Pulmonology (resp emerg)

PulmonologyPulmonology

SectionsSections Review of Respiratory Anatomy

& Physiology Pathophysiology Assessment of the Respiratory

System Management of Respiratory

Disorders Specific Respiratory Diseases

Review of Respiratory Anatomy

& Physiology Pathophysiology Assessment of the Respiratory

System Management of Respiratory

Disorders Specific Respiratory Diseases

Respiratory AnatomyRespiratory Anatomy

Upper AirwayNasal CavityNasopharynxOropharynxLaryngopharynxLarynx

Upper AirwayNasal CavityNasopharynxOropharynxLaryngopharynxLarynx

Respiratory AnatomyRespiratory Anatomy

Upper AirwayThe Sinuses

Upper AirwayThe Sinuses

Respiratory AnatomyRespiratory Anatomy Lower

AirwayTracheaBronchi

Lower AirwayTracheaBronchi

Respiratory AnatomyRespiratory Anatomy Lower Airway

AlveoliLungsPulmonary and Bronchial Vessels

Lower AirwayAlveoliLungsPulmonary and Bronchial Vessels

Respiratory PhysiologyRespiratory Physiology

VentilationBody Structures

Chest Wall Pleura Diaphragm

VentilationBody Structures

Chest Wall Pleura Diaphragm


VentilationInspiration

VentilationInspiration


VentilationExpiration

VentilationExpiration


VentilationAirway Resistance & Lung ComplianceLung Volumes

VentilationAirway Resistance & Lung ComplianceLung Volumes


VentilationRegulation of Ventilation

The Medulla Stretch Receptors Changes in PCO2

COPD Patients

VentilationRegulation of Ventilation

The Medulla Stretch Receptors Changes in PCO2

COPD Patients


DiffusionInterference with Diffusion

Trauma Fluid accumulation in interstitial spaces Thickening of the endothelial lining

Effect of Oxygen Therapy

DiffusionInterference with Diffusion

Trauma Fluid accumulation in interstitial spaces Thickening of the endothelial lining

Effect of Oxygen Therapy


Pulmonary PerfusionRequirements

Adequate blood volume Intact pulmonary capillaries Efficient pumping action by the heart

HemoglobinCarbon Dioxide

Pulmonary PerfusionRequirements

Adequate blood volume Intact pulmonary capillaries Efficient pumping action by the heart

HemoglobinCarbon Dioxide

PathophysiologyPathophysiology

Disruption in VentilationUpper & Lower Respiratory Tracts

Obstruction due to trauma or infectious processes

Chest Wall & Diaphragm Trauma

• Pneumothorax• Hemothorax• Flail chest

Neuromuscular disease

Disruption in VentilationUpper & Lower Respiratory Tracts

Obstruction due to trauma or infectious processes

Chest Wall & Diaphragm Trauma

• Pneumothorax• Hemothorax• Flail chest

Neuromuscular disease


Disruption in VentilationNervous System

Trauma Poisoning or Overdose Disease

Disruption in VentilationNervous System

Trauma Poisoning or Overdose Disease


Disruption in DiffusionHypoxiaDamaged Alveoli

Disruption in PerfusionAlteration in Blood FlowChanges in HemoglobinPulmonary Shunting

Disruption in DiffusionHypoxiaDamaged Alveoli

Disruption in PerfusionAlteration in Blood FlowChanges in HemoglobinPulmonary Shunting

Scene Size-upThreats to Safety

Identify rescue environments having decreased oxygen levels.

Gases and other chemical or biological agents.

Clues to Patient Information

Scene Size-upThreats to Safety

Identify rescue environments having decreased oxygen levels.

Gases and other chemical or biological agents.

