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Dyspnea

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Chronic bronchitis. Emphysema. Asthma. Reversible obstructive ... Chronic Bronchitis. Mucus, swelling interfere with ventilation. Increased CO2, decreased 02 ... – PowerPoint PPT presentation

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Title: Dyspnea


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 persons 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 gt 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 gt 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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