Pulmonology Pulmonology
PulmonologyPulmonology
SectionsSections Review of Respiratory Anatomy
& Physiology Pathophysiology Assessment of the Respiratory
System Management of Respiratory
Disorders Specific Respiratory Diseases
Review of Respiratory Anatomy
& Physiology Pathophysiology Assessment of the Respiratory
System Management of Respiratory
Disorders Specific Respiratory Diseases
Respiratory AnatomyRespiratory Anatomy
Upper AirwayNasal CavityNasopharynxOropharynxLaryngopharynxLarynx
Upper AirwayNasal CavityNasopharynxOropharynxLaryngopharynxLarynx
Respiratory AnatomyRespiratory Anatomy
Upper AirwayThe Sinuses
Upper AirwayThe Sinuses
Respiratory AnatomyRespiratory Anatomy Lower
AirwayTracheaBronchi
Lower AirwayTracheaBronchi
Respiratory AnatomyRespiratory Anatomy Lower Airway
AlveoliLungsPulmonary and Bronchial Vessels
Lower AirwayAlveoliLungsPulmonary and Bronchial Vessels
Respiratory PhysiologyRespiratory Physiology
VentilationBody Structures
Chest Wall Pleura Diaphragm
VentilationBody Structures
Chest Wall Pleura Diaphragm
Respiratory PhysiologyRespiratory Physiology
VentilationInspiration
VentilationInspiration
Respiratory PhysiologyRespiratory Physiology
VentilationExpiration
VentilationExpiration
Respiratory PhysiologyRespiratory Physiology
VentilationAirway Resistance & Lung ComplianceLung Volumes
VentilationAirway Resistance & Lung ComplianceLung Volumes
Respiratory PhysiologyRespiratory Physiology
VentilationRegulation of Ventilation
The Medulla Stretch Receptors Changes in PCO2
COPD Patients
VentilationRegulation of Ventilation
The Medulla Stretch Receptors Changes in PCO2
COPD Patients
Respiratory PhysiologyRespiratory Physiology
DiffusionInterference with Diffusion
Trauma Fluid accumulation in interstitial spaces Thickening of the endothelial lining
Effect of Oxygen Therapy
DiffusionInterference with Diffusion
Trauma Fluid accumulation in interstitial spaces Thickening of the endothelial lining
Effect of Oxygen Therapy
Respiratory PhysiologyRespiratory Physiology
Pulmonary PerfusionRequirements
Adequate blood volume Intact pulmonary capillaries Efficient pumping action by the heart
HemoglobinCarbon Dioxide
Pulmonary PerfusionRequirements
Adequate blood volume Intact pulmonary capillaries Efficient pumping action by the heart
HemoglobinCarbon Dioxide
PathophysiologyPathophysiology
Disruption in VentilationUpper & Lower Respiratory Tracts
Obstruction due to trauma or infectious processes
Chest Wall & Diaphragm Trauma
• Pneumothorax• Hemothorax• Flail chest
Neuromuscular disease
Disruption in VentilationUpper & Lower Respiratory Tracts
Obstruction due to trauma or infectious processes
Chest Wall & Diaphragm Trauma
• Pneumothorax• Hemothorax• Flail chest
Neuromuscular disease
PathophysiologyPathophysiology
Disruption in VentilationNervous System
Trauma Poisoning or Overdose Disease
Disruption in VentilationNervous System
Trauma Poisoning or Overdose Disease
PathophysiologyPathophysiology
Disruption in DiffusionHypoxiaDamaged Alveoli
Disruption in PerfusionAlteration in Blood FlowChanges in HemoglobinPulmonary Shunting
Disruption in DiffusionHypoxiaDamaged Alveoli
Disruption in PerfusionAlteration in Blood FlowChanges in HemoglobinPulmonary Shunting
Scene Size-upThreats to Safety
Identify rescue environments having decreased oxygen levels.
Gases and other chemical or biological agents.
Clues to Patient Information
Scene Size-upThreats to Safety
Identify rescue environments having decreased oxygen levels.
Gases and other chemical or biological agents.
