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The Big Wheeze

The Big Wheeze

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The Big Wheeze

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  1. The Big Wheeze CHF vs. COPD

  2. COPD Facts • COPD is the 4th leading cause of death • 122,486 (2007) • Men – 58,263 • Women – 64,223 Source; cdc.gov/nchs

  3. CHF Facts • 56,565 deaths (2007) • Males – 21,764 • Females – 34,801 Source; cdc.gov/nchs

  4. The Pink Puffer • Emphysema • Barrel chest • Thin • Polycythemia • Wheezes • Tripod • Cor Pulmonale

  5. The Blue Bloater • Chronic Bronchitis • Cyanosis • Overweight • Productive cough • Wheezing

  6. pathophysiology

  7. Emphysema

  8. Mild • Chronic cough • May be productive • May use bronchodilator • May not seek medical attention

  9. Moderate • Seek medical attention • S.O.B. with exertion • Bronchodilators • Pulmonary rehab

  10. Severe • Oxygen therapy • Increased S.O.B. • Episodes of severe dyspnea • May need antibiotics • May need surgical intervention

  11. End stage • Increased symptoms • Frequent episodes of dyspnea • Irreversible

  12. Chronic bronchitis • Breakdown of cilia • Mucous buildup • Bronchiole constriction

  13. Signs and Symptoms of COPD • Dyspnea • Morning headaches • Weight loss or gain • Cyanosis • Pedal edema (cor pulmonale) • Barrel chest (emphysema) • Chronic cough

  14. CHF • Systolic dysfunction • Decreased contractility • Decrease in stroke volume • Compensatory rise in preload

  15. CHF • Diastolic dysfunction • 50% have diastolic dysfunction • Reduction in ventricular compliance • Hypertrophy

  16. Signs and Symptoms of CHF • Weakness • Dyspnea with exertion • Hypertension • PND • Orthopnea • Pedal edema • Pulmonary edema

  17. CHF COPD THE BIG WHEEZE

  18. Assessment • Signs • Time of day (PND) • Position (tripod) • Skin color (pink or blue) • Diaphoresis • Vitals signs • Surroundings (O2, inhaler)

  19. Assessment • Pertinent medical history • Onset (rest or exertion) • Time (acute or persistent) • Medications • Lung sounds • SpO2? • capnography

  20. Capnography It’s the smoke from the fire of metabolism

  21. The air we breathe • Inhalation • O2 = 20.94% • N2 = 79.01% • CO2 = 0.04% • Exhalation • O2 = 16.4% • N2 = 79.6% • CO2 = 4.0%

  22. METABOLISM

  23. ENERGY

  24. Respiration • Intact system • Adequate rate • Adequate quality

  25. Circulation • Intact system • Effective pump • RBC’s • Hemoglobin

  26. Alveoli exhale Inhale

  27. Normal

  28. Bronchoconstriction

  29. Treatment

  30. COPD • Work the airway • Bronchodilators • Nebulizer • IV’s • Cardiac Monitor Follow your protocol!

  31. CHF • Nitroglycerin • Systolic >100 • Rule out RVI • CPAP • IV’s • Cardiac Monitor Follow your protocol

  32. CHF COPD

  33. ASTHMA COPD DKA TRAUMA SEIZURES GI BLEED HEAD TRAUMA

  34. QUESTIONS ? COMMENTS ? APPLAUSE ????????

  35. THANK YOU!! Julie Williams, NREMT-P, NCEE Training Coordinator Beaufort County EMS j_williams01@hargray.com