Respiratory Emergencies: Infectious Disorders

1. 30 Respiratory Emergencies: Infectious Disorders

2. 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.

3. 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.

4. 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.

5. 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

6. Pneumonia causes inflammation of the lungs and causes the alveoli to fill with fluid or pus, leading to poor gas exchange.

7. Pathophysiology (cont’d) • Pertussis • Whooping cough • Development of heavy mucus from airway • Paroxysms of coughing • Complications include pneumonia, dehydration, seizures, brain injuries

8. 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

9. 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

10. Assessment Findings (cont’d) • Additional findings with pneumonia • Malaise and decreased appetite • Cough (possibly productive) • General dyspnea findings • Pleuritic chest pain • Diaphoresis • Possible fever

11. 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

12. 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

13. 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

14. Emergency Medical Care (cont’d) • Administer inhaled bronchodilator PRN. • Keep patient sitting upright if possible. • Provide rapid transport to the ED.

15. 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.

16. 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.

17. 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.

18. Case Study (cont’d) • Medical History • Patient has history of pancreatic cancer • Medications • Primarily comfort medications • Allergies • Demerol

19. 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.

20. 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°

21. 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?

22. 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.

23. 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.