Clues to Patient Information
Assessment of the Respiratory Assessment of the Respiratory SystemSystem
Initial AssessmentGeneral Impression
Position Color Mental status Ability to speak Respiratory effort
Initial AssessmentGeneral Impression
Position Color Mental status Ability to speak Respiratory effort
Assessment of the Respiratory Assessment of the Respiratory SystemSystem
Airway Proper ventilation cannot take place without an
adequate airway.Breathing
Signs of life-threatening problems• Alterations in mental status• Severe central cyanosis, pallor, or diaphoresis• Absent or abnormal breath sounds• Speaking limited to 1–2 words• Tachycardia• Use of accessory muscles or presence of retractions
Airway Proper ventilation cannot take place without an
adequate airway.Breathing
Signs of life-threatening problems• Alterations in mental status• Severe central cyanosis, pallor, or diaphoresis• Absent or abnormal breath sounds• Speaking limited to 1–2 words• Tachycardia• Use of accessory muscles or presence of retractions
Assessment of the Respiratory Assessment of the Respiratory SystemSystem
HistorySAMPLE HistoryOPQRST History
Paroxysmal nocturnal dyspnea and orthopnea Coughing and hemoptysis Associated chest pain Smoking history or exposure to secondary smoke
Similar Past Episodes
HistorySAMPLE HistoryOPQRST History
Paroxysmal nocturnal dyspnea and orthopnea Coughing and hemoptysis Associated chest pain Smoking history or exposure to secondary smoke
Similar Past Episodes
Focused History Focused History & Physical Exam& Physical Exam
Physical ExaminationInspection
Look for asymmetry, increased diameter, or paradoxical motion.
Palpation Feel for subcutaneous emphysema or tracheal
deviation.PercussionAuscultation
Physical ExaminationInspection
Look for asymmetry, increased diameter, or paradoxical motion.
Palpation Feel for subcutaneous emphysema or tracheal
deviation.PercussionAuscultation
Focused History Focused History & Physical Exam& Physical Exam
Auscultation Normal Breath
Sounds• Bronchial,
Bronchovesicular, and Vesicular
Abnormal Breath Sounds• Snoring• Stridor• Wheezing• Rhonchi• Rales/Crackles• Pleural Friction
Rub
Auscultation Normal Breath
Sounds• Bronchial,
Bronchovesicular, and Vesicular
Abnormal Breath Sounds• Snoring• Stridor• Wheezing• Rhonchi• Rales/Crackles• Pleural Friction
Rub
Focused History Focused History & Physical Exam& Physical Exam
adventitious lung sounds video
Extremities Look for peripheral cyanosis. Look for swelling and redness, indicative of a venous clot. Look for finger clubbing, which indicates chronic hypoxia.
Extremities Look for peripheral cyanosis. Look for swelling and redness, indicative of a venous clot. Look for finger clubbing, which indicates chronic hypoxia.
Focused History Focused History & Physical Exam& Physical Exam
Vital SignsHeart Rate
Tachycardia
Blood Pressure Pulsus paradoxus
Respiratory Rate Observe for trends.
Vital SignsHeart Rate
Tachycardia
Blood Pressure Pulsus paradoxus
Respiratory Rate Observe for trends.
Focused History Focused History & Physical Exam& Physical Exam
Diagnostic TestingPulse
Oximetry Inaccurate
Readings
Diagnostic TestingPulse
Oximetry Inaccurate
Readings
Focused History Focused History & Physical Exam& Physical Exam
Peak Flow PEFR
Peak Flow PEFR
Focused History Focused History & Physical Exam& Physical Exam
Capnometry Continuous waveform monitoring, or capnography Colorimetric devices
Capnometry Continuous waveform monitoring, or capnography Colorimetric devices
Focused History Focused History & Physical Exam& Physical Exam
Basic PrinciplesMaintain the airway.
Protect the cervical spine if trauma is suspected.Any patient with respiratory distress should
receive oxygen.Any patient suspected of being hypoxic
should receive oxygen.Oxygen should never be withheld from a
patient suspected of suffering from hypoxia.
Basic PrinciplesMaintain the airway.
Protect the cervical spine if trauma is suspected.Any patient with respiratory distress should
receive oxygen.Any patient suspected of being hypoxic
should receive oxygen.Oxygen should never be withheld from a
patient suspected of suffering from hypoxia.
Management of Management of Respiratory DisordersRespiratory Disorders
Upper-Airway ObstructionUpper-Airway Obstruction
Common CausesTongue, Foreign Matter, Trauma, BurnsAllergic Reaction, Infection
AssessmentDifferentiate Cause.
ManagementConscious Patient
If the patient is able to speak, encourage coughing. If the patient is unable to speak, perform abdominal
thrusts.
