EMS- Respiratory Emergencies (Again)

Steve Cole, Steve Cole,

Paramedic, CCEMT-Paramedic, CCEMT-PP

Respiratory Emergencies Respiratory Emergencies (again)(again)

Why Again?Why Again?

Respiratory Calls are some of the most Respiratory Calls are some of the most Common calls you will see. Common calls you will see.

Respiratory care is as essential as the Respiratory care is as essential as the ABC’sABC’s

Mishandling a respiratory call can be fatal.Mishandling a respiratory call can be fatal. Mishandling a respiratory call can be fatal.Mishandling a respiratory call can be fatal. Mishandling a respiratory call can be fatal.Mishandling a respiratory call can be fatal.

What we are going to discussWhat we are going to discuss

Respiratory PHYSIOLOGYRespiratory PHYSIOLOGY 5 most common respiratory problems in 5 most common respiratory problems in

adults (PEDS will come later)adults (PEDS will come later)

Basic Concept: Basic Concept:

Air Goes in and OutAir Goes in and OutBlood Goes Round and RoundBlood Goes Round and Round

Any thing infringing on this is Any thing infringing on this is a a BAD THINGBAD THING!!

Key ConceptsKey Concepts The primary function of the respiratory The primary function of the respiratory

system is gaseous exchange. system is gaseous exchange. – Ventilation and Oxygenation.Ventilation and Oxygenation.

Air is composed of a mixture of gases. Air is composed of a mixture of gases. Breathing is largely controlled by the Breathing is largely controlled by the

Autonomic Nervous system, in Autonomic Nervous system, in response to changes sensed in all parts response to changes sensed in all parts of the body. The biggest part of this is of the body. The biggest part of this is the “Hypoxic Drive”.the “Hypoxic Drive”.

Key ConceptsKey Concepts

Diffusion of O2 from the lung to the blood is Diffusion of O2 from the lung to the blood is by the binding of O2 to the hemoglobin (Hgb) by the binding of O2 to the hemoglobin (Hgb)

This is dependant on a pressure gradient.This is dependant on a pressure gradient. This is a Passive transport system.This is a Passive transport system. It is also dependant on available surface area It is also dependant on available surface area

and distance it must travel to cross the and distance it must travel to cross the threshold.threshold.

Capillaries are where the real Oxygenation Capillaries are where the real Oxygenation and ventilation take place. and ventilation take place.

Primary ConceptsPrimary Concepts All pt’s with SOB get O2. Lots of O2. All pt’s with SOB get O2. Lots of O2. Listen to ALL lungs. Listen to ALL lungs. Beware of the “silent chest”.Beware of the “silent chest”. Noisy Breathing is abnormal breathingNoisy Breathing is abnormal breathing Visible Breathing is abnormal breathing.Visible Breathing is abnormal breathing. Positional breathing is abnormal breathing.Positional breathing is abnormal breathing. Abnormal Breathing gets O2.Abnormal Breathing gets O2.

VolumeVolume

Tidal VolumeTidal Volume Minute VolumeMinute Volume

– Tidal Volume X Respiratory Rate = Minute Tidal Volume X Respiratory Rate = Minute VolumeVolume

Respiratory PhysiologyRespiratory Physiology

What do we assess?What do we assess?

Presence or absence?Presence or absence? Rate Rate QualityQuality

Respiratory RateRespiratory Rate

Decreased by:Decreased by:– Depressant DrugsDepressant Drugs– SleepSleep

Increased by:Increased by:– FeverFever– FearFear– ExertionExertion

Respiratory QualityRespiratory Quality Irregular: Neuro Insult.Irregular: Neuro Insult. Shallow: Shallow:

– Respiratory DepressantsRespiratory Depressants– CNS DepressantsCNS Depressants– Neuro InsultNeuro Insult

Deep: Deep: – Hyperglycemia with Acidosis (DKA): “Kussmal Hyperglycemia with Acidosis (DKA): “Kussmal

RespirationsRespirations– Electrolyte ImbalancesElectrolyte Imbalances– Neuro InsultNeuro Insult

Adult Lung VolumesAdult Lung Volumes

5,500 to 6,000mL at end inspiration.5,500 to 6,000mL at end inspiration. Normal tidal volume: 500mLNormal tidal volume: 500mL Dead space air: 150mLDead space air: 150mL Alveolar Air: 350mLAlveolar Air: 350mL

Key components of an intact Key components of an intact respiratory systemrespiratory system

An appropriate Drive to BreathAn appropriate Drive to Breath Airway and respiratory tractAirway and respiratory tract Mechanical BellowsMechanical Bellows A diffusion friendly place for gas exchange to A diffusion friendly place for gas exchange to

happen.happen. An O2 friendly RBC with hgb.An O2 friendly RBC with hgb. An intact circulatory system to carry the gasses An intact circulatory system to carry the gasses

and waste through out the body. and waste through out the body. – Must have enough of a pressure to promote diffusion. Must have enough of a pressure to promote diffusion.

