chapter 27 shortness of breath. © 2005 by thomson delmar learning,a part of the thomson...

Chapter 27Shortness of Breath

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Anatomy Review Physiology Review Normal Breathing Respiratory Distress Causes of Shortness of Breath

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Anatomy Review

Respiratory system is made up of:– Airways– Lungs– Blood vessels

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Anatomy Review

Upper airway– Passage of air:

• Nose and mouth• Pharynx• Trachea

– Differences in pediatric patients

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Anatomy Review

Respiratory tree– Trachea– Bronchi– Bronchioles– Alveoli

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Anatomy Review

Respiratory tree– Capillaries: gas exchange

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Anatomy Review

Musculature– Multiple muscles involved in ventilation– Ventilation is the movement of air into and

out of the lungs– Ventilation is unconscious

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Anatomy Review

Musculature– Diaphragm

• A large muscle in the chest • Controlled by nerves from the cervical spinal cord

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Anatomy Review

Musculature– Chest wall muscles

• Help raise the chest• Called the accessory muscles of respiration

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Physiology Review

Respiratory drive– Normal person’s respiratory rate is determined

by the carbon dioxide level– The higher the level, the more stimulation

to breathe– COPD patients

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Physiology Review

Ventilation– Inhalation

• Diaphragm contracts and moves downward• Air is pulled into the chest

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Physiology Review

Ventilation– Exhalation

• Diaphragm relaxes• Passive

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Physiology Review

Respiration Ventilation

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Physiology Review

Respiration– Pulmonary respiration

• Diffusion• Gas exchange• Passive process

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Physiology Review

Respiration– Cellular respiration

• Process which allows the exchange of gases in the periphery

• Uses the same process of diffusion

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Normal Breathing

Breathing normally takes minimal effort The brain sets the breathing rate

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Normal Breathing

Patient appearance– Respiratory difficulty is often

obvious upon looking at the patient• Normal breathing• Respiratory difficulty• Patient may be tired from the effort of

breathing

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Normal Breathing

Lung sounds– Wheezing– Rhonchi– Crackles

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Normal Breathing

Rates and patterns– Normal: 12–20– Pediatric: 15–30– Infants: 25–50

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Normal Breathing

Vital signs– Normal breathing should be reflected in normal

heart rate and blood pressure

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Normal Breathing

Mucous membrane color– Adequate gas exchange—pink– Inadequate gas exchange—bluish– Cyanosis

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Respiratory Distress

Classic signs and symptoms The EMT must recognize them

and act quickly

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Signs and symptoms– Patient may describe own difficulty breathing– Other signs:

• Increased respiratory rate• Increased heart rate• Cyanosis

– Progression of symptoms

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Assessment– Initial assessment

• Very brief• Correct any threats to breathing

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Assessment– Focused history and physical examination

• Done after life threats have been managed• Gather relevant history

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• Responsive patient– Ask about the illness and any remedies tried

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• Responsive patient– Assess lung sounds– Look for JVD– Note skin color– Assess vital signs

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• Unresponsive patient– Complete a rapid physical examination– Obtain vital signs– Obtain history from any family or bystanders

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• Rapid physical examination– After the initial assessment– Look for cause of breathing difficulty

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• Vital signs– The next priority– Pulse oximetry

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• History from others– When patient is unresponsive

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Stop and Review

How would you determine if a patient was having difficulty breathing?

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Management– Oxygen

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Management– Spontaneously breathing patient

• Non-rebreather mask• Nasal cannula

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Management– Assisting ventilations

• Bag valve mask

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Management– Intubation

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Management– Positioning

• Sitting up• Whatever is most comfortable

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Prescribed medications– Patient may need help – Contact medical control

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Prescribed medications– Bronchodilator inhalers

• Inhaled directly into the airways• Help relieve the spasm

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Transport– Initiate quickly for patients in respiratory distress– Obtain a quick history

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Transport– Destination decisions– Advanced life support

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Ongoing assessment Reassessment

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Airway– Foreign body obstruction

• Blocks oxygen from the body• Heimlich maneuver

Causes of Shortness of Breath

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Airway– Epiglottitis

• May occlude the airway• More common in pediatric patients


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• Signs and symptoms– Child will be frightened– Fever, cough, difficulty breathing– Drooling


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• Management– Keep patient calm– Do not examine mouth or throat– Notify receiving hospital– Use a BVM, if necessary


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Airway– Croup

• Viral infection• Not as aggressive as epiglottitis


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Airway– Croup

• Signs and symptoms– May accompany upper respiratory infection – Bark-like cough


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Airway– Croup

• Management– Keep patient calm– Cool humidified oxygen– Notify hospital


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Breathing– Bronchospasm– Asthma


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Breathing– Asthma

• Signs and symptoms– Distress– Elevated respiratory rate– Wheezing


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Asthma

Watch this animation showing the effects of asthma on the airway

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Breathing– Asthma

• Management– ABCs– Assist with inhaler– High-flow oxygen– Transport to hospital

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Breathing– Chronic obstructive pulmonary disease

• Emphysema and chronic bronchitis make up a majority of this group

• Combination of bronchospasm and inflammation


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• Signs and symptoms– Exacerbated by respiratory infection– Shortness of breath– Hypoxic drive


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• Management– ABCs– High-flow oxygen– Assist with medications– Transport to the hospital


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Breathing– Respiratory infections– Signs and symptoms– Management


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Breathing– Chronic lung diseases

• Administer oxygen


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Circulation– Pulmonary embolus

• Signs and symptoms• Management


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Circulation– Pulmonary edema

• Fluid in the lungs• Signs and symptoms• Management

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Stop and Review

What is the prehospital management for COPD?

What is one potential pitfall an EMT needs to be mindful of in treating epiglottitis?

chapter 27 shortness of breath. © 2005 by thomson delmar learning,a part of the thomson...

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