Dyspnea

ARIS NUGROHO S.Kep,Ners

Dyspnea

 Subjective sensation of:

• Difficult, labored breathing or
• Shortness of breath
Hyperventilation Syndrome

 Response to stress, anxiety

 Patient exhales CO2 faster than
metabolism produces it
 Blood vessels in brain constrict
 Anxiety, dizziness, lightheadedness
 Seizures, unconsciousness
Hyperventilation Syndrome

 Chest pains, dyspnea

 Numbness, tingling of fingers, toes,
area around mouth, nose
 Carpopedal spasms of hands, feet
Hyperventilation Syndrome

 Treatment
• Obtain thorough history
• Avoiding misdiagnosis is critical
• Try to “talk patient down”
• Re-breathe CO2 from face mask with
oxygen flowing at 1 to 2 liters/minute
Upper Airway

 Foreign Body Obstruction

 Pharyngeal Edema
 Croup
 Epiglottitis
Foreign Body Obstruction

 Partialor complete
 Most common cause of pediatric
airway obstruction
Foreign Body Obstruction

 Suspect in any child with

• Sudden onset of dyspnea
• Decreased LOC
 Suspect
in any adult who develops
dyspnea or loses consciousness while
eating
Foreign Body Obstruction

 Management
• Partial with good air exchange
• Partial with poor air exchange
• Complete
Pharyngeal Edema
 Swelling of soft tissues of throat
 Allergic reactions, upper airway burns
 Hoarseness, stridor, drooling
Pharyngeal Edema

 Management
• Position of comfort
• Oxygen
• Assist breathing as needed
• Consider ALS intercept for invasive airway
management
Epiglottitis
 Bacterial infection
 Causes edema of
epiglottis
 Children age 4-7
years
 Increasingly
common in adults
 Rapid onset, high
fever, stridor, sore
throat, drooling
Epiglottitis

 Can progress to
complete
obstruction
 Do not look in
throat
 Do not use
obstructed airway
maneuver
Croup

 Laryngotracheobronchitis
 Viralinfection
 Causes edema of larynx/trachea
 Children ages 6 months to 4 years
Croup

 Slow onset, hoarseness, brassy cough,

nightime stridor, dyspnea
 When in doubt, manage as epiglottitis
Croup/Epiglottitis

 Management
• Oxygen
• Assist ventilations as needed
• Do not excite patient
• Do not look in throat
• Consider ALS intercept
Lower Airway

 Asthma
 Chronic Obstructive Pulmonary Disease
• Chronic bronchitis
• Emphysema
Asthma

 Reversible obstructive pulmonary

disease
 Younger person’s disease (80% have
first episode before age 30)
 Lower airway hypersensitive to
allergens, emotional stress, irritants,
infection
Asthma

 Bronchospasm
 Bronchialedema
 Increased mucus production, plugging

Resistance to airflow, work of

breathing increase
Asthma

 Airway narrowing interferes with

exhalation
 Air trapped in chest interferes with gas
exchange
 Wheezing, coughing, respiratory
distress
Asthma

 Allthat wheezes is not asthma

 Other possibilities
• Pulmonary edema
• Pulmonary embolism
• Anaphalaxis (severe allergic reaction)
• Foreign body aspiration
• Pneumonia
Asthma

 Treatment
• High concentration O2, humidified
• Position of comfort
• Assist ventilation as needed
• Bronchodilators via small volume
nebulizer
• Calm patient, reassure
Chronic Obstructive Pulmonary
Disease

 Chronic
Bronchitis
 Emphysema
Chronic Bronchitis

 Chronic lower airway inflammation

• Increased bronchial mucus
production
• Productive cough
 Urban male smokers > 30 years old
Chronic Bronchitis
 Mucus, swelling interfere with ventilation
 Increased CO2, decreased 02
 Cyanosis occurs early in disease
 Lung disease overworks right ventricle
 Right heart failure occurs
 RHF produces peripheral edema

Blue Bloater
Emphysema

 Loss of elasticity
in small airways
 Destruction of
alveolar walls
 Urban male
smokers > 40-50
years old
Emphysema
 Lungs lose elastic recoil
 Retain CO2, maintain near normal O2
 Cyanosis occurs late in disease
 Barrel chest (increased AP diameter)
 Thin, wasted
 Prolonged exhalation through pursed lips

Pink Puffer
COPD
 Prone to periods of “decompensation”
 Triggered by respiratory infections, chest
trauma
 Signs/Symptoms
• Respiratory distress
• Tachypnea
• Cough productive of green, yellow sputum
COPD Management

 Oxygen
• Monitor carefully
• Some COPD patients may
experience respiratory depression on
high concentration oxygen
 Assist ventilations as needed
COPD Management

 Ifwheezing present, nebulized

bronchodilators via Small Volume
Nebulizer
Alveolar Function Problems
Pulmonary Edema

 Fluid
in/around alveoli, small airways
 Causes
• Left heart failure
• Toxic inhalants
• Aspiration
• Drowning
• Trauma
Pulmonary Edema

 Signs/Symptoms
• Labored breathing
• Coughing
• Rales, rhonchi
• Wheezes
• Pink, frothy sputum
Pulmonary Edema

 Signs/Symptoms
• Sit up
• High concentration O2
• Assist ventilation
Pulmonary Embolism

 Clotfrom venous circulation

 Passes through right heart
 Lodges in pulmonary circulation
 Shuts off blood flow past part of alveoli
Pulmonary Embolism

 Associated with:
• Prolonged bed rest or immobilization
• Casts or orthopedic traction
• Pelvic or lower extremity surgery
• Phlebitis
• Use of Birth Control Pills
Pulmonary Embolism

 Signs/Symptoms
• Dyspnea
• Chest pain
• Tachycardia
• Tachypnea
• Hemoptysis

Sudden Dyspnea + No Readily Identifiable Cause =

Pulmonary Embolism
Pulmonary Embolism

 Management
• Oxygen
• Assisted ventilation
• Transport