An intact capillary bed An intact capillary bed

Drive to breathDrive to breath Controlled by the CNS through information Controlled by the CNS through information

gathered from receptors in the body.gathered from receptors in the body. Located in the pons region of the brainstemLocated in the pons region of the brainstem Detects increases in CO2 or decreases in pH Detects increases in CO2 or decreases in pH

and informs the brain to increase the and informs the brain to increase the respiratory rate.respiratory rate.

Increased respiratory rate reduces CO2 and Increased respiratory rate reduces CO2 and will increase pH.will increase pH.

Other things can effect our drive to breathOther things can effect our drive to breath

““Hypoxic Drive”Hypoxic Drive”

Develops in some patients with Chronic Develops in some patients with Chronic Lung DiseaseLung Disease

Pons region of brain becomes sensitized to Pons region of brain becomes sensitized to constant increased CO2 stateconstant increased CO2 state

Regulation is now based on O2 level in Regulation is now based on O2 level in bloodblood

Increased oxygen level states may tell the Increased oxygen level states may tell the brain to stop breathingbrain to stop breathing

Dr. Slovis’s top 5 effects on Dr. Slovis’s top 5 effects on respiratory drive.respiratory drive.

CVACVA Trauma to the brainTrauma to the brain DrugsDrugs TumorTumor Electrolyte ImbalancesElectrolyte Imbalances

The Airway and Respiratory The Airway and Respiratory tracttract

From the tip of the From the tip of the mouth mouth

To the “Functional To the “Functional Unit of the Lungs”Unit of the Lungs”– AlveoliAlveoli

Functions by negative Functions by negative pressure inspiration.pressure inspiration.

““The means of getting The means of getting cargo to the loading cargo to the loading docks.”docks.”

The Mechanical BellowsThe Mechanical Bellows The muscles of the ribs The muscles of the ribs

expand the size of the expand the size of the chest, creating a (relative) chest, creating a (relative) negative pressure.negative pressure.

Air (with O2) moves in to Air (with O2) moves in to fill the void. fill the void.

Commonly thought of as Commonly thought of as Oxygenation.Oxygenation.

Actual oxygenation takes Actual oxygenation takes place at the cellular level.place at the cellular level.

Special Thanks to Charlie Miller for this Graphic.

The Mechanical BellowsThe Mechanical Bellows The intercostals muscles The intercostals muscles

relax, allowing the chest relax, allowing the chest to return to its neutral to return to its neutral position, expelling air out position, expelling air out of the lungs (and CO2 of the lungs (and CO2 with it.)with it.)

Commonly thought of as Commonly thought of as VentilationVentilation..

Actual ventilation takes Actual ventilation takes place at the cellular level. place at the cellular level.

Special Thanks to Charlie Miller for this Graphic.

The Mechanical BellowsThe Mechanical Bellows

Example of a Example of a Compromised BellowsCompromised Bellows

Positional AsphyxiaPositional Asphyxia

Special Thanks to Charlie Miller for this Graphic.

A diffusion friendly place for gas A diffusion friendly place for gas exchange to happen.exchange to happen.

Diffusion is a passive process. Diffusion is a passive process. Intact capillary bed. Intact capillary bed. Jimmie Edwards Fart Theory.Jimmie Edwards Fart Theory. Things that effect diffusion:Things that effect diffusion:

– Thickness of Membrane the gas has to crossThickness of Membrane the gas has to cross– Surface Area to diffuse acrossSurface Area to diffuse across– Partial Pressure differences in Gas on each side.Partial Pressure differences in Gas on each side.– Physiologic PEEPPhysiologic PEEP

DiffusionDiffusion

An O2 friendly RBC with hgb.An O2 friendly RBC with hgb.

