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Dyspnea

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

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Dyspnea

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  1. Dyspnea 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. 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 • 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 > 40-50 years old

  27. 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

  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 • 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. 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

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