Clues to Patient Information

Assessment of the Respiratory Assessment of the Respiratory SystemSystem

Initial AssessmentGeneral Impression

Position Color Mental status Ability to speak Respiratory effort

Initial AssessmentGeneral Impression

Position Color Mental status Ability to speak Respiratory effort


Airway Proper ventilation cannot take place without an

adequate airway.Breathing

Signs of life-threatening problems• Alterations in mental status• Severe central cyanosis, pallor, or diaphoresis• Absent or abnormal breath sounds• Speaking limited to 1–2 words• Tachycardia• Use of accessory muscles or presence of retractions

Airway Proper ventilation cannot take place without an

adequate airway.Breathing

Signs of life-threatening problems• Alterations in mental status• Severe central cyanosis, pallor, or diaphoresis• Absent or abnormal breath sounds• Speaking limited to 1–2 words• Tachycardia• Use of accessory muscles or presence of retractions


HistorySAMPLE HistoryOPQRST History

Paroxysmal nocturnal dyspnea and orthopnea Coughing and hemoptysis Associated chest pain Smoking history or exposure to secondary smoke

Similar Past Episodes

HistorySAMPLE HistoryOPQRST History

Paroxysmal nocturnal dyspnea and orthopnea Coughing and hemoptysis Associated chest pain Smoking history or exposure to secondary smoke

Similar Past Episodes

Focused History Focused History & Physical Exam& Physical Exam

Physical ExaminationInspection

Look for asymmetry, increased diameter, or paradoxical motion.

Palpation Feel for subcutaneous emphysema or tracheal

deviation.PercussionAuscultation

Physical ExaminationInspection

Look for asymmetry, increased diameter, or paradoxical motion.

Palpation Feel for subcutaneous emphysema or tracheal

deviation.PercussionAuscultation


Auscultation Normal Breath

Sounds• Bronchial,

Bronchovesicular, and Vesicular

Abnormal Breath Sounds• Snoring• Stridor• Wheezing• Rhonchi• Rales/Crackles• Pleural Friction

Rub

Auscultation Normal Breath

Sounds• Bronchial,

Bronchovesicular, and Vesicular

Abnormal Breath Sounds• Snoring• Stridor• Wheezing• Rhonchi• Rales/Crackles• Pleural Friction

Rub


adventitious lung sounds video

http://www.youtube.com/watch?v=5JA6D1Mguh0&feature=youtube_gdata_player

Extremities Look for peripheral cyanosis. Look for swelling and redness, indicative of a venous clot. Look for finger clubbing, which indicates chronic hypoxia.

Extremities Look for peripheral cyanosis. Look for swelling and redness, indicative of a venous clot. Look for finger clubbing, which indicates chronic hypoxia.


Vital SignsHeart Rate

Tachycardia

Blood Pressure Pulsus paradoxus

Respiratory Rate Observe for trends.

Vital SignsHeart Rate

Tachycardia

Blood Pressure Pulsus paradoxus

Respiratory Rate Observe for trends.


Diagnostic TestingPulse

Oximetry Inaccurate

Readings

Diagnostic TestingPulse

Oximetry Inaccurate

Readings


Peak Flow PEFR

Peak Flow PEFR


Capnometry Continuous waveform monitoring, or capnography Colorimetric devices

Capnometry Continuous waveform monitoring, or capnography Colorimetric devices


Basic PrinciplesMaintain the airway.

Protect the cervical spine if trauma is suspected.Any patient with respiratory distress should

receive oxygen.Any patient suspected of being hypoxic

should receive oxygen.Oxygen should never be withheld from a

patient suspected of suffering from hypoxia.

Basic PrinciplesMaintain the airway.

Protect the cervical spine if trauma is suspected.Any patient with respiratory distress should

receive oxygen.Any patient suspected of being hypoxic

should receive oxygen.Oxygen should never be withheld from a

patient suspected of suffering from hypoxia.

Management of Management of Respiratory DisordersRespiratory Disorders

Upper-Airway ObstructionUpper-Airway Obstruction

Common CausesTongue, Foreign Matter, Trauma, BurnsAllergic Reaction, Infection

AssessmentDifferentiate Cause.

ManagementConscious Patient

If the patient is able to speak, encourage coughing. If the patient is unable to speak, perform abdominal

thrusts.

