Shortness of Breath

Paul Murphy, MSHA,, MA , Chris Colwell, MD, Gilbert Pineda, MD, FACEP, & Tamara Bryan Murphy, PA-C, MMS

CONTINUING EDUCATION FROM EMS

     This CE activity is approved by EMS Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 1.5 CEUs. To earn your credits, go to www.rapidce.com, or to print and mail a copy, download the test here. The deadline to take the test is August 31, 2009.

OBJECTIVES

  • Review respiratory and cardiac anatomy
  • Discuss cardiac causes of shortness of breath
  • Discuss respiratory causes of shortness of breath
  • Review patient assessment

An ALS ambulance responds to a report of shortness of breath. Upon arrival, the EMS crew finds a female in her mid-40s complaining of difficulty breathing. She is sitting on a chair in the tripod position and says she has never felt like this before.

     Physical assessment reveals that the patient is conscious and oriented with pale, sweaty skin. Her heart rate is 142, sinus tachycardia, with a respiratory rate of 40 and blood pressure of 146/62. Breath sounds reveal expiratory wheezes in all fields. She is able to speak in complete sentences, says she has had a nonproductive cough for three days, and she smokes one pack of cigarettes a day. She denies any other complaints. The remainder of her assessment is unremarkable.

     The EMS providers initiate treatment. Supplemental oxygen is administered and an intravenous line is established. An albuterol breathing treatment is administered via nebulizer and the patient indicates that it is helping. During transport to the hospital, the patient's color improves, her respiratory effort decreases, and she has less wheezing. Vital signs are repeated as the crew arrives at the hospital.

     As illustrated above, EMS frequently responds to requests for assistance due to difficulty breathing. This article provides an overview of respiratory and cardiac anatomy, as well as examples of conditions that can result in shortness of breath.

RESPIRATORY ANATOMY

     Breathing involves the movement of air through the mouth, nose, trachea and lungs. The trachea divides into the left and right main bronchi, which lead to the bronchioles and alveoli. Gas exchange occurs in the alveoli along the alveolar-capillary membranes. Waste products, such as carbon dioxide, are transported to the lungs by venous circulation to the alveoli, where they are removed when an individual exhales.1-3

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