Hemoglobin is an Iron Based compound Hemoglobin is an Iron Based compound essentialessential to the transport of O2. to the transport of O2. – AnemiaAnemia– Cyanide PoisoningCyanide Poisoning– CO PoisoningCO Poisoning

An intact circulatory system An intact circulatory system

Blood LossBlood Loss ShockShock

– Pump ProblemPump Problem– Volume ProblemVolume Problem

» Fluid issueFluid issue» O2 carrying issueO2 carrying issue

– Vessel ProblemVessel Problem

Must have enough of a pressure Must have enough of a pressure to promote diffusion.to promote diffusion.

Conditions like Hypotension cause Conditions like Hypotension cause secondary hypoxia by promoting low secondary hypoxia by promoting low perfusion.perfusion.

Assessing the pt with Respiratory Assessing the pt with Respiratory Distress.Distress.

First ImpressionsFirst Impressions

Air HungryAir Hungry Nasal FlaringNasal Flaring TripodingTripoding Rocking with Rocking with

respirationsrespirations Pursed Lip Pursed Lip

BreathingBreathing Barrel or Sparrow Barrel or Sparrow

ChestChest Home O2Home O2

Skin SignsSkin Signs

CyanosisCyanosis– Nail BedsNail Beds– LipsLips– EarsEars

MottlingMottling– ChestChest– Lower ExtLower Ext– AbdAbd

Noisy breathing is obstructed Noisy breathing is obstructed breathingbreathing

Snoring: obstruction by tongueSnoring: obstruction by tongue Gurgling: Funky Junk in upper airwayGurgling: Funky Junk in upper airway Grunting: Physiologic PEEPGrunting: Physiologic PEEP Stridor: harsh, high pitched sound on Stridor: harsh, high pitched sound on

inhalation: inhalation: – Laryngeal edemaLaryngeal edema– EpiglotitisEpiglotitis– FBAOFBAO

Speech DyspneaSpeech Dyspnea

Inability to speak more than a few sylables Inability to speak more than a few sylables in a sentence between breaths.in a sentence between breaths.

Breath SoundsBreath Sounds

Listening by Listening by comparisoncomparison

Listening anteriorListening anterior Listening posteriorListening posterior FremitusFremitus

Abnormal breath soundsAbnormal breath sounds

Rales (crackles): fine bubbling sound of Rales (crackles): fine bubbling sound of fluid in alveoli (“Rice Krispies”: snap, fluid in alveoli (“Rice Krispies”: snap, crackle and pop) Alveoli popping open.crackle and pop) Alveoli popping open.

Rhonchi: fluid in larger airways, obstructing Rhonchi: fluid in larger airways, obstructing object in the bronchusobject in the bronchus

Wheezes: high pitched whistling, air Wheezes: high pitched whistling, air through narrowed airwaysthrough narrowed airways

SILENCE IS BAD NEWSSILENCE IS BAD NEWS

Causes of respiratory Causes of respiratory abnormalitiesabnormalities

Brain damage: trauma, drugs, strokeBrain damage: trauma, drugs, stroke Spinal cord damage: trauma, polioSpinal cord damage: trauma, polio Upper airways: tongue, swelling, foreign Upper airways: tongue, swelling, foreign

body, traumabody, trauma Lower airways: asthma, chronic bronchitisLower airways: asthma, chronic bronchitis Alveoli: atelectasis, obstruction Alveoli: atelectasis, obstruction Impaired pulmonary circulation: embolismImpaired pulmonary circulation: embolism

Signs/symptoms of distressSigns/symptoms of distress

DyspneaDyspnea Restlessness/anxietyRestlessness/anxiety Tachypnea/BradypneaTachypnea/Bradypnea Cyanosis (core)Cyanosis (core) Abnormal soundsAbnormal sounds RetractionsRetractions Diminished ability to speakDiminished ability to speak

More S/SMore S/S Retractions and/or use of accessory musclesRetractions and/or use of accessory muscles Abdominal breathingAbdominal breathing Nasal flaringNasal flaring Productive coughProductive cough

– Color?Color? Irregular breathing Irregular breathing Tripod positionTripod position Pursed-lip breathingPursed-lip breathing

Take another look ….What do you see?

Hows this?

Pursed Lips

Sparrow Chest

Tripoding

Retractions

Abd retractions

Kewl Haircut

O2

Inadequate Breathing: Infants and Inadequate Breathing: Infants and ChildrenChildren

Retractions

Nasal Flaring

See-Saw Breathing

Diaphragmatic Breathing

BREAK?BREAK?