Common CausesTongue, Foreign Matter, Trauma, BurnsAllergic Reaction, Infection
AssessmentDifferentiate Cause.
ManagementConscious Patient
If the patient is able to speak, encourage coughing. If the patient is unable to speak, perform abdominal
thrusts.
Upper-Airway ObstructionUpper-Airway ObstructionUnconscious Patient
Start CPR
Unconscious Patient Start CPR
Sepsis Aspiration Pneumonia Pulmonary Injury Burns/Inhalation Injury Oxygen Toxicity Drugs High Altitude Hypothermia
Sepsis Aspiration Pneumonia Pulmonary Injury Burns/Inhalation Injury Oxygen Toxicity Drugs High Altitude Hypothermia
Adult Respiratory Adult Respiratory Distress SyndromeDistress Syndrome
Near-Drowning Syndrome
Head Injury
Pulmonary Emboli
Tumor Destruction
Pancreatitis
Invasive ProceduresBypass, hemodialysis
Hypoxia, Hypotension, or Cardiac Arrest
Near-Drowning Syndrome
Head Injury
Pulmonary Emboli
Tumor Destruction
Pancreatitis
Invasive ProceduresBypass, hemodialysis
Hypoxia, Hypotension, or Cardiac Arrest
ARDSVideo Link
PathophysiologyHigh MortalityMultiple Organ FailureAffects Interstitial Fluid
Causes increase in fluid in the interstitial space, disrupts diffusion and perfusion.
AssessmentSymptoms Related to Underlying CauseAbnormal Breath Sounds
Crackles and Rales
PathophysiologyHigh MortalityMultiple Organ FailureAffects Interstitial Fluid
Causes increase in fluid in the interstitial space, disrupts diffusion and perfusion.
AssessmentSymptoms Related to Underlying CauseAbnormal Breath Sounds
Crackles and Rales
Adult Respiratory Adult Respiratory Distress SyndromeDistress Syndrome
ManagementManage the underlying condition.Provide supplemental oxygen.Support respiratory effort.
Provide positive pressure ventilation if respiratory failure is imminent.
Monitor cardiac rhythm and vital signs.Consider medications.
Corticosteroids
ManagementManage the underlying condition.Provide supplemental oxygen.Support respiratory effort.
Provide positive pressure ventilation if respiratory failure is imminent.
Monitor cardiac rhythm and vital signs.Consider medications.
Corticosteroids
Adult Respiratory Adult Respiratory Distress SyndromeDistress Syndrome
For more info go to www.ardsusa.org
Obstructive Lung DiseaseObstructive Lung Disease
TypesEmphysemaChronic BronchitisAsthma
CausesGenetic DispositionSmoking & Other Risk Factors
TypesEmphysemaChronic BronchitisAsthma
CausesGenetic DispositionSmoking & Other Risk Factors
EmphysemaEmphysema
PathophysiologyExposure to Noxious Substances
Exposure results in the destruction of the walls of the alveoli.
Weakens the walls of the small bronchioles and results in increase residual volume.
Cor Pulmonale PolycythemiaIncreased Risk of Infection and Dysrhythmia
PathophysiologyExposure to Noxious Substances
Exposure results in the destruction of the walls of the alveoli.
Weakens the walls of the small bronchioles and results in increase residual volume.
Cor Pulmonale PolycythemiaIncreased Risk of Infection and Dysrhythmia
EmphysemaEmphysema
AssessmentHistory
Recent weight loss, dyspnea with exertion Cigarette and tobacco usage
Lack of Cough
AssessmentHistory
Recent weight loss, dyspnea with exertion Cigarette and tobacco usage
Lack of Cough
EmphysemaEmphysema
AssessmentPhysical Exam
Barrel chest. Prolonged expiration
and rapid rest phase. Thin. Pink skin due to
extra red cell production.
Hypertrophy of accessory muscles.
“Pink Puffers.”
AssessmentPhysical Exam
Barrel chest. Prolonged expiration
and rapid rest phase. Thin. Pink skin due to
extra red cell production.
Hypertrophy of accessory muscles.
“Pink Puffers.”
Chronic BronchitisChronic Bronchitis
Pathophysiology Results from an increase in mucus-secreting cells in
the respiratory tree. Alveoli relatively unaffected. Decreased alveolar ventilation.
AssessmentHistory
Frequent respiratory infections. Productive cough.
Pathophysiology Results from an increase in mucus-secreting cells in
the respiratory tree. Alveoli relatively unaffected. Decreased alveolar ventilation.
