A brand new segment! In Paramedic Pathophys we cover general pathophysiology, physical presentation, and treatment of medical conditions and emergencies. Enjoy!
Foreign welcome back to emtv my name is alex like and today i thought i’d introduce a new segment called paramedic pathophys i’ve designed this segment to provide a quick rundown on the pathophysiology physical findings and treatments for common medical conditions or emergencies please keep in mind for the sake of brevity i’m only sticking to the high points
So sit back relax and let’s talk about asthma so asthma is an obstructive pulmonary disease it affects patients from pediatrics all the way through geriatrics it’s characterized by bronchospasms bronchoconstriction and wheezing and if you think about the physiology behind wheezing it makes a lot of sense you’re narrowing the airways and because it’s taking
Longer for the air to exit it creates pitch foreign ly wheezing is first heard during the expiratory phase and you’ll first hear wheezing usually in the lower lung fields however as asthma progresses you can hear wheezing throughout the entirety of the lungs and you can even hear it during the inspiratory phase one of the most ominous findings we can have with an
Asthmatic patient is to actually have absent lung sounds this is when no air is able to be exchanged so don’t be concerned when you’re treating an asthmatic or if you didn’t hear long sounds before after a treatment now you hear wheezing this is actually considered an improvement what we’re looking for here is an increase in aeration the overall airflow and with
Some asthmatics in addition to the bronchospasm or bronchoconstriction mucus is produced in these smaller airways make them even narrower most severe asthma events especially the ones that you are called to treat are usually preceded by some kind of trigger now depending on the individual triggers may involve things like environmental triggers like pollen chemical
Triggers like certain kinds of perfumes or other strong odors for example allergies and even exercise or exertion and trigger an asthma event though every asthmatic patient that you treat is different they share common characteristics or presentations oftentimes they’ll be tokipnik as in breathing more rapidly than normal they’ll be hypoxic to a degree usually
With an spo2 number below what they would normally be at when they weren’t having an asthma attack they may or may not be using accessory muscles to breathe and what this means is if you lift it up the shirt or looked at the muscles on the neck or the chest you would see them retracting or pulling into the chest in order to enlist additional muscular support or
Strength to take a full and complete deep breath this is considered a very concerning thing to see and if you’re caring for a patient who’s using accessory muscles to breathe you need to begin treatment as soon as you can finally a characteristic of asthma here which is fairly unique to the condition is the presence of a shark fin waveform on the capnogram now if
You remember the normal capnography waveform resembles the shape of a box or rectangle for a patient suffering an acute asthma exacerbation the respiratory phase is elongated or blunted creating what appears to look like a shark fin on the capnogram as the asthma event continues or worsens the capnogram takes a much sharper appearance eventually through treatment
Of the asthma the capnogram will return to the normal shape that it’s supposed to be now the treatment list provided here is fairly long and generally speaking you will not need to use all of these medications in treatment of most asthmatic patients treatment of an asthmatic patient involves the optimization of oxygenation and ventilation and the prevention of a
Secondary asthma event we will provide our patients with high flow oxygen and provide nebulized albuterol albuterol is an inhaled beta-2 agonist designed to relieve the bronchoconstriction or bronchospasm and promote gas exchange and normal airflow within the small airways of the lungs in addition to the albuterol we may also administer atrovent or hypertrophium
Bromide hypertrophium bromide is a short-acting muscarinic antagonist which is a type of anticholinergic this medication doesn’t do well on its own and should be mixed in combination with albuterol hypertropium bromide is designed to dry the secretions associated with some asthma events this medication is more beneficial in adult patients pediatric patients who
Have a diagnosis of asthma the next medication to consider providing for the patient is magnesium sulfate which is a favorite of mine magnesium sulfate is administered iv and it works by blocking the calcium channels in the smooth muscles of the airway which promotes bronchodilation and reduces airway excitability magnesium sulfate should not be used unless
Albuterol and hypertrophium bromide or simply albuterol has been used as well depending on your patient it may also be appropriate to administer iv fluids and this is because tachypnea will actually make the patients slightly dehydrated during the normal process of breathing we exhale water vapor with each breath in a patient who’s been to kipnik for hours is far
More likely to be slightly hypovolemic as a result of this hard breathing and this blowing off of water vapor iv fluid should be cautiously used though in patients if you suspect have a history of chf the next medications that will administer to this patient are corticosteroids corticosteroids like dexamethasone or methylprednisolone are useful in preventing the
Effects of a secondary asthma event many hours later they would be refractory to albuterol or would be more difficult to treat without butyrol these medications do not work immediately and usually have an onset of action several hours after administration occasionally an asthmatic may benefit from the use or application of bipap or cpap to prevent atelectasis
And to promote bronchodilation and reduce the effects of bronchospasm use this cautiously however in pediatric patients and those with a history of emphysema as their lung tissue may be fragile and they would be more likely to suffer at pneumothorax as a result of the application of cpap or bipap finally the last medication here and it should be noted that this
Medication should be used absolutely last and as a last resort measure is epinephrine one to one thousand given either subcutaneously or intramuscularly we recommend not starting with this medication as it can be very taxing to the hearts of older patients who saved this one for last your patient’s refractory to everything else now albuterol be aware can be given
Multiple times there’s no theoretical maximum dose of albuterol especially in the pre-hospital environment but the risk to administering too much albuterol is causing hypokalemia hypertropium bromide is generally given a maximum three times magnesium can be given in one to four gram boluses but generally it’s given once and corticosteroids are only even once as
The effects will not be seen for several hours after administration all right and that’s the quick rundown on asthma thank you for watching paramedic pathophys please remember to like and subscribe for more videos and leave me a comment below on suggestions for future videos and what you’d like to see me do differently until i see you next time stay safe and keep washing your hands
Transcribed from video
Paramedic Pathophys: Asthma By EMTV
