Objectives COPD. Chronic Obstructive Pulmonary Disease (COPD) 4/19/2011

Transcription

1 Objectives Discuss assessment findings and treatment for: Chronic Obstructive Pulmonary Disease Bronchitis Emphysema Asthma Anaphylaxis Other respiratory issues Provide some definitions Chronic Obstructive Pulmonary Disease (COPD) Affects a large percent of US population COPD = 25% of adults Asthma = 4 5% of US pop. Ch i B hi i f d l Chronic Bronchitis = 1 of 5 adult men Most common causes are smoking and pollution Many other triggers can initiate exacerbations COPD Chronic Bronchitis Presence of productive cough for 3 or more months in two consecutive years Airway obstruction caused by inflammation and hypersensitivity of the bronchi Increase in the number of goblet cells They make mucous Chronic Bronchitis Chronic Bronchitis Assessment Usually history of smoking Often overweight and cyanotic ( Blue Bloaters ) Generally will have coarse ronchi throughout Will be aware of their disease (commonly) VS? May show signs of R. ventricular failure WHY? 1

2 Chronic Bronchitis Treatment Primary goal? Reverse hypoxia and bronchoconstriction Establish airway POC VS IV, CM What if they have used their home neb? COPD Emphysema Destruction and loss of elasticity of the alveoli and the terminal bronchioles Significant decrease in alveolar surface area = decreased area for gas exchange Interferes with both ventilation and respiration Emphysema Emphysema Assessment Often have history of: Recent weight loss Dyspnea on exertion (DOE) Decreased physical activity Pursed lip breathing, AM cough Barrel chest with decreased excursion, thin Pink because of polycythemia (huh?) Pursed lip breathing Why? Clubbed fingers Emphysema Assessment Lung sounds? Accessory muscle use, tripoding, etc. Often referred to as Pink Puffers May show signs of R. ventricular failure WHY? Emphysema Treatment Primary goal? Reverse hypoxia and bronchoconstriction Establish airway POC VS VS IV, CM What if they have used their home neb? 2

3 COPD Asthma Chronic inflammatory disorder of the airway Airway becomes hypersensitive (sometimes called Reactive Airway Disease) Can be caused by many triggers Exposure causes release of histamine which causes constriction, excess mucous production and capillary leakage Asthma Asthma Assessment Most common symptoms Dyspnea, wheezing, cough, tachypnea Usually have a PMH of Asthma Follow up questions Does this feel like your normal attack? Do you take steroids for your asthma? Have you ever been to the hospital for this? Were you admitted? (Vs. seen in ER only) Have you ever been intubated? Asthma Assessment Home med use? Use ETCO2 if possible (remember the shark) Auscultate chest and back What do you expect to hear? Asthma Treatment Primary goals? Reverse hypoxia and bronchoconstriction, treat inflammatory changes Establish airway PRN (Nasal?) POC VS IV, CM What if they have used their home neb? Special Considerations (Asthma) Status Asthmaticus Severe, prolonged attack that does not respond to bronchodilators Breath sounds may be severely diminished or absent Prepare for emergent intubation Asthma in Children Becoming more prevalent Children do not have the reserves that adults do Be very concerned with lethargic kids 3

4 Anaphylaxis Bodies overreaction to a specific antigen Typically a systemic reaction Massive histamine release Also causes release of SRS A which hcauses bronchoconstriction (and potentiates histamine) True Anaphylaxis is an immediately life threatening event!! Anaphylaxis Assessment Sudden onset (typically sec. after exposure) May be as long as 15 minutes Severe dyspnea Urticaria (Hives) Widespread wheezing Possible decreased LOC Possible nausea, vomiting and diarrhea VS? Anaphylaxis Anaphylaxis Anaphylaxis Treatment Airway management Supra glottic airways indicated? Oxygen Epinephrine Antihistamine Corticosteroids Vasopressers Beta agonists (inhaled) Rapid transport Other issues: Pneumonia Infection in the lung(s) Interferes with O2 and CO2 exchange Causes Bacteria Viruses Fungi Food (can t really treat all that well) 4

5 Pneumonia Assessment Generally sick looking patient May have been sick for 3 5 days Fever (not always) Cough May be productive with colored mucous (green, yellow, red tinged) May have c/o chest pain Possibly localized rales/wheezes Pneumonia Treatment O2 Method dependant on assessment findings IV with fluid bolus Pts typically dehydrated dhd d CM 12 Lead if any C/O chest pain that may be cardiac Albuterol? Atrovent? CPAP? Other issues: Pulmonary Edema Fluid build up in lungs interferes with O2/CO2 exchange Causes Cardiac Non cardiac Pulmonary Edema Assessment Trouble breathing May have hx. of cardiac problems May have positional dyspnea Usually worse lying down May have dependant edema JVD possible Rales likely Frothy sputum is a really bad sign! Pulmonary Edema Treatment Recognition CPAP is the most definitive EMS treatment! Pushes fluid across alveoli to where it belongs Classic EMS treatment: IV TKO, CM, 12 Lead EKG Oxygen Nitroglycerin Morphine Lasix Is this the best EMS treatment? Suggested Changes Instead of the Classic treatment which doesn t treat the problem directly How about: Keep CPAP, IV TKO, CM and 12 Lead EKG Enalapril 1.25 mg IV ACE Inhibitor Remember the Renin Angiotensin Aldosterone system? Milrinone Causes positive inotropic effects and vasodilation Are these good things in CHF? 5

6 Summary Assessment should be rapid and focused on determining severity of problem. Treatment for all respiratory issues focuses on: Improve oxygenation Reverse causes (if possible) Do we need to find exactly the problem to treat it? Any Questions? 6