So for respiratory distress,
we are starting out for the management back to the basics, back to those ABCs.
When you walk in that room, sit your patient up,
start them on supplemental oxygen as needed.
So if they're hypoxic and their oxygen levels are low,
go ahead and put them either on oxygen in their nose with nasal cannula,
or possibly a non-rebreather mask as needed.
Oftentimes, I say for our patients who are shorter breath
better to start off with the higher amount of oxygen
and we can always titrate it down so that non-rebreather mask
turned all the way up, as oftentimes the way to go.
We wanna start thinking about starting our patients on medications.
I'm not gonna go into too much detail here,
but depending on the etiology of the shortness of breath,
we can start medications nice and early.
Sometimes even our medics go ahead
and they start people out on nebulizer treatments
when they are on their way in to the hospital.
They sometimes will start people out on nitroglycerin,
if there's concern for heart failure.
And lastly, we wanna start thinking about whether our patient
would benefit from non-invasive or invasive ventilation.
So what we mean by noninvasive ventilation
is we start the patient on either continuous positive airway pressure
which stands for CPAP, or bi-level positive airway pressure, abbreviated as BiPAP.
And in those situations we place a tight fitting mask on a patient's face
and hook them up to a machine that delivers either continuous positive airway pressures.
So it's basically forcing air into the patient's lungs with the positive airway pressure,
and what BiPAP does that CPAP doesn't is it provides support
both in inspiration and expiration.
A key thing to remember when you're starting someone on noninvasive ventilation
is they have to be able to cooperate with this treatment, and they have to be breathing.
If someone is not able to cooperate with their treatment
and it's not going to work,
because it's based on the patient's taking spontaneous respirations,
so it delivers that positive airway pressure basically when the patient inhales.
So patient needs to be breathing on their own.
Now, invasive ventilation is when you intubate a patient.
So that's when you provide someone with sedation
and you go ahead and you put a breathing tube into their trachea.
Noninvasive ventilation has really changed the way we practice emergency medicine.
It's been a great way to limit intubations in this invasive ventilations for patient,
so we know that for a lots of patients who present with shortness of breath,
that noninvasive ventilation can decrease the amount of time they stay in the hospital
and stay in the intensive care unit.
You know, noninvasive ventilation is really best for patients
who presents with exacerbations of COPD, and exacerbations of heart failure.
For things like pneumonia, and various other causes,
it might not necessarily be of as much benefit,
but definitely it's a great thing to reach for
in order to help prevent someone from having to be intubated,
and can really save off a lot of intubations for those patients.