These are a basic overview of emergency respiratory disorders that paramedics regularly attend:
This disease is a chronic disorder involving inflammation of the bronchial airways as a result of a pollutant or irritant. During the normal progression of asthma, the inflammatory response causes a narrowing of the bronchial airways which allow a decreased amount of airflow. During the expiratory phase the exhaled air naturally causes the bronchial airways to close, and can be heard in the form of a wheeze. In severe cases, a wheeze may be heard on the inspiratory phase as well as the expiratory phase. This results in an increased difficulty getting rid of the pollutants (often which caused the problem in the first place) and therefore great inflammation. This leads to increased mucous production and increased formation of a mucosal plug. In an attempt to resolve all of this, the body may develop a broncho-spasm, which further narrows the airways and results in an audible wheeze. This results in a difficulty in getting rid of the air that a patient has inhaled. If the patient is young and otherwise healthy, he or she should still be able to compensate well up until this point. However, as the course of asthma progresses the patient will no longer be able to compensate. As the muscles of respiration become fatigued (such as the diagaphram and accessory muscles: sternocloidomastoid, pectoralis major, intercostal muscles) the body will start to decompensate and will eventually result in the patient suffering a respiratory arrest. This is a life-threatening emergency and should be treated as such because of the risk of sudden decompensation leading to respiratory arrest and death.
COPD or CAL
Chronic Obstructive Pulmonary Diseas and Chronic Airway Limitations are both synonymous categories of airway disorders that encompass chronic airway disease, such as emphysema and chronic bronchitis, with the long term complications related to a narrowing of the bronchial airways. Both terms are interchangeable. These are chronic diseases, and generally un-reversible. The diseases are generally sub-acute but may have periods of exacerbation as a result of pollutants in the air or respiratory infections. Treatment for these patients often target holitic solutions aimed at preventing a worsening of the disease, through regular vacinations, imunisations, cessation of smoking, or removal of irritants and pulmonary adjunctive treatment options such as salbutamol and oxygen during periods of exacerbation. Some patients with COPD may develop what is known as a hypoxic drive, in which they become used to living with a very low level of blood oxygen saturations, and (unlike a normal healthy person), require a change in the CO2 levels (a much later change than oxygen saturations) to cause the body to recognise the need to increase its respiratory rate or depth. Consequently, some of these patients, if given high concentration of oxygen, may find that they litterally forget to breath as a result of the low CO2 levels in the blood. This, however, should not prevent a paramedic from administering high levels of oxygen in a patient with severe exacerbation of COPD and shortness of breath.
Acute Pulmonary Oedema
Acute Pulmonary Oedema is the result of an increased fluid build up in the alvioli space, which then increases the space in which 02 and CO2 diffusion must occur. Common causes of APO include increase infection, left sided cardiac failure (resulting in a backlog of fluid in the pulmonary artery), fluid overload, saltwater drownings, and ARDS (adult respiratory distress syndrom).
In these cases, lung tissue cells have over proliferated, resulting in lung tumors and lung tissue damage. Lung tissue cells are some of the fastest growing/replicating cells in the entire body. Consequently, lung cancer often results in very short life expectancies. Treatment is often based on chemotherapy, radiotherapy and supportive measures such as home oxygen, bronchodilators, and pain relief.
Croup is a severe upper respiratory infection (often viral) which although it can affect adults, only causes clinically dangerous manifestations in infants and young children (who already have a very narrow upper respiratory tract). The inflammation to the upper respiratory tract causes swelling to the larynx, trachea and large bronchi. This swelling results in a “barking cough” or “seal like cough” and a stridor (inspiratory airway obstruction). The clinical risk and potential affect on the infant or child is often worsened by severe crying (due to the increased work load on the body and decrease in oxygenation). It should also be noted, that in patients with croup, a suddent lack of stridor occurs as the patient decompensates and the condition worsens.
Emphysema is a chronic disorder as a result of damage and inflammation of the alvioli (air sacs,which are used in the defusion of oxygen and CO2 from the pulmonary arteries and the lungs). This disorder is often secondary to longterm smoking. The damage and destruction of the alvioli results in a decrease of surface area available for oxygen and CO2 diffusion. These patients often rely on a hypoxic drive to breath.
Pneumonia is an inflammatory condition of the lung as a secondary response to infection, bacteria, fungi, parasites, or antigens/pollutants. This often results in a filling of exudate (inflammatory fluid) in the alveoli, which then results in increased sputum production.
Chronic bronchitis is the result of long term damage and inflammation to the large airways. This results in an increased sputum production and chronic lower airway infections.
Acute bronchitis is a sudden onset inflammation of the large airways, often secondary to an infection, bacteria, virus, fungi, parasite, or pollutant. Treatment includes supportive measures, such as rest, oxygen therapy and bronchodilators, such as salbutamol.