The Usual SuspectsThe Usual Suspects

Photo by Linda R. Chen - © 1995 Gramercy Pictures.

Top 6 you need to know Top 6 you need to know

COPD/Reactive Airway DisordersCOPD/Reactive Airway Disorders– EmphysemaEmphysema– AsthmaAsthma– BronchitisBronchitis

PneumoniaPneumonia CHFCHF Pulmonary EmboliPulmonary Emboli Hyperventilation DisordersHyperventilation Disorders PneumothoraxPneumothorax

COPDCOPD

Causes of Chronic Obstructive Causes of Chronic Obstructive Pulmonary Disease (COPD)Pulmonary Disease (COPD)

Cigarette smokingCigarette smoking

Environmental pollution Environmental pollution Previous pulmonary infectionsPrevious pulmonary infections Chronic asthmaChronic asthma

Common Traits of COPD’ersCommon Traits of COPD’ers– ““pink puffer”pink puffer”– ““air trapping”air trapping”– destruction of alveoli, destruction of alveoli,

loss of elasticityloss of elasticity– barrel chest/Sparrow barrel chest/Sparrow

ChestChest– use of accessory use of accessory

musclesmuscles– noisy breath sounds: noisy breath sounds:

wheezing prolonged wheezing prolonged and increasing on and increasing on exhalationexhalation

Air TrappingAir Trapping

Due to loss of elasticity in the alveoli, these Due to loss of elasticity in the alveoli, these pt’s trap air. pt’s trap air.

They need over double the exhalation They need over double the exhalation period period

This means inhibited gas exchange and This means inhibited gas exchange and possibly……possibly……

They can develop a spontaneous They can develop a spontaneous pneumothorax.. pneumothorax..

EMPHYSEMAEMPHYSEMA

In Emphysema the chronic damage to the lungs In Emphysema the chronic damage to the lungs interferes with gas exchange.interferes with gas exchange.

A secondary point of exacerbation is the irritation A secondary point of exacerbation is the irritation of the broncheols, making them constrict and of the broncheols, making them constrict and spasm. Since the alveoli are damaged, this spasm. Since the alveoli are damaged, this causes them to collapse easily.causes them to collapse easily.

Chronic BronchitisChronic Bronchitis

““The English Disease”The English Disease” Chronic irritation cause increases mucus Chronic irritation cause increases mucus

production as a defense mechanism. production as a defense mechanism. This in turn decreases surface area for gas This in turn decreases surface area for gas

exchange. exchange. The phlegm also irritates the bronchioles, The phlegm also irritates the bronchioles,

causing bronchio-constriction and spasm.causing bronchio-constriction and spasm.

ASTHMA: causes….ASTHMA: causes….

Reactive airway event caused by Reactive airway event caused by bronchospasm, reversiblebronchospasm, reversible

Extrinsic: environmental, allergic trigger, Extrinsic: environmental, allergic trigger, temperaturetemperature

Intrinsic: exertion/ stress, illness Intrinsic: exertion/ stress, illness Inflammatory reaction Inflammatory reaction

Acute asthmatic attack:Acute asthmatic attack:

Bronchospasm: rapid onset, can be relieved Bronchospasm: rapid onset, can be relieved by medicationsby medications

Swelling of mucous membranes in Swelling of mucous membranes in bronchial walls (inflammatory response)bronchial walls (inflammatory response)

Mucus plugging of bronchiMucus plugging of bronchi

Signs and SymptomsSigns and Symptoms Usually patient has history of asthma, may Usually patient has history of asthma, may

have prescription for medshave prescription for meds ““Noisy” breath sounds (increased on Noisy” breath sounds (increased on

exhalation)exhalation)– BEWARE A SILENT CHESTBEWARE A SILENT CHEST

Accessory muscle useAccessory muscle use Tachycardia and tachypneaTachycardia and tachypnea Pulsus paradoxus (decrease in systolic BP Pulsus paradoxus (decrease in systolic BP

with inhalation)with inhalation) ExhaustionExhaustion

Status AsthmaticusStatus Asthmaticus

Prolonged asthma attack that is not broken Prolonged asthma attack that is not broken by normal treatmentsby normal treatments

Requires aggressive treatment and Requires aggressive treatment and transportationtransportation

A SILENT CHEST IS BAD!A SILENT CHEST IS BAD!

