The lungs are one of the most important organs in the human body. Without the lungs a person is unable to intake oxygen that is need to life. There are many problems that can develop within the lungs. Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. This paper will discuss the epidemiology and pathophysiology of COPD. The pre-hospital treatment of COPD will also be covered. A detailed example of a field impression and treatment plan will also be illustrated.
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Chronic obstructive pulmonary disease causes a person to have difficulty in breathing. There are to main forms of COPD; chronic bronchitis and emphysema. Chronic bronchitis is a long-term cough that produces mucus. Emphysema is the destruction of the lungs of a period of time. Most people that have COPD have a combination of chronic bronchitis and emphysema. There are several causes of COPD, with smoking being the most prevalent. The more a person smokes, the more likely they are to develop COPD. There are also several causes of COPD in non-smokers. Patients who lack the protein alpha-1 antitrypsin can develop emphysema. Other airway irritants such as, exposure to gases and fumes in the workplace, second-hand smoke, and frequent use of cooking gases without ventilation are other potential risk factors. Again, smoking is the primary cause of COPD; however someone can be a lifelong smoker and not develop COPD.
All diseases have a pathophysiologic reason as to how and why it affects the body. However, according to the American Academy of Family Physicians, COPD does not have a clear pathophysiology. What is known about COPD is that the cells of the bronchial tree have been subjected to chronic inflammation. This inflammation is caused by smoking and other irritants that mentioned previously. When the cells of the bronchial tree are inflamed it causes the smooth muscles of the airway to constriction excessively. This hyperactivity causes the airway to become swollen, production of excess amounts of mucus, and decreased effectiveness of the cilia. As COPD progress, patients begin to have difficulty clearing secretions, which causes a chronic productive cough, wheezing and difficulty breathing. Due to the inability for the patient to clear the productive cough, mucus begins to collect in the airway. The collection of mucus is an issue because it collects bacteria and cause causes infections. Both chronic bronchitis and emphysema caused airway obstruction. In cases of chronic bronchitis the airway is obstruction caused by the build-up of mucus describe previously. In cases of emphysema, the alveoli become enlarged an eventually destroy. This hinders the necessary exchange of oxygen and carbon dioxide. Chronic obstructive pulmonary disease has many negative effects on the body that impedes the body from respiring efficiently.
Just like every condition chronic obstructive pulmonary disease has signs and symptoms that all providers the ability to both diagnosis and treat their patients. The classic signs of COPD include an ongoing productive cough, shortness of breath, wheezing, and tightness in the chest. These symptoms can appear both early and late in the disease process. If a patients presents with these symptoms early, then it is possible that they have not lost the ability effectively move air. COPD patients may also present with the following symptoms: difficulty catching breath, signs of cyanosis such as blue or gray lips and nail beds, alerted mental status, and tachycardia. It is important for the provider to have good assessment skills so that he/she picks up on these signs and symptoms. Most COPD patients that an EMS provider will come in contact with will already be diagnosed with the disease, thus making it important for the provider to obtain SAMPLE and OPQRST history. After the provider has concluded that this patient is suffering from chronic obstructive pulmonary disease it is time for treatment to begin.
The treatment of chronic obstructive pulmonary disease is pretty straight forward in the pre-hospital arena. Due to difficulty breathing, the patient should be placed on high-flow oxygen via non-rebreather. The provider should keep a constant monitor on the patients pulse oximetry to issue adequate oxygen levels in the blood. If the patient is wheezing then a nebulized albuterol treatment is indicated. Albuterol dilates the airway, thus increasing air movement. The next step in the treatment plan should be obtaining intravenous access for medicine administration. A blood draw should also be performed at this time. The provider should monitor the patient’s ECG. If accessible the provider should also obtain a 12-lead ECG and monitor Capnography. If the patient continues wheezing after the initial albuterol treatment, a second dosage should be administered after ten minutes. If wheezing still continues, the provider should consider administering Solu-Medrol intravenously. Solu-Medrol is a parenteral steroid that attempts to lower the inflammation of the cells in the bronchial tree. If the patient’s pulse oximetry is below 90 percent on high flow oxygen via non-rebreather, the provider should consider use of positive-pressure ventilation. There are two types of positive-pressure ventilation, bi-level positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP). Since local protocols allow the use of CPAP, it will be used for the purposes of this paper. CPAP decreases the workload of the patient on inspiration. CPAP also keeps the alveoli open allowing better gas exchange. Fluid build-up in the lungs is another indication for CPAP. The positive pressure supplied by a CPAP device will push the fluid from the lungs back into the vascular space. CPAP is contraindication on patients with altered mental status and systolic blood pressure of less than 100. With the treatment plan listed above, the pre-hospital provider should be able to effective treat a symptomatic chronic obstructive pulmonary disease patient.
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Chronic obstructive pulmonary disease is disease that Emergency Medical Services provider will have to deal with on a daily basis in a busy locality. This is caused mainly by the high popularity of tobacco smoking in the United States over the last century. COPD can by a gateway to other medical issues in the body, such as congestive heart failure and infection. The effects on the body in COPD patients works like a chain reaction, inflammation causes fluid build-up, which causes airway compromise and possibly infection. Patients suffering from COPD should immediate stop smoking. The treatment plan describe above is straight forward and can provide short term relief in the pre-hospital setting. Like stated at the beginning of this paper Chronic obstructive pulmonary disease is a like changing disease that can destroy one of the body’s most important organs, the lungs, and if a patient is unable to breath, they will die!
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