TRANSITION SERIESTRANSITION SERIES

Topics for the Advanced EMTTopics for the Advanced EMT

CHAPTERCHAPTER

Respiratory Emergencies: Respiratory Emergencies: Infectious DisordersInfectious Disorders

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ObjectivesObjectives

• Review frequency of infectious respiratory disorders.

• Relate pathophysiology of infectious disorder to presenting signs and symptoms.

• Discuss current treatment standards for patients with dyspnea from an infectious disorder.

IntroductionIntroduction

• This topic deals with disorders that alter normal gas diffusion in the lungs due to an infectious pulmonary problem.

• As in previous topics, the patient will have general dyspnea findings, but the history should help illustrate the cause.

EpidemiologyEpidemiology

• Lower respiratory infections are a leading cause of death worldwide.

• CDC reports recent outbreaks of pertussis in the United States.

• VRIs are the most common cause of symptomatic disease among children and adults.

PathophysiologyPathophysiology

• Pneumonia– Bacteria or virus induced– Lower respiratory lung infection– Can result in fluid- or pus-filled alveoli– Diminishes ventilation (V/Q ratio) with

resultant dyspnea and blood gas alterations

Pneumonia causes inflammation of the lungs and causes the alveoli to fill with fluid or pus, leading to poor gas exchange.

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Pertussis– Whooping cough– Development of heavy mucus from

airway Paroxysms of coughing

– Complications include pneumonia, dehydration, seizures, brain injuries

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Viral respiratory infections– Common VRIs

Bronchiolitis, colds, flu

– Usually mild and self-limiting– Can cause upper or lower respiratory

infections– Cause inflammatory response and

mucus production in airway structures

Assessment FindingsAssessment Findings

• General assessment findings– Common to most patients with dyspnea

Changes in respiratory rate and breath sounds

Accessory muscle use Tripod positioning and retractions Nasal flaring, mouth breathing Changes in pulse oximetry and vitals Skin change and mental status changes

Assessment Findings (cont’d)Assessment Findings (cont’d)

• Additional findings with pneumonia– Malaise and decreased appetite– Cough (possibly productive)– General dyspnea findings– Pleuritic chest pain– Diaphoresis– Possible fever

Assessment Findings (cont’d)Assessment Findings (cont’d)

• Additional findings with pertussis– History of URI– Runny nose, low-grade fever– Episodes of coughing followed by

“whooping” sound– Fatigue from coughing

Assessment Findings (cont’d)Assessment Findings (cont’d)

• Additional findings with a VRI– Nasal congestion– Irritated or painful throat– Mild dyspnea– Fever– Malaise, headache, body ache– Poor feeding in infants

Emergency Medical CareEmergency Medical Care

• Ensure airway adequacy.• Provide oxygen based on ventilatory

need.– NRB mask at 15 lpm with adequate

breathing– PPV with 15 lpm oxygen with inadequate

breathing

Emergency Medical Care (cont’d)Emergency Medical Care (cont’d)

• Administer inhaled bronchodilator PRN.• Keep patient sitting upright if possible.• Provide rapid transport to the ED.

Case StudyCase Study

• You are called to an elder care facility for a patient with an altered mental status. Upon your arrival, you are escorted to a patient's room where an elderly male patient lies in bed, seemingly asleep.

Case Study (cont’d)Case Study (cont’d)

• Scene Size-Up– Scene is safe, standard precautions

taken.– Patient is 91 years old, about 145 lbs.– Entry and egress from room is

unobstructed.– NOI appears to be altered mental status.– No additional resources needed.

Case Study (cont’d)Case Study (cont’d)

• Primary Assessment Findings– Patient moans to loud verbal stimuli.– Airway patent and self-maintained.– Breathing adequate but tachypneic.– Central and peripheral pulses present.– Skin is noted to be diaphoretic.

Case Study (cont’d)Case Study (cont’d)

• Medical History– Patient has history of pancreatic cancer

• Medications– Primarily comfort medications

• Allergies– Demerol

Case Study (cont’d)Case Study (cont’d)

• Pertinent Secondary Assessment Findings– Pupils equal and reactive, membranes

dry.– Airway patent, breathing rapid with

markedly diminished breath sounds over left lung – some crackles and rhonchi discernible.

– Peripheral perfusion intact, heart rate fast and regular.

Case Study (cont’d)Case Study (cont’d)

• Pertinent Secondary Assessment Findings (continued)– Pulse ox 92% on room air, B/P WNL.– Skin diaphoretic and warm.– Patient has not eaten for a day and a

half.– Fever 101.5 F°

Case Study (cont’d)Case Study (cont’d)

• What pathologic change is causing the abnormal breath sounds?

• What respiratory condition does this patient likely have?

• What would be three assessment findings that could confirm your suspicion?

Case Study (cont’d)Case Study (cont’d)

• Care provided:– Patient placed on high-flow oxygen.– Placed in a semi-Fowler position on

wheeled cot.– Transport initiated to ED.

SummarySummary

• With infectious disorders, many times the presentation will be the same despite a varied etiologic background.

• Fortunately, treatment of most all infectious diseases is similar enough that if the exact cause is not known, the treatment will still be appropriate.