AssessmentHistory
Frequent respiratory infections. Productive cough.
Chronic BronchitisChronic BronchitisPhysical Exam
Often overweight. Rhonchi present on
auscultation. Jugular vein distention. Ankle edema. Hepatic congestion. “Blue Bloater.”
Physical Exam Often overweight. Rhonchi present on
auscultation. Jugular vein distention. Ankle edema. Hepatic congestion. “Blue Bloater.”
Bronchitis & EmphysemaBronchitis & Emphysema
ManagementMaintain airway.Support breathing.
Find position of comfort. Monitor oxygen saturation. Be prepared to ventilate or intubate.
Monitor cardiac rhythm.Establish IV access.Administer medications.
Bronchodilators & corticosteroids.
ManagementMaintain airway.Support breathing.
Find position of comfort. Monitor oxygen saturation. Be prepared to ventilate or intubate.
Monitor cardiac rhythm.Establish IV access.Administer medications.
Bronchodilators & corticosteroids.
AsthmaAsthma
PathophysiologyChronic Inflammatory Disorder
Results in widespread but variable air flow obstruction.
The airway becomes hyperresponsive. Induced by a trigger, which can vary by individual. Trigger causes release of histamine, causing
bronchoconstriction and bronchial edema. 6–8 hours later, immune system cells invade the
bronchial mucosa and cause additional edema.
PathophysiologyChronic Inflammatory Disorder
Results in widespread but variable air flow obstruction.
The airway becomes hyperresponsive. Induced by a trigger, which can vary by individual. Trigger causes release of histamine, causing
bronchoconstriction and bronchial edema. 6–8 hours later, immune system cells invade the
bronchial mucosa and cause additional edema.
AsthmaAsthma
AssessmentIdentify immediate threats.Obtain history.
SAMPLE & OPQRST History• History of asthma-related hospitalization?• History of respiratory failure/ventilator use?
AssessmentIdentify immediate threats.Obtain history.
SAMPLE & OPQRST History• History of asthma-related hospitalization?• History of respiratory failure/ventilator use?
AsthmaAsthmaPhysical Exam
Presenting signs may include dyspnea, wheezing, cough.• Wheezing is not present in all asthmatics.• Speech may be limited to 1–2 consecutive words.
Look for hyperinflation of the chest and accessory muscle use.
Carefully auscultate breath sounds and measure peak expiratory flow rate.
Physical Exam Presenting signs may include dyspnea, wheezing,
cough.• Wheezing is not present in all asthmatics.• Speech may be limited to 1–2 consecutive words.
Look for hyperinflation of the chest and accessory muscle use.
Carefully auscultate breath sounds and measure peak expiratory flow rate.
AsthmaAsthma
ManagementTreatment goals:
Correct hypoxia. Reverse bronchospasm. Reduce inflammation.
Maintain the airway.Support breathing.
High-flow oxygen or assisted ventilations as indicated.
ManagementTreatment goals:
Correct hypoxia. Reverse bronchospasm. Reduce inflammation.
Maintain the airway.Support breathing.
High-flow oxygen or assisted ventilations as indicated.
AsthmaAsthmaMonitor cardiac rhythm.Establish IV Access.Administer medications.
Beta-agonists Ipratropium bromide Corticosteroids
Monitor cardiac rhythm.Establish IV Access.Administer medications.
Beta-agonists Ipratropium bromide Corticosteroids
Administration of Administration of Nebulized MedicationsNebulized Medications
Complete the initial assessment.Complete the initial assessment.
Administration of Administration of Nebulized MedicationsNebulized Medications
Place the patient on an ECG monitor.Place the patient on an ECG monitor.
Administration of Administration of Nebulized MedicationsNebulized Medications
Select the desired medication.Select the desired medication.
Administration of Administration of Nebulized MedicationsNebulized Medications
Add medication to the nebulizer.Add medication to the nebulizer.
Administration of Administration of Nebulized MedicationsNebulized Medications
Assemble the nebulizer and determine pre-treatment pulse rate.Assemble the nebulizer and determine pre-treatment pulse rate.
Administration of Administration of Nebulized MedicationsNebulized Medications
Administer the medication.Administer the medication.
Administration of Administration of Nebulized MedicationsNebulized Medications
Determine post-treatment pulse rate.Determine post-treatment pulse rate.
