Shortness of Breath

Question 1

Primary Survey

Answer 1

• Confirm there are no D-Spine
• Assess lvl of consciousness (AVPU scale)
• Assess and manage ABC’s as required
• Expose and examine chest
  1. Palpate and inspect for signs of trauma and central cyanosis
  2. Have patient take a deep breath to see if that changes the pain
  3. Auscultate 6 points for medical SOB PT’s
• Complete RBS
• Apply O2 (non rebreather or BVM if indicated)
• Consider the PT’s position based on ease of breathing - full fowlers
• Unconscious PT’s requiring BVM are positioned supine
• Assist patient in self administering medications if appropriate

Question 2

Decision Point

Answer 2

Findings in unstable patient include:
- Acute shortness of breath
- Severe hypoxia
- Traumatic chest injuries (flail chest, penetrating injuries, inhalation injuries, etc.)
- Airway obstruction
- Signs and symptoms of anaphylaxis
- Cyanotic, cool and diaphoretic skin
- Severe dyspnea with decreased LOC

Question 3

Load and Transport

Answer 3

Transport unstable patient immediately after primary survey OR after assisting with first dose of patient’s MDI, if available. Epi pen in the MDI assist(?)

Transport stable patient after all treatments are complete

Question 4

Critical History

Answer 4

• Compare breathing problems to previous episodes
• Note previous hospitalizations and severity
• Auscultate minimum of 6 points on scene and monitor with each set of vital signs
• Note cause of onset and length of episode
• Note any other allergies and consider the possibility of an allergic or anaphylactic response
• Note the use of inhalers or other medications associated with respiratory or cardiac disorders

Question 5

Patient History

Answer 5

SAMPLE/OPQRRRST

Question 6

Vital Signs

Answer 6

• Auscultate a minimum of 6 points with each set of vitals
• Complete vital signs q5 for unstable patient
• Complete vital signs q15 for stable patient

Question 7

Hospital Notification and Head to Toe/Functional Inquiry

Answer 7

Completed enroute to hospital

Question 8

Protocol(s)

Answer 8

None

Question 9

Treatment

Answer 9

• Continue with high flow O2 and seek higher care
• Consider causes of shortness of breath and if available, encourage patient to self-administer medication as directed by their doctor
• Encourage the patient to cough up any secretions
• Consider assisting ventilation for failing respirations

Question 10

Signs and Symptoms of shortness of breath (requiring supplemental oxygen)

Answer 10

• Increased RR
• Restlessness/anxiety
• Abnormal rate/rhythm
• Tripod position (?)
• Skin colour changes (pale, flushed, or cyanotic)
• Changes in mental status
• Inability to speak in full sentences
• Noisy breathing (stridor, wheezes, rhonchi, etc.)
• Increased work of breathing/accessory muscle use
• Decreased SpO2

Question 11

Signs and Symptoms of Failing Respirations (requiring assisted ventilations)

Answer 11

• Decreasing LOC
• Absent respirations
• Hyperventilation (with DLOC and cyanosis)
• RR < 10 in adults, RR < 12 in children, RR < 16 in infants
• Agonal respirations
• Central/peripheral cyanosis
• Decreasing SpO2