Dyspnea

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Dyspnea

• Temple College
• EMS Professions

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Dyspnea

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

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Hyperventilation Syndrome

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

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Hyperventilation Syndrome

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

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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

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Upper Airway

• Foreign Body Obstruction
• Pharyngeal Edema
• Croup
• Epiglottitis

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Foreign Body Obstruction

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

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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

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Foreign Body Obstruction

• Management
• Partial with good air exchange
• Partial with poor air exchange
• Complete

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Pharyngeal Edema

• Swelling of soft tissues of throat
• Allergic reactions, upper airway burns
• Hoarseness, stridor, drooling

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Pharyngeal Edema

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

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Epiglottitis

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

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Epiglottitis

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

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Croup

• Laryngotracheobronchitis
• Viral infection
• Causes edema of larynx/trachea
• Children ages 6 months to 4 years

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Croup

• Slow onset, hoarseness, brassy cough, nightime
  stridor, dyspnea
• When in doubt, manage as epiglottitis

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Croup/Epiglottitis

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

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Lower Airway

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

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Asthma

• Reversible obstructive pulmonary disease
• Younger persons disease (80 have first episode
  before age 30)
• Lower airway hypersensitive to allergens,
  emotional stress, irritants, infection

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Asthma

• Bronchospasm
• Bronchial edema
• Increased mucus production, plugging

Resistance to airflow, work of breathing increase
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Asthma

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

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Asthma

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

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Asthma

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

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Chronic Obstructive Pulmonary Disease

• Chronic Bronchitis
• Emphysema

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Chronic Bronchitis

• Chronic lower airway inflammation
• Increased bronchial mucus production
• Productive cough
• Urban male smokers gt 30 years old

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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
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Emphysema

• Loss of elasticity in small airways
• Destruction of alveolar walls
• Urban male smokers gt 40-50 years old

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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
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COPD

• Prone to periods of decompensation
• Triggered by respiratory infections, chest trauma
• Signs/Symptoms
• Respiratory distress
• Tachypnea
• Cough productive of green, yellow sputum

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COPD Management

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

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COPD Management

• If wheezing present, nebulized bronchodilators
  via SVN

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Alveolar Function Problems
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Pulmonary Edema

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

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Pulmonary Edema

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

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Pulmonary Edema

• Signs/Symptoms
• Sit up
• High concentration O2
• Assist ventilation

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Pulmonary Embolism

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

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Pulmonary Embolism

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

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Pulmonary Embolism

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

Sudden Dyspnea No Readily Identifiable Cause

Pulmonary Embolism
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Pulmonary Embolism

• Management
• Oxygen
• Assisted ventilation
• Transport