Emt dyspnea

DyspneaDyspnea

Temple CollegeTemple College

EMS ProfessionsEMS Professions

DyspneaDyspnea

Subjective sensation of: Subjective sensation of: • Difficult, labored breathing orDifficult, labored breathing or

• Shortness of breathShortness of breath

Hyperventilation Hyperventilation SyndromeSyndrome

Response to stress, anxietyResponse to stress, anxiety Patient exhales COPatient exhales CO2 2 faster than faster than

metabolism produces itmetabolism produces it Blood vessels in brain constrictBlood vessels in brain constrict Anxiety, dizziness, lightheadednessAnxiety, dizziness, lightheadedness Seizures, unconsciousnessSeizures, unconsciousness


Chest pains, dyspneaChest pains, dyspnea Numbness, tingling of fingers, toes, Numbness, tingling of fingers, toes,

area around mouth, nose area around mouth, nose Carpopedal spasms of hands, feetCarpopedal spasms of hands, feet


TreatmentTreatment• Obtain thorough historyObtain thorough history• Avoiding misdiagnosis is Avoiding misdiagnosis is criticalcritical• Try to “talk patient down”Try to “talk patient down”

• Re-breathe CORe-breathe CO22 from face mask with from face mask with

oxygen flowing at 1 to 2 liters/minuteoxygen flowing at 1 to 2 liters/minute

Upper AirwayUpper Airway

Foreign Body ObstructionForeign Body Obstruction Pharyngeal EdemaPharyngeal Edema CroupCroup EpiglottitisEpiglottitis

Foreign Body Foreign Body ObstructionObstruction

Partial or completePartial or completeMost common cause of pediatric Most common cause of pediatric

airway obstructionairway obstruction


Suspect in any child with Suspect in any child with • Sudden onset of dyspneaSudden onset of dyspnea• Decreased LOCDecreased LOC

Suspect in any adult who develops Suspect in any adult who develops dyspnea or loses consciousness while dyspnea or loses consciousness while eatingeating


ManagementManagement• Partial with good air exchangePartial with good air exchange

• Partial with poor air exchangePartial with poor air exchange

• CompleteComplete

Pharyngeal EdemaPharyngeal Edema

Swelling of soft tissues of throatSwelling of soft tissues of throat Allergic reactions, upper airway burnsAllergic reactions, upper airway burns Hoarseness, stridor, droolingHoarseness, stridor, drooling

Pharyngeal EdemaPharyngeal Edema

ManagementManagement• Position of comfortPosition of comfort• OxygenOxygen• Assist breathing as neededAssist breathing as needed• Consider ALS intercept for invasive airway Consider ALS intercept for invasive airway

managementmanagement

EpiglottitisEpiglottitis

Bacterial infection Bacterial infection Causes edema of epiglottisCauses edema of epiglottis Children age 4-7 years Children age 4-7 years Increasingly common in adultsIncreasingly common in adults Rapid onset, high fever, stridor, Rapid onset, high fever, stridor, sore sore

throatthroat, , droolingdrooling

EpiglottitisEpiglottitis

Can progress to complete obstructionCan progress to complete obstruction Do Do notnot look in throat look in throat Do Do notnot use obstructed airway maneuver use obstructed airway maneuver

CroupCroup

LaryngotracheobronchitisLaryngotracheobronchitis Viral infectionViral infection Causes edema of larynx/tracheaCauses edema of larynx/trachea Children ages 6 months to 4 yearsChildren ages 6 months to 4 years

CroupCroup

Slow onset, hoarseness, brassy cough, Slow onset, hoarseness, brassy cough, nightime stridor, dyspneanightime stridor, dyspnea

When in doubt, manage as epiglottitisWhen in doubt, manage as epiglottitis

Croup/Epiglottitis Croup/Epiglottitis

ManagementManagement• OxygenOxygen

• Assist ventilations as neededAssist ventilations as needed

• Do Do notnot excite patient excite patient

• Do Do notnot look in throat look in throat

• Consider ALS interceptConsider ALS intercept

Lower AirwayLower Airway

AsthmaAsthma Chronic Obstructive Pulmonary DiseaseChronic Obstructive Pulmonary Disease

• Chronic bronchitisChronic bronchitis• EmphysemaEmphysema

AsthmaAsthma

Reversible obstructive pulmonary Reversible obstructive pulmonary diseasedisease

Younger person’s disease (80% have Younger person’s disease (80% have first episode before age 30)first episode before age 30)

Lower airway hypersensitive to Lower airway hypersensitive to allergens, emotional stress, irritants, allergens, emotional stress, irritants, infectioninfection

AsthmaAsthma

BronchospasmBronchospasm Bronchial edemaBronchial edema Increased mucus production, pluggingIncreased mucus production, plugging

Resistance to airflow, work of breathing increase

AsthmaAsthma

Airway narrowing interferes with Airway narrowing interferes with exhalationexhalation