Administration of Administration of Nebulized MedicationsNebulized Medications
Reassess breath sounds.Reassess breath sounds.
Special Cases of AsthmaSpecial Cases of Asthma
Status AsthmaticusA severe, prolonged attack that cannot be broken by
bronchodilators.Greatly diminished breath sounds.Recognize imminent respiratory arrest.
Aggressively manage airway and breathing. Transport immediately.
Asthma in ChildrenPathophysiology and management similar.Adjust medication dosages as needed.
Status AsthmaticusA severe, prolonged attack that cannot be broken by
bronchodilators.Greatly diminished breath sounds.Recognize imminent respiratory arrest.
Aggressively manage airway and breathing. Transport immediately.
Asthma in ChildrenPathophysiology and management similar.Adjust medication dosages as needed.
Upper Respiratory InfectionsFrequent patient complaint
Common pediatric complaintRarely life threatening
PathophysiologyFrequently caused by viral and bacterial infections.Affect multiple parts of the upper airway.Typically resolve after several days of symptoms.
Upper Respiratory InfectionsFrequent patient complaint
Common pediatric complaintRarely life threatening
PathophysiologyFrequently caused by viral and bacterial infections.Affect multiple parts of the upper airway.Typically resolve after several days of symptoms.
Upper RespiratoryUpper RespiratoryInfection (URI)Infection (URI)
Upper RespiratoryUpper RespiratoryInfection (URI)Infection (URI)
AssessmentLook for underlying illness.Evaluate pediatrics for epiglottitis.
ManagementMaintain the airway.Support breathing.Treat signs and symptoms.
AssessmentLook for underlying illness.Evaluate pediatrics for epiglottitis.
ManagementMaintain the airway.Support breathing.Treat signs and symptoms.
Upper RespiratoryUpper RespiratoryInfection (URI)Infection (URI)
PneumoniaPneumonia
Infection of the LungsImmune-Suppressed Patients
PathophysiologyBacterial & Viral Infections
Hospital-acquired vs. community-acquired. Infection can spread throughout lungs. Alveoli may collapse, resulting in a ventilation
disorder.
Infection of the LungsImmune-Suppressed Patients
PathophysiologyBacterial & Viral Infections
Hospital-acquired vs. community-acquired. Infection can spread throughout lungs. Alveoli may collapse, resulting in a ventilation
disorder.
PneumoniaPneumonia
AssessmentFocused History & Physical Exam
SAMPLE & OPQRST• Recent fever, chills, weakness, and malaise• Deep, productive cough with associated pain
Tachypnea and tachycardia may be present. Breath sounds:
• Presence of rales/crackles in affected lung segments• Decreased air movement in the affected lung
AssessmentFocused History & Physical Exam
SAMPLE & OPQRST• Recent fever, chills, weakness, and malaise• Deep, productive cough with associated pain
Tachypnea and tachycardia may be present. Breath sounds:
• Presence of rales/crackles in affected lung segments• Decreased air movement in the affected lung
PneumoniaPneumonia
ManagementMaintain the airway.Support breathing.
High-flow oxygen or assisted ventilation as indicated.Monitor vital signs.Establish IV access.
Avoid fluid overload.Medications
Antibiotics, antipyretics, beta-agonists.
ManagementMaintain the airway.Support breathing.
High-flow oxygen or assisted ventilation as indicated.Monitor vital signs.Establish IV access.
Avoid fluid overload.Medications
Antibiotics, antipyretics, beta-agonists.
Lung CancerLung Cancer
PathophysiologyGeneral
Majority are caused by carcinogens secondary to cigarette smoking or occupational exposure.
May start elsewhere and spread to lungs. High mortality.
Types Adenocarcinoma. Epidermoid, small-cell, and large-cell carcinomas.
PathophysiologyGeneral
Majority are caused by carcinogens secondary to cigarette smoking or occupational exposure.
May start elsewhere and spread to lungs. High mortality.
Types Adenocarcinoma. Epidermoid, small-cell, and large-cell carcinomas.
Lung CancerLung Cancer
AssessmentFocused History & Physical Exam
SAMPLE & OPQRST History• Cancer-related treatments and hospitalizations.
Physical Exam• Evaluate for severe respiratory distress.
ManagementFollow general principles.
Administer oxygen, support ventilation.Provide emotional support.
AssessmentFocused History & Physical Exam
SAMPLE & OPQRST History• Cancer-related treatments and hospitalizations.
Physical Exam• Evaluate for severe respiratory distress.
