Dyspnea Dyspnea b Subjective sensation of Difficult labored

Dyspnea

Dyspnea b Subjective sensation of: • Difficult, labored breathing or • Shortness of breath

Hyperventilation Syndrome b Response to stress, anxiety b Patient exhales CO 2 faster than metabolism produces it b Blood vessels in brain constrict b Anxiety, dizziness, lightheadedness b Seizures, unconsciousness

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

Hyperventilation Syndrome b Treatment • • Obtain thorough history Avoiding misdiagnosis is critical Try to “talk patient down” Re-breathe CO 2 from face mask with oxygen flowing at 1 to 2 liters/minute

Upper Airway b Foreign Body Obstruction b Pharyngeal Edema b Croup b Epiglottitis

Foreign Body Obstruction b Partial or complete b Most common cause of pediatric airway obstruction

Foreign Body Obstruction b Suspect in any child with • Sudden onset of dyspnea • Decreased LOC b Suspect in any adult who develops dyspnea or loses consciousness while eating

Foreign Body Obstruction b Management • • • Partial with good air exchange Partial with poor air exchange Complete

Pharyngeal Edema b Swelling of soft tissues of throat b Allergic reactions, upper airway burns b Hoarseness, stridor, drooling

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

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

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

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

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

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

Lower Airway b Asthma b Chronic • • Obstructive Pulmonary Disease Chronic bronchitis Emphysema

Asthma b Reversible obstructive pulmonary disease b Younger person’s disease (80% have first episode before age 30) b Lower airway hypersensitive to allergens, emotional stress, irritants, infection

Asthma b Bronchospasm b Bronchial edema b Increased mucus production, plugging Resistance to airflow, work of breathing increase

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

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

Asthma b Treatment • • High concentration O 2, humidified Position of comfort Assist ventilation as needed Bronchodilators via small volume nebulizer • Calm patient, reassure

Chronic Obstructive Pulmonary Disease b Chronic Bronchitis b Emphysema

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

Chronic Bronchitis b Mucus, swelling interfere with ventilation b Increased CO 2, decreased 02 b Cyanosis occurs early in disease b Lung disease overworks right ventricle b Right heart failure occurs b RHF produces peripheral edema Blue Bloater

Emphysema b Loss of elasticity in small airways b Destruction of alveolar walls b Urban male smokers > 40 -50 years old

Emphysema b Lungs lose elastic recoil b Retain CO 2, maintain near normal O 2 b Cyanosis occurs late in disease b Barrel chest (increased AP diameter) b Thin, wasted b Prolonged exhalation through pursed lips Pink Puffer

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

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

COPD Management b If wheezing present, nebulized bronchodilators via SVN

Alveolar Function Problems

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

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

Pulmonary Edema b Signs/Symptoms • • • Sit up High concentration O 2 Assist ventilation

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

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

Pulmonary Embolism b Signs/Symptoms • • • Dyspnea Chest pain Tachycardia Tachypnea Hemoptysis Sudden Dyspnea + No Readily Identifiable Cause = Pulmonary Embolism

Pulmonary Embolism b Management • • • Oxygen Assisted ventilation Transport