Air trapped in chest interferes with gas Air trapped in chest interferes with gas exchangeexchange

Wheezing, coughing, respiratory Wheezing, coughing, respiratory distressdistress

AsthmaAsthma

All that wheezes is All that wheezes is notnot asthma asthma Other possibilitiesOther possibilities

• Pulmonary edemaPulmonary edema• Pulmonary embolismPulmonary embolism• Anaphalaxis (severe allergic reaction)Anaphalaxis (severe allergic reaction)• Foreign body aspirationForeign body aspiration• PneumoniaPneumonia

AsthmaAsthma

TreatmentTreatment• High concentration OHigh concentration O22, humidified, humidified

• Position of comfortPosition of comfort

• Assist ventilation as neededAssist ventilation as needed

• Bronchodilators via small volume Bronchodilators via small volume nebulizernebulizer

• Calm patient, reassureCalm patient, reassure

Chronic Obstructive Chronic Obstructive Pulmonary DiseasePulmonary Disease

Chronic BronchitisChronic BronchitisEmphysemaEmphysema

Chronic BronchitisChronic Bronchitis

Chronic lower airway inflammationChronic lower airway inflammation

• Increased bronchial mucus Increased bronchial mucus productionproduction

• Productive coughProductive cough Urban male smokers > 30 years oldUrban male smokers > 30 years old

Chronic BronchitisChronic Bronchitis

Mucus, swelling interfere with ventilationMucus, swelling interfere with ventilation Increased COIncreased CO22, decreased 0, decreased 022

CyanosisCyanosis occurs occurs earlyearly in disease in disease Lung disease overworks right ventricleLung disease overworks right ventricle Right heart failure occursRight heart failure occurs RHF produces peripheral edemaRHF produces peripheral edema

Blue Bloater

EmphysemaEmphysema

Loss of elasticity in small airwaysLoss of elasticity in small airways Destruction of alveolar wallsDestruction of alveolar walls Urban male smokers > 40-50 years oldUrban male smokers > 40-50 years old

EmphysemaEmphysema

Lungs lose elastic recoil Lungs lose elastic recoil Retain CORetain CO22, maintain near normal O, maintain near normal O22

CyanosisCyanosis occurs occurs latelate in disease in disease Barrel chest (increased AP diameter) Barrel chest (increased AP diameter) Thin, wastedThin, wasted Prolonged exhalation through pursed lipsProlonged exhalation through pursed lips

Pink Puffer

COPDCOPD

Prone to periods of “decompensation”Prone to periods of “decompensation” Triggered by respiratory infections, chest Triggered by respiratory infections, chest

traumatrauma Signs/SymptomsSigns/Symptoms

• Respiratory distressRespiratory distress• TachypneaTachypnea• Cough productive of green, yellow sputumCough productive of green, yellow sputum

COPD ManagementCOPD Management

OxygenOxygen• Monitor carefullyMonitor carefully

• Some COPD patients may Some COPD patients may experience respiratory depression on experience respiratory depression on high concentration oxygenhigh concentration oxygen

Assist ventilations as neededAssist ventilations as needed

COPD ManagementCOPD Management

If wheezing present, nebulized If wheezing present, nebulized bronchodilators via SVNbronchodilators via SVN

Alveolar Function Alveolar Function ProblemsProblems

Pulmonary EdemaPulmonary Edema

Fluid in/around alveoli, small airwaysFluid in/around alveoli, small airways CausesCauses

• Left heart failureLeft heart failure• Toxic inhalantsToxic inhalants• AspirationAspiration• DrowningDrowning• TraumaTrauma


Signs/SymptomsSigns/Symptoms• Labored breathingLabored breathing

• CoughingCoughing

• Rales, rhonchiRales, rhonchi

• WheezesWheezes

• Pink, frothy sputumPink, frothy sputum


Signs/SymptomsSigns/Symptoms• Sit upSit up

• High concentration OHigh concentration O22

• Assist ventilationAssist ventilation

Pulmonary EmbolismPulmonary Embolism

Clot from venous circulation Clot from venous circulation Passes through right heartPasses through right heart Lodges in pulmonary circulationLodges in pulmonary circulation Shuts off blood flow past part of alveoliShuts off blood flow past part of alveoli


Associated with:Associated with:• Prolonged bed rest or immobilizationProlonged bed rest or immobilization

• Casts or orthopedic tractionCasts or orthopedic traction

• Pelvic or lower extremity surgeryPelvic or lower extremity surgery

• PhlebitisPhlebitis

• Use of BCPsUse of BCPs


Signs/SymptomsSigns/Symptoms• DyspneaDyspnea• Chest painChest pain• TachycardiaTachycardia• TachypneaTachypnea• HemoptysisHemoptysis

Sudden Dyspnea + No Readily Identifiable Cause = Pulmonary Embolism


ManagementManagement• OxygenOxygen

• Assisted ventilationAssisted ventilation

• TransportTransport

Health & Medicine

Emt dyspnea