ManagementFollow general principles.
Administer oxygen, support ventilation.Provide emotional support.
Toxic InhalationToxic Inhalation
Pathophysiology Includes inhalation of heated air, chemical irritants,
and steam. Airway obstruction due to edema and laryngospasm
due to thermal and chemical burns.
AssessmentFocused History & Physical Exam
SAMPLE & OPQRST History• Determine nature of substance.• Length of exposure and loss of consciousness.
Pathophysiology Includes inhalation of heated air, chemical irritants,
and steam. Airway obstruction due to edema and laryngospasm
due to thermal and chemical burns.
AssessmentFocused History & Physical Exam
SAMPLE & OPQRST History• Determine nature of substance.• Length of exposure and loss of consciousness.
Toxic InhalationToxic Inhalation
ManagementEnsure scene safety.
Enter a scene only if properly trained and equipped. Remove the patient from the toxic environment.
Maintain the airway. Early, aggressive management may be indicated.
Support breathing.Establish IV access.Transport promptly.
ManagementEnsure scene safety.
Enter a scene only if properly trained and equipped. Remove the patient from the toxic environment.
Maintain the airway. Early, aggressive management may be indicated.
Support breathing.Establish IV access.Transport promptly.
Carbon MonoxideOdorless, Colorless Gas
Results from the combustion of carbon-containing compounds.
Often builds up to dangerous levels in confined spaces such as mines, autos, and poorly ventilated homes.
Hazardous to Rescuers
Carbon MonoxideOdorless, Colorless Gas
Results from the combustion of carbon-containing compounds.
Often builds up to dangerous levels in confined spaces such as mines, autos, and poorly ventilated homes.
Hazardous to Rescuers
Carbon Monoxide InhalationCarbon Monoxide Inhalation
PathophysiologyBinds to Hemoglobin
Prevents oxygen from binding and creates hypoxia at the cellular level.
AssessmentFocused History and Physical Exam
SAMPLE & OPQRST History• Determine source and length of exposure.• Presence of headache, confusion, agitation, lack of
coordination, loss of consciousness, and seizures.
PathophysiologyBinds to Hemoglobin
Prevents oxygen from binding and creates hypoxia at the cellular level.
AssessmentFocused History and Physical Exam
SAMPLE & OPQRST History• Determine source and length of exposure.• Presence of headache, confusion, agitation, lack of
coordination, loss of consciousness, and seizures.
Carbon Monoxide InhalationCarbon Monoxide Inhalation
ManagementEnsure scene safety.
Enter a scene only if properly trained and equipped. Remove the patient from the toxic environment.
Maintain the airway.Support breathing.
High-flow oxygen or assisted ventilations as indicated.Establish IV access.Transport promptly.
ManagementEnsure scene safety.
Enter a scene only if properly trained and equipped. Remove the patient from the toxic environment.
Maintain the airway.Support breathing.
High-flow oxygen or assisted ventilations as indicated.Establish IV access.Transport promptly.
Carbon Monoxide InhalationCarbon Monoxide Inhalation
Pulmonary EmbolismPulmonary Embolism
PathophysiologyObstruction of a pulmonary artery
Emboli may be of air, thrombus, fat, or amniotic fluid.
Foreign bodies may also cause an embolus.
Risk Factors Recent surgery, long-bone fractures, pregnancy. Pregnant or postpartum. Oral contraceptive use, tobacco use.
PathophysiologyObstruction of a pulmonary artery
Emboli may be of air, thrombus, fat, or amniotic fluid.
Foreign bodies may also cause an embolus.
Risk Factors Recent surgery, long-bone fractures, pregnancy. Pregnant or postpartum. Oral contraceptive use, tobacco use.
Pulmonary EmbolismPulmonary Embolism
AssessmentFocused History & Physical Exam
SAMPLE & OPQRST History• Presence of risk factors• Sudden onset of severe dyspnea and pain• Cough, often blood-tinged
Physical Exam• Signs of heart failure, including JVD and hypotension• Warm, swollen extremities
AssessmentFocused History & Physical Exam
SAMPLE & OPQRST History• Presence of risk factors• Sudden onset of severe dyspnea and pain• Cough, often blood-tinged
Physical Exam• Signs of heart failure, including JVD and hypotension• Warm, swollen extremities
Pulmonary EmbolismPulmonary Embolism
ManagementMaintain the airway.Support breathing.
