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Medical: 5 Pulmonary: 1

      • (1)

        Smooth muscle spasm

        • (a)

          Beta receptors

      • (2)

        Mucous

        • (a)

          Goblet cells

        • (b)

          Cilia

      • (3)

        Inflammation

    • c)

      Obstruction may be reversible or irreversible

    • d)

      Obstruction causes air trapping through the following mechanism

      • (1)

        Bronchioles dilate naturally on inspiration

      • (2)

        Dilation enables air to enter the alveoli despite the presence of obstruction

      • (3)

        Bronchioles naturally constrict on expiration

      • (4)

        Air becomes trapped distal to obstruction on exhalation

  • 5.

    Pathophysiology varies slightly by disease

    • a)

      Asthma

      • (1)

        Reversible obstruction

      • (2)

        Obstruction caused by a combination of smooth muscle spasm, mucous, and edema

      • (3)

        Exacerbating factors tend to be extrinsic in children, intrinsic in adults

      • (4)

        Status asthmaticus - prolonged exacerbation which doesn't respond to therapy

    • b)

      Chronic bronchitis

      • (1)

        Reversible and irreversible obstruction

      • (2)

        Characterized by hyperplasia and hypertrophy of mucous-producing glands

      • (3)

        Clinical definition - productive cough for at least 3 months per year for 2 or more consecutive years

      • (4)

        Typically associated with cigarette smoking, but may also occur in non- smokers

    • c)

      Emphysema

      • (1)

        Irreversible airway obstruction

      • (2)

        Diffusion defect also exists because of the presence of blebs

      • (3)

        Because blebs have extremely thin walls, they are prone to collapse

      • (4)

        To prevent collapse, the patient often exhales through pursed lips, effectively maintaining a positive airway pressure

      • (5)

        Almost always associated with cigarette smoking or significant exposure to environmental toxins

  • 6.

    Assessment findings

    • a)

      Signs of severe respiratory impairment

      • (1)

        Altered mentation

      • (2)

        1-2 word dyspnea

      • (3)

        Absent breath sounds

    • b)

      Chief complaint

      • (1)

        Dyspnea

      • (2)

        Cough

      • (3)

        Nocturnal awakening with dyspnea and wheezing

    • c)

      History

      • (1)

        Personal or family history of asthma and/ or allergies

      • (2)

        History of acute exposure to pulmonary irritant

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United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum

17

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