Dyspnea Temple College EMS Professions

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

Hyperventilation Syndrome b Response to stress, anxiety b Patient exhales CO 2 faster than metabolism produces it b Blood vessels in brain constrict b Anxiety, dizziness, lightheadedness b Seizures, unconsciousness

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

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

Upper Airway b Foreign Body Obstruction b Pharyngeal Edema b Croup b Epiglottitis

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

Foreign Body Obstruction b Suspect in any child with Sudden onset of dyspneaSudden onset of dyspnea Decreased LOCDecreased LOC b Suspect in any adult who develops dyspnea or loses consciousness while eating

Foreign Body Obstruction b Management Partial with good air exchangePartial with good air exchange Partial with poor air exchangePartial with poor air exchange CompleteComplete

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

Pharyngeal Edema b Management Position of comfortPosition of comfort OxygenOxygen Assist breathing as neededAssist breathing as needed Consider ALS intercept for invasive airway managementConsider ALS intercept for invasive airway management

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

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

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

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

Croup/Epiglottitis b Management OxygenOxygen Assist ventilations as neededAssist ventilations as needed Do not excite patientDo not excite patient Do not look in throatDo not look in throat Consider ALS interceptConsider ALS intercept

Lower Airway b Asthma b Chronic Obstructive Pulmonary Disease Chronic bronchitisChronic bronchitis EmphysemaEmphysema

Asthma b Reversible obstructive pulmonary disease b Younger person’s disease (80% have first episode before age 30) b Lower airway hypersensitive to allergens, emotional stress, irritants, infection

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

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

Asthma b All that wheezes is not asthma b Other possibilities Pulmonary edemaPulmonary edema Pulmonary embolismPulmonary embolism Anaphalaxis (severe allergic reaction)Anaphalaxis (severe allergic reaction) Foreign body aspirationForeign body aspiration PneumoniaPneumonia

Asthma b Treatment High concentration O 2, humidifiedHigh concentration O 2, humidified Position of comfortPosition of comfort Assist ventilation as neededAssist ventilation as needed Bronchodilators via small volume nebulizerBronchodilators via small volume nebulizer Calm patient, reassureCalm patient, reassure

Chronic Obstructive Pulmonary Disease b Chronic Bronchitis b Emphysema

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

Chronic Bronchitis b Mucus, swelling interfere with ventilation b Increased CO 2, decreased 0 2 b Cyanosis occurs early in disease b Lung disease overworks right ventricle b Right heart failure occurs b RHF produces peripheral edema Blue Bloater

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

Emphysema b Lungs lose elastic recoil b Retain CO 2, maintain near normal O 2 b Cyanosis occurs late in disease b Barrel chest (increased AP diameter) b Thin, wasted b Prolonged exhalation through pursed lips Pink Puffer

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

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

COPD Management b If wheezing present, nebulized bronchodilators via SVN

Alveolar Function Problems

Pulmonary Edema b Fluid in/around alveoli, small airways b Causes Left heart failureLeft heart failure Toxic inhalantsToxic inhalants AspirationAspiration DrowningDrowning TraumaTrauma

Pulmonary Edema b Signs/Symptoms Labored breathingLabored breathing CoughingCoughing Rales, rhonchiRales, rhonchi WheezesWheezes Pink, frothy sputumPink, frothy sputum

Pulmonary Edema b Signs/Symptoms Sit upSit up High concentration O 2High concentration O 2 Assist ventilationAssist ventilation

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

Pulmonary Embolism b 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

Pulmonary Embolism b Signs/Symptoms DyspneaDyspnea Chest painChest pain TachycardiaTachycardia TachypneaTachypnea HemoptysisHemoptysis Sudden Dyspnea + No Readily Identifiable Cause = Pulmonary Embolism

Pulmonary Embolism b Management OxygenOxygen Assisted ventilationAssisted ventilation TransportTransport