Common CausesTongue, Foreign Matter, Trauma, BurnsAllergic Reaction, Infection

AssessmentDifferentiate Cause.

ManagementConscious Patient

If the patient is able to speak, encourage coughing. If the patient is unable to speak, perform abdominal

thrusts.

Upper-Airway ObstructionUpper-Airway ObstructionUnconscious Patient

Start CPR

Unconscious Patient Start CPR

Sepsis Aspiration Pneumonia Pulmonary Injury Burns/Inhalation Injury Oxygen Toxicity Drugs High Altitude Hypothermia

Sepsis Aspiration Pneumonia Pulmonary Injury Burns/Inhalation Injury Oxygen Toxicity Drugs High Altitude Hypothermia

Adult Respiratory Adult Respiratory Distress SyndromeDistress Syndrome

Near-Drowning Syndrome

Head Injury

Pulmonary Emboli

Tumor Destruction

Pancreatitis

Invasive ProceduresBypass, hemodialysis

Hypoxia, Hypotension, or Cardiac Arrest

Near-Drowning Syndrome

Head Injury

Pulmonary Emboli

Tumor Destruction

Pancreatitis

Invasive ProceduresBypass, hemodialysis

Hypoxia, Hypotension, or Cardiac Arrest

ARDSVideo Link

http://www.youtube.com/watch?v=aXjaxvL6y7I&feature=youtube_gdata_player

PathophysiologyHigh MortalityMultiple Organ FailureAffects Interstitial Fluid

Causes increase in fluid in the interstitial space, disrupts diffusion and perfusion.

AssessmentSymptoms Related to Underlying CauseAbnormal Breath Sounds

Crackles and Rales

PathophysiologyHigh MortalityMultiple Organ FailureAffects Interstitial Fluid

Causes increase in fluid in the interstitial space, disrupts diffusion and perfusion.

AssessmentSymptoms Related to Underlying CauseAbnormal Breath Sounds

Crackles and Rales


ManagementManage the underlying condition.Provide supplemental oxygen.Support respiratory effort.

Provide positive pressure ventilation if respiratory failure is imminent.

Monitor cardiac rhythm and vital signs.Consider medications.

Corticosteroids

ManagementManage the underlying condition.Provide supplemental oxygen.Support respiratory effort.

Provide positive pressure ventilation if respiratory failure is imminent.

Monitor cardiac rhythm and vital signs.Consider medications.

Corticosteroids


For more info go to www.ardsusa.org

Obstructive Lung DiseaseObstructive Lung Disease

TypesEmphysemaChronic BronchitisAsthma

CausesGenetic DispositionSmoking & Other Risk Factors

TypesEmphysemaChronic BronchitisAsthma

CausesGenetic DispositionSmoking & Other Risk Factors

EmphysemaEmphysema

PathophysiologyExposure to Noxious Substances

Exposure results in the destruction of the walls of the alveoli.

Weakens the walls of the small bronchioles and results in increase residual volume.

Cor Pulmonale PolycythemiaIncreased Risk of Infection and Dysrhythmia

PathophysiologyExposure to Noxious Substances

Exposure results in the destruction of the walls of the alveoli.

Weakens the walls of the small bronchioles and results in increase residual volume.

Cor Pulmonale PolycythemiaIncreased Risk of Infection and Dysrhythmia

EmphysemaEmphysema

AssessmentHistory

Recent weight loss, dyspnea with exertion Cigarette and tobacco usage

Lack of Cough

AssessmentHistory

Recent weight loss, dyspnea with exertion Cigarette and tobacco usage

Lack of Cough

EmphysemaEmphysema

AssessmentPhysical Exam

Barrel chest. Prolonged expiration

and rapid rest phase. Thin. Pink skin due to

extra red cell production.

Hypertrophy of accessory muscles.

“Pink Puffers.”

AssessmentPhysical Exam

Barrel chest. Prolonged expiration

and rapid rest phase. Thin. Pink skin due to

extra red cell production.