TreatmentTreatment

ReassureReassure High flow humidified High flow humidified

oxygenoxygen Assist with medication Assist with medication

(per protocol)(per protocol) Position of comfortPosition of comfort Insure adequate Insure adequate

ventilationventilation BronchoDilatorsBronchoDilators

BronchodilatorsBronchodilators Beta II agonistBeta II agonist

– Stimulate receptor sites causing bronchiole relaxationStimulate receptor sites causing bronchiole relaxation– First Line.First Line.– AlbuterolAlbuterol

Parasympatholytic Parasympatholytic – Inhibit Parasympathetic broncheoconstrictionInhibit Parasympathetic broncheoconstriction– Second line.Use only onceSecond line.Use only once– AtroventAtrovent

May improve air passage around mucous plugsMay improve air passage around mucous plugs Many side effectsMany side effects

Metered Dose InhalerMetered Dose Inhaler

EMT’s may “assist” a patient with a EMT’s may “assist” a patient with a PRESCRIBEDPRESCRIBED MDI in: MDI in:– Respiratory DistressRespiratory Distress– Allergic reactions with wheezingAllergic reactions with wheezing

BASIC USE OF AN MDIBASIC USE OF AN MDI

Remember to Obtain orders from medical Remember to Obtain orders from medical direction.direction.

Remember the 5 R’sRemember the 5 R’s

Remember the 5 R’sRemember the 5 R’s

RIGHT PATIENTRIGHT PATIENT RIGHT MEDICATIONRIGHT MEDICATION RIGHT DOSERIGHT DOSE RIGHT ROUTERIGHT ROUTE RIGHT SITUATION/TIMERIGHT SITUATION/TIME

Shake vigorouslyShake vigorously

Depress hand-held inhaler asDepress hand-held inhaler aspatient inhales deeply.patient inhales deeply.

Instruct patient to hold/blow out Instruct patient to hold/blow out breath.breath.

Allow patient to breathe. Allow patient to breathe. Repeat dose if ordered.Repeat dose if ordered.

Spacer DeviceSpacer Device

REMEMBER:REMEMBER:ALL THAT WHEEZES IS ALL THAT WHEEZES IS

NOT ASTHMA…..NOT ASTHMA…..AND NOT ALL ASTHMA AND NOT ALL ASTHMA

WHEEZES!WHEEZES!

All that wheezes is not asthma:All that wheezes is not asthma:

Other causes:Other causes:– acute left heart failure (“cardiac asthma”)acute left heart failure (“cardiac asthma”)– smoke inhalationsmoke inhalation– chronic bronchitischronic bronchitis– acute pulmonary embolismacute pulmonary embolism

May be localized: suspect an obstructionMay be localized: suspect an obstruction

The Oxygen Myth and COPDThe Oxygen Myth and COPD

People used to think that if you gave a People used to think that if you gave a COPD’er too much O2, they would stop COPD’er too much O2, they would stop breathing…..breathing…..

This is major BS..purely theoretical at best.This is major BS..purely theoretical at best. In short:In short: If their SOB, they gets lots of O2If their SOB, they gets lots of O2

– ““High Flow” 10-15 LPM NRBHigh Flow” 10-15 LPM NRB

NEVER WITHHOLD OXYGEN NEVER WITHHOLD OXYGEN FROM A PATIENT WHO FROM A PATIENT WHO

NEEDS IT!NEEDS IT!

Signs and SymptomsSigns and Symptoms

Something has changed from normalSomething has changed from normal Marked respiratory distressMarked respiratory distress Diaphoresis, cyanosis Diaphoresis, cyanosis Agitation and confusion (hypoxemia), Agitation and confusion (hypoxemia),

lethargy (hypercarbia)lethargy (hypercarbia) Tachypnea, tachycardia, irregular heart beatTachypnea, tachycardia, irregular heart beat

TreatmentTreatment

Ventilate appropriatelyVentilate appropriately Expect low pulse oximetry: don’t try to Expect low pulse oximetry: don’t try to

raise to “normal” Base on Mental Status raise to “normal” Base on Mental Status and subjective statements. Try at least and subjective statements. Try at least above 85-90%above 85-90%

Position of comfort (upright, tripod)Position of comfort (upright, tripod) Rapid transportRapid transport Monitor ventilationsMonitor ventilations

Pulmonary EdemaPulmonary Edema

Definition: Definition: accumulation of fluid in alveoli, accumulation of fluid in alveoli, chronic or acutechronic or acute

Primary Cause is Cardiac (CHF)Primary Cause is Cardiac (CHF) Other Causes:Other Causes:

