1. Respiratory System Diseases and Management Part IV
Diana Jones
Paramedic

2. Respiratory System
Many diseases affect the respiratory system. Covered in this lecture will be
Asthma
Pneumonia
Pulmonary Edema
Pulmonary Embolism
COPD – chronic bronchitis and emphysema
Trauma

3. Asthma
Characterized by inflammation and narrowing of the airways and excess mucus production. Occurs primarily in two stages. Results in difficulty breathing and commonly associated with wheezing.

4. Stage I: Hyper-reactivity Stage II: Inflammatory Response
Asthma
Stage I: Hyper-reactivity
Stage II: Inflammatory Response
Airways constrict and narrow in response to exposure from inhaled allergen or irritant
Caused by smooth muscle contraction
The airway does not relax and difficulty breathing results
Airways swell
Fill with fluid
Excess mucus production
Progress from wheezing to diminished breath sounds
Difficulty exhaling – air trapping

5. Asthma Signs and Symptoms
Difficulty breathing
Shortness of breath
Wheezing or diminished breath sounds
Productive cough
Cyanosis
Tripod position, pursed lips/nasal flaring, accessory muscles, retractions

6. Asthma Treatment Supplemental oxygen Glucocorticoid
Optimal positioning
Beta2 adrenergic agonist
Albuterol
Anticholinergic
Atrovent
Glucocorticoid
SoluMedrol
Magnesium sulfate
CPAP
Always consult local protocols

7. Pneumonia
An infection in the lung that may be caused by bacteria, virus, or fungus

8. Pneumonia Signs and Symptoms
Cough, can be productive resulting in yellowish or greenish sputum
Chest pain
Shortness of breath
Fever
Altered mental status
Loss of appetite

9. Pneumonia Treatment Position Supplemental Oxygen
Bronchodilators (Albuterol)
CPAP
IV fluids
If febrile, treat
Always consult local protocols

10. Pneumonia
*Remember your differential diagnosis* Pneumonia patients have been improperly treated because EMS providers believe they are CHF. What do you think would happen if a pneumonia patient were slammed with Lasix?

11. Pulmonary Edema
Result of excess fluid in the lungs, collecting in the alveoli. Can develop from a number of causes, ranging from high altitude to chemical exposure. However, it is primarily cardiac in origin and what we will consider in this case.

12. Pulmonary Edema
When the heart loses its ability to efficiently pump blood it results in congestive heart failure (CHF). CHF leads to a back up of blood in the veins and this high pressure system causes fluid to be shifted into the lungs

13. Pulmonary Edema Signs and Symptoms
Difficulty breathing
Shortness of breath
Tachycardia
Tachypnea
Pallor
May be hypo or hypertensive
Cyanosis
Crackles or rales
JVD
Edema – pedal
Anxiety or restlessness
Frothy sputum, can be bloody

14. Pulmonary Edema Treatment
Patient position
Supplemental oxygen
IV fluid if hypotensive
CPAP
Consider Nitroglycerin if blood pressure parameters are met
Lasix
Consider Morphine

15. Pulmonary Embolism
Pulmonary embolism is a blood clot lodged in the lung. Results in a V/Q mismatch. Clot typically originates from another site and migrates to the lung where it lodges.

16. Pulmonary Embolism
What is a V/Q mismatch? To understand you must know the difference between perfusion and ventilation. Ventilation is the mechanical part of breathing, simple act of inhaling and exhaling. A PE does not affect this ability. Perfusion is the delivery of blood. So, in the case of a PE, blood is not delivered to the capillary beds of the alveoli, therefore gas exchange cannot take place. The result is a mismatch. Ventilation continues but perfusion is inhibited.

17. Pulmonary Embolism Signs and Symptoms
Shortness of breath
Tachypnea
Tachycardia
Chest pain that may migrate
Anxiety/restlessness
Cough, maybe bloody sputum

18. Pulmonary Embolism Treatment
Patient position
Supplemental oxygen
IV access
The main goal of field treatment is oxygenation and transport. Definitive care is provided by the hospital with rapid diagnosis and dissolving of the clot
You may consider an anxiolytic if protocol allows

19. Chronic Obstructive Pulmonary Disease
Umbrella term which includes chronic bronchitis and emphysema. By either mechanism, the result is decrease air flow.

20. COPD Chronic Bronchitis
Airways are thick and inflamed
Airways are clogged with excessive mucus production
“Blue Bloaters”

21. COPD Emphysema Walls of alveoli become floppy
Walls of alveoli may be destroyed
Alveoli collapse
“Pink Puffers”

22. COPD
Regardless of the underlying cause of COPD, the result is the same. Decreased surface area for gas exchange. COPD is progressive and treatment is aimed at symptom management.

23. COPD Signs and Symptoms
Shortness of breath
Difficulty breathing
Chronic cough
Clubbing of fingers
Cyanosis
Wheezing
Frequent infections

24. COPD Treatment Patient position Supplemental oxygen Bronchodilators
Anticholinergics
Glucocorticoid

25. These will all be considered in a different lecture
Trauma
The respiratory system can also be affected by trauma. Injury can lead to
Pneumothorax
Hemothorax
Hemopneumothorax
These will all be considered in a different lecture

26. Questions?