Hypertrophy of accessory muscles.

“Pink Puffers.”

Chronic BronchitisChronic Bronchitis

Pathophysiology Results from an increase in mucus-secreting cells in

the respiratory tree. Alveoli relatively unaffected. Decreased alveolar ventilation.

AssessmentHistory

Frequent respiratory infections. Productive cough.

Pathophysiology Results from an increase in mucus-secreting cells in

the respiratory tree. Alveoli relatively unaffected. Decreased alveolar ventilation.

AssessmentHistory

Frequent respiratory infections. Productive cough.

Chronic BronchitisChronic BronchitisPhysical Exam

Often overweight. Rhonchi present on

auscultation. Jugular vein distention. Ankle edema. Hepatic congestion. “Blue Bloater.”

Physical Exam Often overweight. Rhonchi present on

auscultation. Jugular vein distention. Ankle edema. Hepatic congestion. “Blue Bloater.”

Bronchitis & EmphysemaBronchitis & Emphysema

ManagementMaintain airway.Support breathing.

Find position of comfort. Monitor oxygen saturation. Be prepared to ventilate or intubate.

Monitor cardiac rhythm.Establish IV access.Administer medications.

Bronchodilators & corticosteroids.

ManagementMaintain airway.Support breathing.

Find position of comfort. Monitor oxygen saturation. Be prepared to ventilate or intubate.

Monitor cardiac rhythm.Establish IV access.Administer medications.

Bronchodilators & corticosteroids.

AsthmaAsthma

PathophysiologyChronic Inflammatory Disorder

Results in widespread but variable air flow obstruction.

The airway becomes hyperresponsive. Induced by a trigger, which can vary by individual. Trigger causes release of histamine, causing

bronchoconstriction and bronchial edema. 6–8 hours later, immune system cells invade the

bronchial mucosa and cause additional edema.

PathophysiologyChronic Inflammatory Disorder

Results in widespread but variable air flow obstruction.

The airway becomes hyperresponsive. Induced by a trigger, which can vary by individual. Trigger causes release of histamine, causing

bronchoconstriction and bronchial edema. 6–8 hours later, immune system cells invade the

bronchial mucosa and cause additional edema.

AsthmaAsthma

AssessmentIdentify immediate threats.Obtain history.

SAMPLE & OPQRST History• History of asthma-related hospitalization?• History of respiratory failure/ventilator use?

AssessmentIdentify immediate threats.Obtain history.

SAMPLE & OPQRST History• History of asthma-related hospitalization?• History of respiratory failure/ventilator use?

AsthmaAsthmaPhysical Exam

Presenting signs may include dyspnea, wheezing, cough.• Wheezing is not present in all asthmatics.• Speech may be limited to 1–2 consecutive words.

Look for hyperinflation of the chest and accessory muscle use.

Carefully auscultate breath sounds and measure peak expiratory flow rate.

Physical Exam Presenting signs may include dyspnea, wheezing,

cough.• Wheezing is not present in all asthmatics.• Speech may be limited to 1–2 consecutive words.

Look for hyperinflation of the chest and accessory muscle use.

Carefully auscultate breath sounds and measure peak expiratory flow rate.

AsthmaAsthma

ManagementTreatment goals:

Correct hypoxia. Reverse bronchospasm. Reduce inflammation.

Maintain the airway.Support breathing.

High-flow oxygen or assisted ventilations as indicated.

ManagementTreatment goals:

Correct hypoxia. Reverse bronchospasm. Reduce inflammation.


High-flow oxygen or assisted ventilations as indicated.

AsthmaAsthmaMonitor cardiac rhythm.Establish IV Access.Administer medications.

Beta-agonists Ipratropium bromide Corticosteroids

Monitor cardiac rhythm.Establish IV Access.Administer medications.

Beta-agonists Ipratropium bromide Corticosteroids

Administration of Administration of Nebulized MedicationsNebulized Medications

Complete the initial assessment.Complete the initial assessment.


