CHAPTER 40: Pulmonary Emergencies

INTRODUCTION

There are inconsistent data on the percentage of EMS calls involving pulmonary emergencies. A search of the literature reveals respiratory calls make up approximately 11% to 15% of all EMS requests.^1,2 Few publications actually define the types of calls and concomitant demographics of those patients. After the terrorist attacks of 9/11, there was an increase in “syndrome surveillance” across the country primarily in an attempt to discover aberrant trends in the incidence of pulmonary disease. Despite attempts to classify the number of disease presentations, including using EMS/9-1-1 call records, the information remains scarce.³

Nevertheless a patient with a pulmonary emergency is an anxiety-provoking situation for both the patient and the prehospital provider.

OBJECTIVES

1. Discuss demographics of respiratory disease pertaining to EMS, including percent of EMS calls, the incidence and increase of acute and chronic lung disease, as well as fatality data from respiratory distress.

2. Understand and be able to integrate knowledge about normal respiratory physiology including normal versus positive pressure ventilation, mechanics of gas exchange, and the CNS control of respiratory drive.

3. Discuss and list common causes of respiratory illness including pathophysiology, presentation, and treatment for asthma, COPD, CHF, and lung malignancy.

4. Describe differences between acute and chronic respiratory conditions including chronic and acute phases of respiratory failure.

5. Discuss and list causes, presentation, and treatment for other acute medical causes of respiratory distress including PE, pneumonia, pulmonary edema, croup, and epiglottitis.

6. List and discuss other nonmedical causes of respiratory distress including asphyxiants, respiratory toxins, and foreign body airway obstruction.

7. Describe the indications for prehospital endotracheal intubation.

8. Discuss the use of supraglottic airway devices and their role in prehospital care.

9. Describe the physiology and indications for use of prehospital noninvasive positive pressure ventilation.

10. Discuss and understand the RSI process including indications and medications.

According to the CDC, in 2007 the number of visits to ambulatory cares sites in the United States, including physician offices, hospital outpatient, and emergency departments for chronic and unspecified bronchitis, as a primary diagnosis, was 11.7 million, and for other chronic obstructive pulmonary disease conditions, as a primary diagnosis, was 6.1 million.⁴

Health statistics provided by the CDC for US adults in 2009 reveal the number of noninstitutionalized adults diagnosed with chronic bronchitis as 9.9 million or 4.4% of the US population. The percent of noninstitutionalized adults who had been diagnosed with emphysema was 4.1 million (2.2%) of the population. The number of deaths in the United States from chronic/unspecified bronchitis per 100,000 population is 0.2. The number of deaths per 100,000 population from emphysema is 4.2 and for other chronic lower respiratory diseases excluding asthma per 100,000 population is 36.8.⁵

These statistics reveal that COPD is responsible for a significant economic burden on society and a significant medical burden on EMS responders.

RESPIRATORY PHYSIOLOGY