The Big Wheeze

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The Big Wheeze

• CHF vs. COPD

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COPD Facts

• COPD is the 4th leading cause of death
• 122,486 (2007)
• Men 58,263
• Women 64,223

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CHF Facts

• 56,565 deaths (2007)
• Males 21,764
• Females 34,801

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The Pink Puffer

• Emphysema
• Barrel chest
• Thin
• Polycythemia
• Wheezes
• Tripod
• Cor Pulmonale

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The Blue Bloater

• Chronic Bronchitis
• Cyanosis
• Overweight
• Productive cough
• Wheezing

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pathophysiology
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Emphysema
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Mild

• Chronic cough
• May be productive
• May use bronchodilator
• May not seek medical attention

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Moderate

• Seek medical attention
• S.O.B. with exertion
• Bronchodilators
• Pulmonary rehab

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Severe

• Oxygen therapy
• Increased S.O.B.
• Episodes of severe dyspnea
• May need antibiotics
• May need surgical intervention

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End stage

• Increased symptoms
• Frequent episodes of dyspnea
• Irreversible

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Chronic bronchitis

• Breakdown of cilia
• Mucous buildup
• Bronchiole constriction

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Signs and Symptoms of COPD

• Dyspnea
• Morning headaches
• Weight loss or gain
• Cyanosis
• Pedal edema (cor pulmonale)
• Barrel chest (emphysema)
• Chronic cough

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CHF

• Systolic dysfunction
• Decreased contractility
• Decrease in stroke volume
• Compensatory rise in preload

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CHF

• Diastolic dysfunction
• 50 have diastolic dysfunction
• Reduction in ventricular compliance
• Hypertrophy

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Signs and Symptoms of CHF

• Weakness
• Dyspnea with exertion
• Hypertension
• PND
• Orthopnea
• Pedal edema
• Pulmonary edema

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THE BIG WHEEZE

• CHF

• COPD

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Assessment

• Signs
• Time of day (PND)
• Position (tripod)
• Skin color (pink or blue)
• Diaphoresis
• Vitals signs
• Surroundings (O2, inhaler)

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Assessment

• Pertinent medical history
• Onset (rest or exertion)
• Time (acute or persistent)
• Medications
• Lung sounds
• SpO2?
• capnography

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Capnography
Its the smoke from the fire of metabolism
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The air we breathe

• Inhalation
• O2 20.94
• N2 79.01
• CO2 0.04

• Exhalation
• O2 16.4
• N2 79.6
• CO2 4.0

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METABOLISM
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ENERGY
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Respiration

• Intact system
• Adequate rate
• Adequate quality

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Circulation

• Intact system
• Effective pump
• RBCs
• Hemoglobin

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Alveoli
exhale
Inhale
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Normal
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Bronchoconstriction
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Treatment
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COPD

• Work the airway
• Bronchodilators
• Nebulizer
• IVs
• Cardiac Monitor
• Follow your protocol!

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CHF

• Nitroglycerin
• Systolic gt100
• Rule out RVI
• CPAP
• IVs
• Cardiac Monitor

Follow your protocol
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CHF
COPD
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ASTHMA
COPD
DKA
TRAUMA
SEIZURES
GI BLEED
HEAD TRAUMA
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QUESTIONS ?
COMMENTS ?
APPLAUSE ????????
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THANK YOU!!

• Julie Williams, NREMT-P, NCEE
• Training Coordinator
• Beaufort County EMS
• j_williams01_at_hargray.com