly common in adults a Rapid onset, high fever, stridor, sore Rapid throat, drooling throat drooling a Epiglottitis Epiglottitis Can progress to complete obstruction a Do not look in throat Do not a Do not use obstructed airway maneuver Do not a Croup Croup Laryngotracheobronchitis a Viral infection a Causes edema of larynx/trachea a Children ages 6 months to 4 years a Croup Croup Slow onset, hoarseness, brassy cough, Slow nightime stridor, dyspnea nightime a When in doubt, manage as epiglottitis a Croup/Epiglottitis Croup/Epiglottitis a Management • • • • • Oxygen Assist ventilations as needed Do not excite patient Do not Do not look in throat Do not Consider ALS intercept Lower Airway Lower Airway Asthma a Chronic Obstructive Pulmonary Disease a • Chronic bronchitis • Emphysema Asthma Asthma Reversible obstructive pulmonary Reversible disease disease a Younger person’s disease (80% have Younger first episode before age 30) first a Lower airway hypersensitive to Lower allergens, emotional stress, irritants, infection infection a Asthma Asthma Bronchospasm a Bronchial edema a Increased mucus production, plugging a Resistance to airflow, work of breathing increase Asthma Asthma Airway narrowing interferes with Airway exhalation exhalation a Air trapped in chest interferes with gas Air exchange exchange a Wheezing, coughing, respiratory Wheezing, distress distress a Asthma Asthma All that wheezes is not asthma All not a Other possibilities a • • • • • Pulmonary edema Pulmonary embolism Anaphalaxis (severe allergic reaction) Foreign body aspiration Pneumonia Asthma Asthma a Treatment • High concentration O2, humidified • • • Position of comfort Assist ventilation as needed Bronchodilators via small volume Bronchodilators nebulizer nebulizer • Calm patient, reassure Chronic Obstructive Pulmonary Chronic Obstructive Pulmonary Disease a Chronic Bronchitis a Emphysema Chronic Bronchitis Chronic Bronchitis Chronic lower airway inflammation • Increased bronchial mucus Increased production production • Productive cough a Urban male smokers > 30 years old a Chronic Bronchitis Chronic Bronchitis a a a a a a Mucus, swelling interfere with ventilation Increased CO2, decreased 02 Cyanosis occurs early in disease early Lung disease overworks right ventricle Right heart failure occurs RHF produces peripheral edema Blue Bloater Emphysema Emphysema Loss of elasticity in small airways a Destruction of alveolar walls a Urban male smokers > 40-50 years old a Emphysema Emphysema a a a a a a Lungs lose elastic recoil Lungs Retain CO2, maintain near normal O2 Cyanosis occurs late in disease late Barrel chest (increased AP diameter) Barrel Thin, wasted Prolonged exhalation through pursed lips Pink Puffer COPD COPD a a a Prone to periods of “decompensation” Triggered by respiratory infections, chest Triggered trauma trauma Signs/Symptoms • • • Respiratory distress Tachypnea Cough productive of green, yellow sputum COPD Management COPD Management a Oxygen • Monitor carefully • Some COPD patients may Some experience respiratory depression on high concentration oxygen high a Assist ventilations as needed COPD Management COPD Management a If If wheezing present, nebulized bronchodilators via SVN bronchodilators Alveolar Function Problems Alveolar Function Problems Pulmonary Edema Pulmonary Edema Fluid in/around alveoli, small airways a Causes a • • • • • Left heart failure Toxic inhalants Aspiration Drowning Trauma Pulmonary Edema Pulmonary Edema a Signs/Symptoms • • • • • Labored breathing Coughing Rales, rhonchi Wheezes Pink, frothy sputum Pulmonary Edema Pulmonary Edema a Signs/Symptoms • Sit up • High concentration O2 • Assist ventilation Pulmonary Embolism Pulmonary Embolism Clot from venous circulation Clot a Passes through right heart a Lodges in pulmonary circulation a Shuts off blood flow past part of alveoli a Pulmonary Embolism Pulmonary Embolism a Associated • • • • • with: Prolonged bed rest or immobilization Casts or orthopedic traction Pelvic or lower extremity surgery Phlebitis Use of BCPs Pulmonary Embolism Pulmonary Embolism a Signs/Symptoms • • • • • Dyspnea Chest pain Tachycardia Tachypnea Hemoptysis Sudden Dyspnea + No Readily Identifiable Cause = Pulmonary Embolism Pulmonary Embolism Pulmonary Embolism a Management • • • Oxygen Assisted ventilation Transport ...
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