Dyspnea

Temple College EMS Professions

Dyspnea

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

Hyperventilation Syndrome

 Response to stress, anxiety  Patient exhales CO 2 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 CO 2 from face mask with oxygen flowing at 1 to 2 liters/minute

Upper Airway

 Foreign Body Obstruction  Pharyngeal Edema  Croup  Epiglottitis

Foreign Body Obstruction

 Partial or complete  Most common cause of pediatric airway obstruction

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

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  Viral infection  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  Bronchial edema  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

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

Asthma

 Treatment • High concentration O 2 , humidified • • • Position of comfort Assist ventilation as needed Bronchodilators via small volume nebulizer • Calm patient, reassure

Chronic Obstructive Pulmonary Disease

 Chronic Bronchitis  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 CO 2 , decreased 0 2  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 CO 2 , maintain near normal O 2  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

 If wheezing present, nebulized bronchodilators via SVN

Alveolar Function Problems

Pulmonary Edema

 Fluid in/around alveoli, small airways  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 O 2 Assist ventilation

Pulmonary Embolism

 Clot from 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