Transcript AEMT Transition - Unit 30 - Respiratory Infectious

TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
30
Respiratory Emergencies:
Infectious Disorders
Objectives
• 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.
Introduction
• 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.
Epidemiology
• 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.
Pathophysiology
• 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)
• Pertussis
– Whooping cough
– Development of heavy mucus from
airway
 Paroxysms of coughing
– Complications include pneumonia,
dehydration, seizures, brain injuries
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 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)
• Additional findings with pneumonia
– Malaise and decreased appetite
– Cough (possibly productive)
– General dyspnea findings
– Pleuritic chest pain
– Diaphoresis
– Possible fever
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)
• Additional findings with a VRI
– Nasal congestion
– Irritated or painful throat
– Mild dyspnea
– Fever
– Malaise, headache, body ache
– Poor feeding in infants
Emergency 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)
• Administer inhaled bronchodilator PRN.
• Keep patient sitting upright if possible.
• Provide rapid transport to the ED.
Case 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)
• 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)
• 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)
• Medical History
– Patient has history of pancreatic cancer
• Medications
– Primarily comfort medications
• Allergies
– Demerol
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)
• 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)
• 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)
• Care provided:
– Patient placed on high-flow oxygen.
– Placed in a semi-Fowler position on
wheeled cot.
– Transport initiated to ED.
Summary
• 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.