Place the patient on an ECG monitor.Place the patient on an ECG monitor.


Select the desired medication.Select the desired medication.


Add medication to the nebulizer.Add medication to the nebulizer.


Assemble the nebulizer and determine pre-treatment pulse rate.Assemble the nebulizer and determine pre-treatment pulse rate.


Administer the medication.Administer the medication.


Determine post-treatment pulse rate.Determine post-treatment pulse rate.


Reassess breath sounds.Reassess breath sounds.

Special Cases of AsthmaSpecial Cases of Asthma

Status AsthmaticusA severe, prolonged attack that cannot be broken by

bronchodilators.Greatly diminished breath sounds.Recognize imminent respiratory arrest.

Aggressively manage airway and breathing. Transport immediately.

Asthma in ChildrenPathophysiology and management similar.Adjust medication dosages as needed.

Status AsthmaticusA severe, prolonged attack that cannot be broken by

bronchodilators.Greatly diminished breath sounds.Recognize imminent respiratory arrest.

Aggressively manage airway and breathing. Transport immediately.

Asthma in ChildrenPathophysiology and management similar.Adjust medication dosages as needed.

Upper Respiratory InfectionsFrequent patient complaint

Common pediatric complaintRarely life threatening

PathophysiologyFrequently caused by viral and bacterial infections.Affect multiple parts of the upper airway.Typically resolve after several days of symptoms.

Upper Respiratory InfectionsFrequent patient complaint

Common pediatric complaintRarely life threatening

PathophysiologyFrequently caused by viral and bacterial infections.Affect multiple parts of the upper airway.Typically resolve after several days of symptoms.

Upper RespiratoryUpper RespiratoryInfection (URI)Infection (URI)

AssessmentLook for underlying illness.Evaluate pediatrics for epiglottitis.

ManagementMaintain the airway.Support breathing.Treat signs and symptoms.

AssessmentLook for underlying illness.Evaluate pediatrics for epiglottitis.

ManagementMaintain the airway.Support breathing.Treat signs and symptoms.


PneumoniaPneumonia

Infection of the LungsImmune-Suppressed Patients

PathophysiologyBacterial & Viral Infections

Hospital-acquired vs. community-acquired. Infection can spread throughout lungs. Alveoli may collapse, resulting in a ventilation

disorder.

Infection of the LungsImmune-Suppressed Patients

PathophysiologyBacterial & Viral Infections

Hospital-acquired vs. community-acquired. Infection can spread throughout lungs. Alveoli may collapse, resulting in a ventilation

disorder.

PneumoniaPneumonia

AssessmentFocused History & Physical Exam

SAMPLE & OPQRST• Recent fever, chills, weakness, and malaise• Deep, productive cough with associated pain

Tachypnea and tachycardia may be present. Breath sounds:

• Presence of rales/crackles in affected lung segments• Decreased air movement in the affected lung


SAMPLE & OPQRST• Recent fever, chills, weakness, and malaise• Deep, productive cough with associated pain

Tachypnea and tachycardia may be present. Breath sounds:

• Presence of rales/crackles in affected lung segments• Decreased air movement in the affected lung

PneumoniaPneumonia

ManagementMaintain the airway.Support breathing.

High-flow oxygen or assisted ventilation as indicated.Monitor vital signs.Establish IV access.

Avoid fluid overload.Medications

Antibiotics, antipyretics, beta-agonists.


High-flow oxygen or assisted ventilation as indicated.Monitor vital signs.Establish IV access.

Avoid fluid overload.Medications

Antibiotics, antipyretics, beta-agonists.

Lung CancerLung Cancer

PathophysiologyGeneral

Majority are caused by carcinogens secondary to cigarette smoking or occupational exposure.

May start elsewhere and spread to lungs. High mortality.

Types Adenocarcinoma. Epidermoid, small-cell, and large-cell carcinomas.

