The Big Wheeze
CHF vs. COPD
COPD Facts
 COPD
is the 4th leading cause of
death
 122,486 (2007)
 Men – 58,263
 Women – 64,223
Source; cdc.gov/nchs
CHF Facts
 56,565
deaths (2007)
 Males – 21,764
 Females – 34,801
Source; cdc.gov/nchs
The Pink Puffer
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Emphysema
Barrel chest
Thin
Polycythemia
Wheezes
Tripod
Cor Pulmonale
The Blue Bloater
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Chronic Bronchitis
Cyanosis
Overweight
Productive cough
Wheezing
PATHOPHYSIOLOGY
Emphysema
Mild
 Chronic cough
 May be productive
 May use
bronchodilator
 May not seek medical
attention
Moderate
 Seek medical attention
 S.O.B. with exertion
 Bronchodilators
 Pulmonary rehab
Severe
 Oxygen therapy
 Increased S.O.B.
 Episodes of severe
dyspnea
 May need antibiotics
 May need surgical
intervention
End stage
 Increased symptoms
 Frequent episodes of
dyspnea
 Irreversible
Chronic bronchitis
Breakdown of cilia
 Mucous buildup
 Bronchiole
constriction

Signs and Symptoms of COPD
Dyspnea
 Morning headaches
 Weight loss or gain
 Cyanosis
 Pedal edema (cor pulmonale)
 Barrel chest (emphysema)
 Chronic cough

CHF

Systolic dysfunction
◦ Decreased contractility
◦ Decrease in stroke volume
◦ Compensatory rise in preload
CHF

Diastolic dysfunction
◦ 50% have diastolic dysfunction
◦ Reduction in ventricular compliance
◦ Hypertrophy
Signs and Symptoms of CHF
Weakness
 Dyspnea with exertion
 Hypertension
 PND
 Orthopnea
 Pedal edema
 Pulmonary edema

THE BIG WHEEZE
CHF
COPD
Assessment

Signs
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Time of day (PND)
Position (tripod)
Skin color (pink or blue)
Diaphoresis
Vitals signs
Surroundings (O2, inhaler)
Assessment

Pertinent medical history
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Onset (rest or exertion)
Time (acute or persistent)
Medications
Lung sounds
SpO2?
capnography
Capnography
It’s the smoke from the fire of
metabolism
The air we breathe
 Inhalation
 Exhalation
 O2
 O2
= 20.94%
 N2 = 79.01%
 CO2 = 0.04%
= 16.4%
 N2 = 79.6%
 CO2 = 4.0%
METABOLISM
ENERGY
Respiration
 Intact
system
 Adequate rate
 Adequate quality
Circulation
 Intact
system
 Effective pump
 RBC’s
 Hemoglobin
Alveoli
exhale
Inhale
Normal
Bronchoconstriction
TREATMENT
COPD
Work the airway
 Bronchodilators
 Nebulizer
 IV’s
 Cardiac Monitor

Follow your protocol!
CHF

Nitroglycerin
◦ Systolic >100
◦ Rule out RVI
CPAP
 IV’s
 Cardiac Monitor

Follow your protocol
CHF
COPD
QUESTIONS ?
COMMENTS ?
APPLAUSE ????????
THANK YOU!!
Julie Williams, NREMT-P, NCEE
Training Coordinator
Beaufort County EMS
j_williams01@hargray.com