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

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

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

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

5. 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

6. Upper Airway Foreign Body Obstruction Pharyngeal Edema Croup
Epiglottitis

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

8. 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

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

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

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

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

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

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

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

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

17. Lower Airway Asthma Chronic Obstructive Pulmonary Disease
Chronic bronchitis
Emphysema

18. 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

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

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

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

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

23. Chronic Obstructive Pulmonary Disease
Chronic Bronchitis
Emphysema

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

25. 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

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

27. 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

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

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

30. COPD Management
If wheezing present, nebulized bronchodilators via SVN

31. Alveolar Function Problems

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

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

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

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

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

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

38. Pulmonary Embolism
Management
Oxygen
Assisted ventilation
Transport