– exposure to toxic substancesexposure to toxic substances– damaged tissuedamaged tissue– Actively Dying (ARDS)Actively Dying (ARDS)

Signs and SymptomsSigns and Symptoms

AnxietyAnxiety tachypnea/tachycardiatachypnea/tachycardia dyspnea, hemoptysisdyspnea, hemoptysis abnormal breath sounds (moist, wheezes)abnormal breath sounds (moist, wheezes) JVDJVD Elevated blood pressureElevated blood pressure orthopnea/paroxysmal nocturnal dyspneaorthopnea/paroxysmal nocturnal dyspnea

Treatment:Treatment:

ReassureReassure High flow oxygen (positive pressure)High flow oxygen (positive pressure) NTG (Medical Control Only)NTG (Medical Control Only) Position of comfortPosition of comfort Rapid transportRapid transport

PneumoniaPneumonia

Definition: Definition: infection of respiratory infection of respiratory tree, may result in systemic sepsistree, may result in systemic sepsis

Types:Types:– bacterial 90%bacterial 90%– viral (from influenza)viral (from influenza)– mycoplasmal/fungalmycoplasmal/fungal– aspirationaspiration

Signs and symptomsSigns and symptoms

Patient looks sick/dehydratedPatient looks sick/dehydrated Illness over several daysIllness over several days FeverFever DehydrationDehydration Productive cough Productive cough tachypnea/ tachycardiatachypnea/ tachycardia Rales and rhonchiRales and rhonchi

Treatment:Treatment:

Oxygen and transportOxygen and transport

Pulmonary EmbolismPulmonary Embolism

Definition:Definition:sudden blocking of pulmonary sudden blocking of pulmonary artery by clot artery by clot

Causes: Causes: – blood clots in legsblood clots in legs– prolonged immobilizationprolonged immobilization– birth control pillsbirth control pills

Signs and symptoms:Signs and symptoms:

Sudden onset of severe, unexplained Sudden onset of severe, unexplained dyspneadyspnea

other s/s may or may not be presentother s/s may or may not be present chest pain made worse on coughingchest pain made worse on coughing Tachycardia/tachypneaTachycardia/tachypnea JVDJVD

TreatmentTreatment

RecognitionRecognition OxygenOxygen HospitalizationHospitalization Suspect PE when there is acute onset of Suspect PE when there is acute onset of

tachycardia or dyspnea of unknown origintachycardia or dyspnea of unknown origin

HyperventilationHyperventilation

Definition: Definition: rapid, deep respirations causing rapid, deep respirations causing imbalance of CO2 in body often caused by imbalance of CO2 in body often caused by emotions or stressemotions or stress

May be hard to recognizeMay be hard to recognize There may be other causes of patternThere may be other causes of pattern

Signs and symptomsSigns and symptoms

Elevated respiratory rate or increased depthElevated respiratory rate or increased depth chest painchest pain tingling or numbness around mouth, hands, tingling or numbness around mouth, hands,

feetfeet Carpopedal spasmCarpopedal spasm

Treatment:Treatment:

Do NOT use a paper bagDo NOT use a paper bag Try to calm and reassureTry to calm and reassure Remove patient from environment that may Remove patient from environment that may

be causing problembe causing problem Transport if problem can’t be resolvedTransport if problem can’t be resolved

Spontaneous PneumothoraxSpontaneous Pneumothorax

Definition: Definition: sudden leak of air into pleural sudden leak of air into pleural space; may have no apparent causespace; may have no apparent cause

Frequently young, tall, thin malesFrequently young, tall, thin males May have previous historyMay have previous history

Signs/ symptomsSigns/ symptoms

Sudden, sharp chest painSudden, sharp chest pain Sudden dyspneaSudden dyspnea Diminished breath soundsDiminished breath sounds Pleuritic chest painPleuritic chest pain

TreatmentTreatment

Oxygen and transportOxygen and transport

Other problems:Other problems:

Pickwickian syndrome: patient is VERY Pickwickian syndrome: patient is VERY obese, related to sleep apneaobese, related to sleep apnea

Cystic fibrosisCystic fibrosis Legionnaires (type of pneumonia)Legionnaires (type of pneumonia)

Getting a good history will be one of Getting a good history will be one of the most important ways to the most important ways to differentiate between respiratory differentiate between respiratory conditionsconditions

Look for underlying conditionsLook for underlying conditions

Questions?Questions?