PathophysiologyGeneral

Majority are caused by carcinogens secondary to cigarette smoking or occupational exposure.

May start elsewhere and spread to lungs. High mortality.

Types Adenocarcinoma. Epidermoid, small-cell, and large-cell carcinomas.

Lung CancerLung Cancer


SAMPLE & OPQRST History• Cancer-related treatments and hospitalizations.

Physical Exam• Evaluate for severe respiratory distress.

ManagementFollow general principles.

Administer oxygen, support ventilation.Provide emotional support.


SAMPLE & OPQRST History• Cancer-related treatments and hospitalizations.

Physical Exam• Evaluate for severe respiratory distress.

ManagementFollow general principles.

Administer oxygen, support ventilation.Provide emotional support.

Toxic InhalationToxic Inhalation

Pathophysiology Includes inhalation of heated air, chemical irritants,

and steam. Airway obstruction due to edema and laryngospasm

due to thermal and chemical burns.


SAMPLE & OPQRST History• Determine nature of substance.• Length of exposure and loss of consciousness.

Pathophysiology Includes inhalation of heated air, chemical irritants,

and steam. Airway obstruction due to edema and laryngospasm

due to thermal and chemical burns.


SAMPLE & OPQRST History• Determine nature of substance.• Length of exposure and loss of consciousness.

Toxic InhalationToxic Inhalation

ManagementEnsure scene safety.

Enter a scene only if properly trained and equipped. Remove the patient from the toxic environment.

Maintain the airway. Early, aggressive management may be indicated.

Support breathing.Establish IV access.Transport promptly.



Maintain the airway. Early, aggressive management may be indicated.

Support breathing.Establish IV access.Transport promptly.

Carbon MonoxideOdorless, Colorless Gas

Results from the combustion of carbon-containing compounds.

Often builds up to dangerous levels in confined spaces such as mines, autos, and poorly ventilated homes.

Hazardous to Rescuers

Carbon MonoxideOdorless, Colorless Gas

Results from the combustion of carbon-containing compounds.

Often builds up to dangerous levels in confined spaces such as mines, autos, and poorly ventilated homes.

Hazardous to Rescuers

Carbon Monoxide InhalationCarbon Monoxide Inhalation

PathophysiologyBinds to Hemoglobin

Prevents oxygen from binding and creates hypoxia at the cellular level.

AssessmentFocused History and Physical Exam

SAMPLE & OPQRST History• Determine source and length of exposure.• Presence of headache, confusion, agitation, lack of

coordination, loss of consciousness, and seizures.

PathophysiologyBinds to Hemoglobin

Prevents oxygen from binding and creates hypoxia at the cellular level.

AssessmentFocused History and Physical Exam

SAMPLE & OPQRST History• Determine source and length of exposure.• Presence of headache, confusion, agitation, lack of

coordination, loss of consciousness, and seizures.





High-flow oxygen or assisted ventilations as indicated.Establish IV access.Transport promptly.




High-flow oxygen or assisted ventilations as indicated.Establish IV access.Transport promptly.


Pulmonary EmbolismPulmonary Embolism

PathophysiologyObstruction of a pulmonary artery

Emboli may be of air, thrombus, fat, or amniotic fluid.

Foreign bodies may also cause an embolus.

Risk Factors Recent surgery, long-bone fractures, pregnancy. Pregnant or postpartum. Oral contraceptive use, tobacco use.

PathophysiologyObstruction of a pulmonary artery

Emboli may be of air, thrombus, fat, or amniotic fluid.

Foreign bodies may also cause an embolus.

Risk Factors Recent surgery, long-bone fractures, pregnancy. Pregnant or postpartum. Oral contraceptive use, tobacco use.



SAMPLE & OPQRST History• Presence of risk factors• Sudden onset of severe dyspnea and pain• Cough, often blood-tinged

Physical Exam• Signs of heart failure, including JVD and hypotension• Warm, swollen extremities


SAMPLE & OPQRST History• Presence of risk factors• Sudden onset of severe dyspnea and pain• Cough, often blood-tinged

Physical Exam• Signs of heart failure, including JVD and hypotension• Warm, swollen extremities



High-flow oxygen or assist ventilations as indicated. Intubation may be indicated.

