Deadly Respiratory Distress Mimic

Conclusion It’s important for prehospital providers to be able to differentiate metabolic disturbances in the setting of respiratory distress and not be fooled into thinking tachypnea always has a respiratory cause. The physical exam and adjuncts such as end-tidal capnography can assist in the prehospital diagnosis. A COPD exacerbation generally presents as diminished lung sounds, wheezing on exhalation, and a prolonged expiratory phase. Here, a patient will attempt to compensate for the inflammation and mucus accumulation associated with the destruction and narrowing of peripheral airways and a subsequent lack of available space for air exchange. The EtCO2 may be increased in these patients as carbon dioxide accumulates due to air trapping; however, the physiologic deadspace associated with some forms or COPD may lower the EtCO2. Without knowing the patient’s baseline EtCO2, this value may be difficult to interpret in this setting and the physical exam will be more diagnostic. In this case, although the patient had a history of COPD and appeared to be in respiratory distress, her normal lung sounds and air entry heard on auscultation, the history of recent infection, and the decreased capnography  reading suggested she likely had a metabolic acidosis associated with sepsis. References 1. Kellum JA. Metabolic acidosis in patients with sepsis: Epiphenomenon or part of the pathophysiology? Crit Care Resusc. 2004;6(3):197–203. 2. Fuller BM, Dellinger RP. Lactate as a ...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Exclusive Articles Patient Care Source Type: news