High-flow oxygen or assist ventilations as indicated. Intubation may be indicated.
Establish IV accessMonitor vital signs closely.Transport to appropriate facility.
ManagementMaintain the airway.Support breathing.
High-flow oxygen or assist ventilations as indicated. Intubation may be indicated.
Establish IV accessMonitor vital signs closely.Transport to appropriate facility.
PathophysiologyPneumothorax
Occurs in the absence of blunt or penetrating trauma.Risk factors
AssessmentFocused history
SAMPLE & OPQRST history. Presence of risk factors. Rapid onset of symptoms. Sharp, pleuritic chest or shoulder pain. Often precipitated by coughing or lifting.
PathophysiologyPneumothorax
Occurs in the absence of blunt or penetrating trauma.Risk factors
AssessmentFocused history
SAMPLE & OPQRST history. Presence of risk factors. Rapid onset of symptoms. Sharp, pleuritic chest or shoulder pain. Often precipitated by coughing or lifting.
Spontaneous PneumothoraxSpontaneous Pneumothorax
Physical exam: Decreased or absent breath sounds on affected side Tachypnea, diaphoresis, and pallor
ManagementMaintain the airway.Support breathing.Monitor for tension pneumothorax.
Pleural decompression may be indicated if patient becomes cyanotic, hypoxic, and difficult to ventilate.
JVD and tracheal deviation away from the affected side.
Physical exam: Decreased or absent breath sounds on affected side Tachypnea, diaphoresis, and pallor
ManagementMaintain the airway.Support breathing.Monitor for tension pneumothorax.
Pleural decompression may be indicated if patient becomes cyanotic, hypoxic, and difficult to ventilate.
JVD and tracheal deviation away from the affected side.
Spontaneous PneumothoraxSpontaneous Pneumothorax
Hyperventilation Hyperventilation SyndromeSyndrome
AssessmentFocused History & Physical Exam
SAMPLE & OPQRST history.• Fatigue, nervousness, dizziness, dyspnea, chest pain.• Numbness and tingling in hands, mouth, and feet.
Presence of tachypnea and tachycardia. Spasms of the fingers and feet.
AssessmentFocused History & Physical Exam
SAMPLE & OPQRST history.• Fatigue, nervousness, dizziness, dyspnea, chest pain.• Numbness and tingling in hands, mouth, and feet.
Presence of tachypnea and tachycardia. Spasms of the fingers and feet.
Hyperventilation Hyperventilation SyndromeSyndrome
ManagementMaintain the airway.Support breathing.
Provide high-flow oxygen or assist ventilations as indicated.
Do NOT allow the patient to rebreathe exhaled air.
Reassure the patient.
ManagementMaintain the airway.Support breathing.
Provide high-flow oxygen or assist ventilations as indicated.
Do NOT allow the patient to rebreathe exhaled air.
Reassure the patient.
Hyperventilation Hyperventilation SyndromeSyndrome
CNS DysfunctionCNS Dysfunction Pathophysiology
Causes can include traumatic/atraumatic brain injury, tumors, and drugs.
AssessmentEvaluate potentially treatable causes, such as narcotic
drug overdose or CNS trauma.Carefully evaluate breathing pattern.
ManagementFollow general management principles.Maintain the airway and support breathing.Use cervical spine precautions if indicated.
PathophysiologyCauses can include traumatic/atraumatic brain injury,
tumors, and drugs.
AssessmentEvaluate potentially treatable causes, such as narcotic
drug overdose or CNS trauma.Carefully evaluate breathing pattern.
ManagementFollow general management principles.Maintain the airway and support breathing.Use cervical spine precautions if indicated.
PathophysiologyPNS problems affecting respiratory function may
include trauma, polio, myasthenia gravis, viral infections, tumors.
AssessmentRule out traumatic injury, and assess for numbness,
pain, or signs of PNS dysfunction.
ManagementFollow general management principles.Maintain the airway and support breathing.Use cervical spine precautions if indicated.
PathophysiologyPNS problems affecting respiratory function may
include trauma, polio, myasthenia gravis, viral infections, tumors.
AssessmentRule out traumatic injury, and assess for numbness,
pain, or signs of PNS dysfunction.
ManagementFollow general management principles.Maintain the airway and support breathing.Use cervical spine precautions if indicated.
Dysfunction of the Spinal Cord, Dysfunction of the Spinal Cord, Nerves, or Respiratory MusclesNerves, or Respiratory Muscles