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The Big Wheeze. CHF vs. COPD. COPD Facts. COPD is the 4 th leading cause of death 122,486 (2007) Men – 58,263 Women – 64,223. CHF Facts. 56,565 deaths (2007) Males – 21,764 Females – 34,801. The Pink Puffer. Emphysema Barrel chest Thin Polycythemia Wheezes Tripod Cor Pulmonale.

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The big wheeze

The Big Wheeze

CHF vs. COPD


Copd facts
COPD Facts

  • COPD is the 4th leading cause of death

  • 122,486 (2007)

  • Men – 58,263

  • Women – 64,223

Source; cdc.gov/nchs


Chf facts
CHF Facts

  • 56,565 deaths (2007)

  • Males – 21,764

  • Females – 34,801

Source; cdc.gov/nchs


The pink puffer
The Pink Puffer

  • Emphysema

  • Barrel chest

  • Thin

  • Polycythemia

  • Wheezes

  • Tripod

  • Cor Pulmonale


The blue bloater
The Blue Bloater

  • Chronic Bronchitis

  • Cyanosis

  • Overweight

  • Productive cough

  • Wheezing




Mild

  • Chronic cough

  • May be productive

  • May use bronchodilator

  • May not seek medical attention


Moderate
Moderate

  • Seek medical attention

  • S.O.B. with exertion

  • Bronchodilators

  • Pulmonary rehab


Severe
Severe

  • Oxygen therapy

  • Increased S.O.B.

  • Episodes of severe dyspnea

  • May need antibiotics

  • May need surgical intervention


End stage
End stage

  • Increased symptoms

  • Frequent episodes of dyspnea

  • Irreversible


Chronic bronchitis
Chronic bronchitis

  • Breakdown of cilia

  • Mucous buildup

  • Bronchiole constriction


Signs and symptoms of copd
Signs and Symptoms of COPD

  • Dyspnea

  • Morning headaches

  • Weight loss or gain

  • Cyanosis

  • Pedal edema (cor pulmonale)

  • Barrel chest (emphysema)

  • Chronic cough


CHF

  • Systolic dysfunction

    • Decreased contractility

    • Decrease in stroke volume

    • Compensatory rise in preload


CHF

  • Diastolic dysfunction

    • 50% have diastolic dysfunction

    • Reduction in ventricular compliance

    • Hypertrophy


Signs and symptoms of chf
Signs and Symptoms of CHF

  • Weakness

  • Dyspnea with exertion

  • Hypertension

  • PND

  • Orthopnea

  • Pedal edema

  • Pulmonary edema


The big wheeze1

CHF

COPD

THE BIG WHEEZE


Assessment
Assessment

  • Signs

    • Time of day (PND)

    • Position (tripod)

    • Skin color (pink or blue)

    • Diaphoresis

    • Vitals signs

    • Surroundings (O2, inhaler)


Assessment1
Assessment

  • Pertinent medical history

    • Onset (rest or exertion)

    • Time (acute or persistent)

    • Medications

    • Lung sounds

    • SpO2?

    • capnography


Capnography
Capnography

It’s the smoke from the fire of metabolism


The air we breathe
The air we breathe

  • Inhalation

  • O2 = 20.94%

  • N2 = 79.01%

  • CO2 = 0.04%

  • Exhalation

  • O2 = 16.4%

  • N2 = 79.6%

  • CO2 = 4.0%




Respiration
Respiration

  • Intact system

  • Adequate rate

  • Adequate quality


Circulation
Circulation

  • Intact system

  • Effective pump

  • RBC’s

  • Hemoglobin


Alveoli

exhale

Inhale





COPD

  • Work the airway

  • Bronchodilators

  • Nebulizer

  • IV’s

  • Cardiac Monitor

    Follow your protocol!


CHF

  • Nitroglycerin

    • Systolic >100

    • Rule out RVI

  • CPAP

  • IV’s

  • Cardiac Monitor

Follow your protocol


CHF

COPD


ASTHMA

COPD

DKA

TRAUMA

SEIZURES

GI BLEED

HEAD TRAUMA


QUESTIONS ?

COMMENTS ?

APPLAUSE ????????


Thank you
THANK YOU!!

Julie Williams, NREMT-P, NCEE

Training Coordinator

Beaufort County EMS

[email protected]


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