Common Presentations: Respiratory patients.

Respiratory complaints:

Asthma:

• Usually known Hx of asthma.

• Dyspnea with prolonged expiratory phase.

• Expiratory wheeze.

• Auscultation reveals wheezing or diminished/absent breath sounds.

• Diminished SPO2

• Elevated ETCO2

• Usually a dry cough is present

• Tripod positioning, accessory muscle use, or head bobbing.

• Typically has an environmental trigger.

Treatments:

• Salbutamol/albuterol (USA) MDI or Neb

• Epinephrine 0.01mg/kg Max 0.5mg in patients with severe dyspnea requiring BVM and a known Hx of asthma ONLY if they are <50 years of age.

• Supplemental oxygen.

COPD Exacerbation:

• Usually there is a known Hx of COPD (emphysema, CB, or both).

• Typically the patients are already on home O2 (Nasal cannula sign).

• The patient usually has a chronic productive cough, and some level of dyspnea on exertion. However, during exacerbation this is going to be much more pronounced.

• There will be a trigger for the exacerbation. Usually recent infections, fevers, allergen exposure, abnormal exercise level, or very hot or cold environmental exposures.

• SPO2 will normally be high 80s to low 90s, but will likely be <88% in exacerbations.

• ETCO2 of 50-60mmhg is not uncommon.

Treatments:

• Supplemental O2 (increase above home O2 level if it is not effective).

• CPAP in severe cases.

• Salbutamol

• 12-lead ECG to rule-out cardiac causes of increased dyspnea.

Pneumonia:

• Dyspnea that develops gradually over several hours to days.

• Sharp, diffuse, pleuritic chest pain.

• Cough, typically productive of yellow, green, or while sputum.

• Rhonchi on auscultation.

• Fever or chills (currently or recently).

• Often occurs in the setting of other comorbidity such as COPD or asthma, or in immunocompromised patients, or those with respiratory difficulties (post-surgery, neuromuscular disorders, etc).

Treatments:

• Supplemental oxygen.

• Salbutamol

• IV cannulation and potential bolus if the patient is hypotensive (sepsis).

• Passive temperature reduction in the setting of fever.

Pulmonary Embolism:

• Sudden sharp, well localized (“pinpoint”) pleuritic chest pain.

• Dyspnea, with clear lung sounds throughout.

• Low SPO2

• LOW ETCO2

• Hypotension

• Tachycardia

• DVT or recent history suggestive of one.

Treatments:

• Supplemental O2.

• 12-lead ECG to rule out MI and look for changes that support PE (Right heart strain pattern).

• IV cannulation and potential bolus.

• Rapid transport.

Pneumothorax:

• Sudden onset of sharp pleuritic chest pain on the affected side.

• Unilateral breath sounds (diminished or absent over affected region).

• Low SPO2.

• Dyspnea

• Tachycardia

• Hypotension if Tension Pneumothorax develops (especially with mediastinal shift).

• Possible subcutaneous emphysema.

• Tracheal deviation (late sign).

• ALS may provide needle decompression.

Treatments:

• Supplemental O2, and potentially PPV with a reduced tidal volume.

• IV cannulation in anticipation of potential hypotension.

• Rapid transport.