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30. Respiratory Emergencies: Infectious Disorders. 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.

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30

Respiratory Emergencies: Infectious Disorders


Objectives
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.


Introduction
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.


Epidemiology
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.


Pathophysiology
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


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


Pathophysiology cont d
Pathophysiology (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • Pertussis

    • Whooping cough

    • Development of heavy mucus from airway

      • Paroxysms of coughing

    • Complications include pneumonia, dehydration, seizures, brain injuries


Pathophysiology cont d1
Pathophysiology (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • 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


Assessment findings
Assessment Findings alveoli to fill with fluid or pus, leading to poor gas exchange.

  • 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


Assessment findings cont d
Assessment Findings (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • Additional findings with pneumonia

    • Malaise and decreased appetite

    • Cough (possibly productive)

    • General dyspnea findings

    • Pleuritic chest pain

    • Diaphoresis

    • Possible fever


Assessment findings cont d1
Assessment Findings (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • Additional findings with pertussis

    • History of URI

    • Runny nose, low-grade fever

    • Episodes of coughing followed by “whooping” sound

    • Fatigue from coughing


Assessment findings cont d2
Assessment Findings (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • Additional findings with a VRI

    • Nasal congestion

    • Irritated or painful throat

    • Mild dyspnea

    • Fever

    • Malaise, headache, body ache

    • Poor feeding in infants


Emergency medical care
Emergency Medical Care alveoli to fill with fluid or pus, leading to poor gas exchange.

  • 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


Emergency medical care cont d
Emergency Medical Care (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • Administer inhaled bronchodilator PRN.

  • Keep patient sitting upright if possible.

  • Provide rapid transport to the ED.


Case study
Case Study alveoli to fill with fluid or pus, leading to poor gas exchange.

  • 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.


Case study cont d
Case Study (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • 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.


Case study cont d1
Case Study (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • 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.


Case study cont d2
Case Study (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • Medical History

    • Patient has history of pancreatic cancer

  • Medications

    • Primarily comfort medications

  • Allergies

    • Demerol


Case study cont d3
Case Study (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • 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.


Case study cont d4
Case Study (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • 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°


Case study cont d5
Case Study (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • 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?


Case study cont d6
Case Study (cont’d) alveoli to fill with fluid or pus, leading to poor gas exchange.

  • Care provided:

    • Patient placed on high-flow oxygen.

    • Placed in a semi-Fowler position on wheeled cot.

    • Transport initiated to ED.


Summary
Summary alveoli to fill with fluid or pus, leading to poor gas exchange.

  • 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.


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