Establish IV accessMonitor vital signs closely.Transport to appropriate facility.


High-flow oxygen or assist ventilations as indicated. Intubation may be indicated.

Establish IV accessMonitor vital signs closely.Transport to appropriate facility.

PathophysiologyPneumothorax

Occurs in the absence of blunt or penetrating trauma.Risk factors

AssessmentFocused history

SAMPLE & OPQRST history. Presence of risk factors. Rapid onset of symptoms. Sharp, pleuritic chest or shoulder pain. Often precipitated by coughing or lifting.

PathophysiologyPneumothorax

Occurs in the absence of blunt or penetrating trauma.Risk factors

AssessmentFocused history

SAMPLE & OPQRST history. Presence of risk factors. Rapid onset of symptoms. Sharp, pleuritic chest or shoulder pain. Often precipitated by coughing or lifting.

Spontaneous PneumothoraxSpontaneous Pneumothorax

Physical exam: Decreased or absent breath sounds on affected side Tachypnea, diaphoresis, and pallor

ManagementMaintain the airway.Support breathing.Monitor for tension pneumothorax.

Pleural decompression may be indicated if patient becomes cyanotic, hypoxic, and difficult to ventilate.

JVD and tracheal deviation away from the affected side.

Physical exam: Decreased or absent breath sounds on affected side Tachypnea, diaphoresis, and pallor

ManagementMaintain the airway.Support breathing.Monitor for tension pneumothorax.

Pleural decompression may be indicated if patient becomes cyanotic, hypoxic, and difficult to ventilate.

JVD and tracheal deviation away from the affected side.

Spontaneous PneumothoraxSpontaneous Pneumothorax

Hyperventilation Hyperventilation SyndromeSyndrome


SAMPLE & OPQRST history.• Fatigue, nervousness, dizziness, dyspnea, chest pain.• Numbness and tingling in hands, mouth, and feet.

Presence of tachypnea and tachycardia. Spasms of the fingers and feet.


SAMPLE & OPQRST history.• Fatigue, nervousness, dizziness, dyspnea, chest pain.• Numbness and tingling in hands, mouth, and feet.

Presence of tachypnea and tachycardia. Spasms of the fingers and feet.



Provide high-flow oxygen or assist ventilations as indicated.

Do NOT allow the patient to rebreathe exhaled air.

Reassure the patient.


Provide high-flow oxygen or assist ventilations as indicated.

Do NOT allow the patient to rebreathe exhaled air.

Reassure the patient.


CNS DysfunctionCNS Dysfunction Pathophysiology

Causes can include traumatic/atraumatic brain injury, tumors, and drugs.

AssessmentEvaluate potentially treatable causes, such as narcotic

drug overdose or CNS trauma.Carefully evaluate breathing pattern.

ManagementFollow general management principles.Maintain the airway and support breathing.Use cervical spine precautions if indicated.

PathophysiologyCauses can include traumatic/atraumatic brain injury,

tumors, and drugs.

AssessmentEvaluate potentially treatable causes, such as narcotic

drug overdose or CNS trauma.Carefully evaluate breathing pattern.


PathophysiologyPNS problems affecting respiratory function may

include trauma, polio, myasthenia gravis, viral infections, tumors.

AssessmentRule out traumatic injury, and assess for numbness,

pain, or signs of PNS dysfunction.


PathophysiologyPNS problems affecting respiratory function may

include trauma, polio, myasthenia gravis, viral infections, tumors.

AssessmentRule out traumatic injury, and assess for numbness,

pain, or signs of PNS dysfunction.


Dysfunction of the Spinal Cord, Dysfunction of the Spinal Cord, Nerves, or Respiratory MusclesNerves, or Respiratory Muscles

Pulmonology (resp emerg)

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