Pulmonary system
Read the scenario. Answer the questions at the end of the scenario. Also, respond to student answer.

*** Here is the scenario:
You are a paramedic in an ALS state. Your service transports patients (you don’t have to call for a transport unit). You have a paramedic partner.

At 0200 you respond to a residence where a 60 y/o male is having severe respiratory distress. He is sitting upright in bed when you arrive. You immediately note that his breathing is shallow and rapid and the patient using accessory muscles to breath. He is breathing 44 times per minute and he has a strong pulse at 142 beats per minute. He has cyanotic lips and nailbeds. The patient is very confused and somewhat belligerent. The patient has pitting edema in lower extremities and rales in the lower lobes upon auscultation. The patients wife states he has a history of noncompliance with medicine for hypertension and has gained weight in the past week.

1) What pathophysiologic abnormality of the respiratory system do you suspect?

2) How would you manage this patient?

3) What is the significance of edema and rales?

*** Here is the student answer:
1) What pathophysiologic abnormality of the respiratory system do you suspect?

The pathophysiologic abnormality of the respiratory system that I suspect the patient is suffering from is Adult Respiratory Distress Syndrome (ARDS) as a result of left-sided heart failure due to noncompliance with hypertension medications. ARDS, also known as non-cardiogenic pulmonary edema, is a form of life-threatening lung failure that occurs among the very ill or severely injured individuals. Symptoms include shortness of breath, bluish skins, rapid pulse, headache, and dry cough .

2) How would you manage this patient?

In this case, I would manage the patient by initially assessing the airway. CHF or heart failure-related emergency most commonly involve respiratory distress. The first thing to do is to go through the ABCs and look for cardiogenic shock signs cyanotic, clammy, and diaphoretic skin, jugular vein distention, rales in the lower lung lobes, pitting edema in the legs, and tachypnea . Also, the underlying cause should be treated while providing support to the lungs via oxygen.

3) What is the significance of edema and rales?

The presence of edema and rales are significant signs that the patient is experiencing left-sided heart failure. Left-sided heart failure shows respiratory signs of increased respiratory rate, increased breathing workload such as in the case of respiratory distress, crackles or rales heard in the lung bases or throughout the lung fields, pulmonary edema, and cyanosis . Particularly, left ventricular heart failure and pulmonary edema are caused by chronic hypertension .
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In summary: You will have to answer the questions and then respond to the student answer.

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