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					Dyspnea


Temple College
EMS Professions
Dyspnea

 Subjective   sensation of:
  • Difficult, labored breathing or
  • Shortness of breath
Hyperventilation Syndrome

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

 Chest pains, dyspnea
 Numbness, tingling of fingers, toes,
  area around mouth, nose
 Carpopedal spasms of hands, feet
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
Upper Airway

 Foreign  Body Obstruction
 Pharyngeal Edema
 Croup
 Epiglottitis
Foreign Body Obstruction

 Partialor complete
 Most common cause of pediatric
  airway obstruction
Foreign Body Obstruction

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

 Management
 • Partial with good air exchange
 • Partial with poor air exchange
 • Complete
Pharyngeal Edema

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

 Management
  •   Position of comfort
  •   Oxygen
  •   Assist breathing as needed
  •   Consider ALS intercept for invasive airway
      management
Epiglottitis

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

 Can progress to complete obstruction
 Do not look in throat
 Do not use obstructed airway maneuver
Croup

 Laryngotracheobronchitis
 Viralinfection
 Causes edema of larynx/trachea
 Children ages 6 months to 4 years
Croup

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

 Management
 •   Oxygen
 •   Assist ventilations as needed
 •   Do not excite patient
 •   Do not look in throat
 •   Consider ALS intercept
Lower Airway

 Asthma
 Chronic   Obstructive Pulmonary Disease
  • Chronic bronchitis
  • Emphysema
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
Asthma

 Bronchospasm
 Bronchialedema
 Increased mucus production, plugging



   Resistance to airflow, work of
        breathing increase
Asthma

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

 Allthat wheezes is not asthma
 Other possibilities
  •   Pulmonary edema
  •   Pulmonary embolism
  •   Anaphalaxis (severe allergic reaction)
  •   Foreign body aspiration
  •   Pneumonia
Asthma

 Treatment
  • High concentration O2, humidified
  • Position of comfort
  • Assist ventilation as needed
  • Bronchodilators via small volume
    nebulizer
  • Calm patient, reassure
Chronic Obstructive Pulmonary
Disease

        Bronchitis
 Chronic
 Emphysema
Chronic Bronchitis

 Chronic lower airway inflammation
  • Increased bronchial mucus
    production
  • Productive cough
 Urban male smokers > 30 years old
Chronic Bronchitis
 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
Emphysema

 Loss of elasticity in small airways
 Destruction of alveolar walls
 Urban male smokers > 40-50 years old
Emphysema
 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
COPD
 Prone to periods of “decompensation”
 Triggered by respiratory infections, chest
  trauma
 Signs/Symptoms
    • Respiratory distress
    • Tachypnea
    • Cough productive of green, yellow sputum
COPD Management

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

 Ifwheezing present, nebulized
  bronchodilators via SVN
Alveolar Function Problems
Pulmonary Edema

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

 Signs/Symptoms
 •   Labored breathing
 •   Coughing
 •   Rales, rhonchi
 •   Wheezes
 •   Pink, frothy sputum
Pulmonary Edema

 Signs/Symptoms
 • Sit up
 • High concentration O2
 • Assist ventilation
Pulmonary Embolism

 Clotfrom venous circulation
 Passes through right heart
 Lodges in pulmonary circulation
 Shuts off blood flow past part of alveoli
Pulmonary Embolism

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

   Signs/Symptoms
    •   Dyspnea
    •   Chest pain
    •   Tachycardia
    •   Tachypnea
    •   Hemoptysis


     Sudden Dyspnea + No Readily Identifiable Cause =
                 Pulmonary Embolism
Pulmonary Embolism

 Management
 • Oxygen
 • Assisted ventilation
 • Transport

				
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