Dyspnea
Temple College
EMS Professions
Dyspnea
 Subjective
sensation of:
• Difficult, labored breathing or
• Shortness of breath
Hyperventilation Syndrome
 Response
to stress, anxiety
 Patient exhales CO2 faster than
metabolism produces it
 Blood vessels in brain constrict
 Anxiety, dizziness, lightheadedness
 Seizures, unconsciousness
Hyperventilation Syndrome
 Chest
pains, dyspnea
 Numbness, tingling of fingers, toes,
area around mouth, nose
 Carpopedal spasms of hands, feet
Hyperventilation Syndrome
 Treatment
•
•
•
•
Obtain thorough history
Avoiding misdiagnosis is critical
Try to “talk patient down”
Re-breathe CO2 from face mask with
oxygen flowing at 1 to 2 liters/minute
Upper Airway
 Foreign
Body Obstruction
 Pharyngeal Edema
 Croup
 Epiglottitis
Foreign Body Obstruction
 Partial
or complete
 Most common cause of pediatric
airway obstruction
Foreign Body Obstruction
 Suspect
in any child with
• Sudden onset of dyspnea
• Decreased LOC
 Suspect
in any adult who develops
dyspnea or loses consciousness while
eating
Foreign Body Obstruction
 Management
• Partial with good air exchange
• Partial with poor air exchange
• Complete
Pharyngeal Edema
 Swelling
of soft tissues of throat
 Allergic reactions, upper airway burns
 Hoarseness, stridor, drooling
Pharyngeal Edema
 Management
•
•
•
•
Position of comfort
Oxygen
Assist breathing as needed
Consider ALS intercept for invasive airway
management
Epiglottitis
 Bacterial
infection
 Causes edema of epiglottis
 Children age 4-7 years
 Increasingly common in adults
 Rapid onset, high fever, stridor, sore
throat, drooling
Epiglottitis
 Can
progress to complete obstruction
 Do not look in throat
 Do not use obstructed airway maneuver
Croup
 Laryngotracheobronchitis
 Viral
infection
 Causes edema of larynx/trachea
 Children ages 6 months to 4 years
Croup
 Slow
onset, hoarseness, brassy cough,
nightime stridor, dyspnea
 When in doubt, manage as epiglottitis
Croup/Epiglottitis
 Management
•
•
•
•
•
Oxygen
Assist ventilations as needed
Do not excite patient
Do not look in throat
Consider ALS intercept
Lower Airway
 Asthma
 Chronic
Obstructive Pulmonary Disease
• Chronic bronchitis
• Emphysema
Asthma
 Reversible
obstructive pulmonary
disease
 Younger person’s disease (80% have
first episode before age 30)
 Lower airway hypersensitive to
allergens, emotional stress, irritants,
infection
Asthma
 Bronchospasm
 Bronchial
edema
 Increased mucus production, plugging
Resistance to airflow, work of
breathing increase
Asthma
 Airway
narrowing interferes with
exhalation
 Air trapped in chest interferes with gas
exchange
 Wheezing, coughing, respiratory
distress
Asthma
 All
that wheezes is not asthma
 Other possibilities
•
•
•
•
•
Pulmonary edema
Pulmonary embolism
Anaphalaxis (severe allergic reaction)
Foreign body aspiration
Pneumonia
Asthma
 Treatment
•
•
•
•
High concentration O2, humidified
Position of comfort
Assist ventilation as needed
Bronchodilators via small volume
nebulizer
• Calm patient, reassure
Chronic Obstructive Pulmonary
Disease
 Chronic
Bronchitis
 Emphysema
Chronic Bronchitis
 Chronic
lower airway inflammation
• Increased bronchial mucus
production
• Productive cough
 Urban male smokers > 30 years old
Chronic Bronchitis
Mucus, swelling interfere with ventilation
 Increased CO2, decreased 02
 Cyanosis occurs early in disease
 Lung disease overworks right ventricle
 Right heart failure occurs
 RHF produces peripheral edema

Blue Bloater
Emphysema
 Loss
of elasticity in small airways
 Destruction of alveolar walls
 Urban male smokers > 40-50 years old
Emphysema
Lungs lose elastic recoil
 Retain CO2, maintain near normal O2
 Cyanosis occurs late in disease
 Barrel chest (increased AP diameter)
 Thin, wasted
 Prolonged exhalation through pursed lips

Pink Puffer
COPD
Prone to periods of “decompensation”
 Triggered by respiratory infections, chest
trauma
 Signs/Symptoms

• Respiratory distress
• Tachypnea
• Cough productive of green, yellow sputum
COPD Management
 Oxygen
• Monitor carefully
• Some COPD patients may
experience respiratory depression on
high concentration oxygen
 Assist
ventilations as needed
COPD Management
 If
wheezing present, nebulized
bronchodilators via SVN
Alveolar Function Problems
Pulmonary Edema
 Fluid
in/around alveoli, small airways
 Causes
•
•
•
•
•
Left heart failure
Toxic inhalants
Aspiration
Drowning
Trauma
Pulmonary Edema
 Signs/Symptoms
•
•
•
•
•
Labored breathing
Coughing
Rales, rhonchi
Wheezes
Pink, frothy sputum
Pulmonary Edema
 Signs/Symptoms
• Sit up
• High concentration O2
• Assist ventilation
Pulmonary Embolism
 Clot
from venous circulation
 Passes through right heart
 Lodges in pulmonary circulation
 Shuts off blood flow past part of alveoli
Pulmonary Embolism
 Associated
•
•
•
•
•
with:
Prolonged bed rest or immobilization
Casts or orthopedic traction
Pelvic or lower extremity surgery
Phlebitis
Use of BCPs
Pulmonary Embolism

Signs/Symptoms
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•
•
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Dyspnea
Chest pain
Tachycardia
Tachypnea
Hemoptysis
Sudden Dyspnea + No Readily Identifiable Cause =
Pulmonary Embolism
Pulmonary Embolism
 Management
• Oxygen
• Assisted ventilation
• Transport