Respiratory Emergencies: Infectious Disorders

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Respiratory Emergencies Infectious Disorders
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Objectives

• Review frequency of infectious respiratory
  disorders.
• Relate pathophysiology of infectious disorder to
  presenting signs and symptoms.
• Discuss current treatment standards for patients
  with dyspnea from an infectious disorder.

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Introduction

• This topic deals with disorders that alter normal
  gas diffusion in the lungs due to an infectious
  pulmonary problem.
• As in previous topics, the patient will have
  general dyspnea findings, but the history should
  help illustrate the cause.

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Epidemiology

• Lower respiratory infections are a leading cause
  of death worldwide.
• CDC reports recent outbreaks of pertussis in the
  United States.
• VRIs are the most common cause of symptomatic
  disease among children and adults.

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Pathophysiology

• Pneumonia
• Bacteria or virus induced
• Lower respiratory lung infection
• Can result in fluid- or pus-filled alveoli
• Diminishes ventilation (V/Q ratio) with resultant
  dyspnea and blood gas alterations

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Pneumonia causes inflammation of the lungs and
causes the alveoli to fill with fluid or pus,
leading to poor gas exchange.
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Pathophysiology (contd)

• Pertussis
• Whooping cough
• Development of heavy mucus from airway
• Paroxysms of coughing
• Complications include pneumonia, dehydration,
  seizures, brain injuries

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Pathophysiology (contd)

• Viral respiratory infections
• Common VRIs
• Bronchiolitis, colds, flu
• Usually mild and self-limiting
• Can cause upper or lower respiratory infections
• Cause inflammatory response and mucus production
  in airway structures

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Assessment Findings

• General assessment findings
• Common to most patients with dyspnea
• Changes in respiratory rate and breath sounds
• Accessory muscle use
• Tripod positioning and retractions
• Nasal flaring, mouth breathing
• Changes in pulse oximetry and vitals
• Skin change and mental status changes

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Assessment Findings (contd)

• Additional findings with pneumonia
• Malaise and decreased appetite
• Cough (possibly productive)
• General dyspnea findings
• Pleuritic chest pain
• Diaphoresis
• Possible fever

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Assessment Findings (contd)

• Additional findings with pertussis
• History of URI
• Runny nose, low-grade fever
• Episodes of coughing followed by whooping sound
• Fatigue from coughing

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Assessment Findings (contd)

• Additional findings with a VRI
• Nasal congestion
• Irritated or painful throat
• Mild dyspnea
• Fever
• Malaise, headache, body ache
• Poor feeding in infants

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Emergency Medical Care

• Ensure airway adequacy.
• Provide oxygen based on ventilatory need.
• NRB mask at 15 lpm with adequate breathing
• PPV with 15 lpm oxygen with inadequate breathing

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Emergency Medical Care (contd)

• Administer inhaled bronchodilator PRN.
• Keep patient sitting upright if possible.
• Provide rapid transport to the ED.

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Case Study

• You are called to an elder care facility for a
  patient with an altered mental status. Upon your
  arrival, you are escorted to a patient's room
  where an elderly male patient lies in bed,
  seemingly asleep.

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Case Study (contd)

• Scene Size-Up
• Scene is safe, standard precautions taken.
• Patient is 91 years old, about 145 lbs.
• Entry and egress from room is unobstructed.
• NOI appears to be altered mental status.
• No additional resources needed.

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Case Study (contd)

• Primary Assessment Findings
• Patient moans to loud verbal stimuli.
• Airway patent and self-maintained.
• Breathing adequate but tachypneic.
• Central and peripheral pulses present.
• Skin is noted to be diaphoretic.

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Case Study (contd)

• Medical History
• Patient has history of pancreatic cancer
• Medications
• Primarily comfort medications
• Allergies
• Demerol

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Case Study (contd)

• Pertinent Secondary Assessment Findings
• Pupils equal and reactive, membranes dry.
• Airway patent, breathing rapid with markedly
  diminished breath sounds over left lung some
  crackles and rhonchi discernible.
• Peripheral perfusion intact, heart rate fast and
  regular.

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Case Study (contd)

• Pertinent Secondary Assessment Findings
  (continued)
• Pulse ox 92 on room air, B/P WNL.
• Skin diaphoretic and warm.
• Patient has not eaten for a day and a half.
• Fever 101.5 F

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Case Study (contd)

• What pathologic change is causing the abnormal
  breath sounds?
• What respiratory condition does this patient
  likely have?
• What would be three assessment findings that
  could confirm your suspicion?

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Case Study (contd)

• Care provided
• Patient placed on high-flow oxygen.
• Placed in a semi-Fowler position on wheeled cot.
• Transport initiated to ED.

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Summary

• With infectious disorders, many times the
  presentation will be the same despite a varied
  etiologic background.
• Fortunately, treatment of most all infectious
  diseases is similar enough that if the exact
  cause is not known, the treatment will still be
  appropriate.