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Respiratory Emergencies | Part Five | Other Respiratory Issues

Pulmonary Thrombo(from a clot) Embolism(break off and float up): blockage of a pulmonary artery by foreign matter. Usually it’s a blood clot formed in a pelvic or deep leg vein. 50,000 death annually, 5% of sudden deaths. Around 10% die, and that 10% in less than an hour. Risks:

Sedentary lifestyle
Obesity
Infection
Cancer
Thromboplebitis
BCPs
Fracture of long bone
Pregnancy
Recent surgery
Blood diseases

Pathophysiology: blood supply to some lung is blocked. Clot breaks off in leg, follows blood through right artia and ventricle and becomes lodged in the lung where it can go no farther >> lung tissue ischemic >> blood pools>right ventricle pumping against very high pressures >> acute for pulmonale >>decreased blood supply

Assessment: Massive PE= cardiac arrest/syncope, altered mentation, cyanosis profound hypotension. Smaller = sudden chest pain, increases with deep breaths, pleuritic chest pain, shortness of breath, respiratory distress, wheezing, hemoptysis, anxiety, shock. Similar to MI or spontaneous pneumothorax. Tachypnea, tachycardia

Management: ABC, high flow O2, IV, watch for shock, cardiac monitor, transport in position of comfort

Spontaneous Pneumothorax: sudden accumulation of air in the pleural space. Lung on the involved side collapses. Tension pneumo can also develop.

  • More common in men
  • Young tall male smokers
  • Congenital defect
  • Menstruation
  • Lung disease
  • COPD

Assessment: sudden onset, sharp chest pain, shortness of breath, decreased lung sounds, increased respirations, coughing anxious agitated.

Signs and Symptoms of a Tension Pneumothorax
Weak pulse
Cyanosis
Hypotension
Decreased breath sounds
JVD
Tracheal deviation (late sign)
Subcutaneous emphysema, crepitus

Management:
Maintain airway, high flow O2
IV
Cardiac monitor
Transport in position of comfort
Needle decompression as allowed by protocol

Hyperventilation Syndrome: respiratory rate greater that that required for normal body function. Disease states resulting in hyperventilation:

Asthma attack
COPD
MI
Spontaneous. Pneumo
CHF
Diabetic ketoacidosis
Drugs
Psychogenic factors

Assessment: Chest pain, dizzy, faint, numbness, tingling in extremities, altered mental status, tachycardia, and palpitations.

Management: don’t assume it is just anxiety, there are lots of disease states that cause hyperventilation. Assume illness until proven otherwise. Give O2, Take a pulse Ox, try to help them slow breathing, if chest pain >>IV, transport according to protocols.

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