As you read through these blog posts, you will notice quotes, videos, links, and research abstracts. This is just a way to let you know that the information is factual and not based on my own anecdotal evidence. It is my intention to spread the practice of evidence-based medicine amongst the world of prehospital clinicians. So lets get started...
This is a very frequent call type. A few things that stand out are the patient's young age and sex. This age coupled with the female gender may alert many that this could be something stress induced. This demographic is highly sensitive to relationship-induced stress. This is not a conclusive finding however, and we should always consider the worst. This patient also fits into a category of patient's that may take birth control. If she is on birth control and is a smoker, than she would be at increased risk of developing a pulmonary embolism.
To create a differential diagnosis, and treat this patient effectively, we need a clear understanding of what conditions may be causing her signs and symptoms. With this we can develop an adequate assessment to figure out what exactly is going on.
- Cardiovascular etiologies (pulmonary embolism, CHF, AMI, HTN)
- Pulmonary etiologies (COPD, asthma, pneumothorax, restrictive lung disease)
- Metabolic/Toxicologic etiologies (DKA, dehydration, salicylate toxicity, acidosis)
- Neurologic etiologies (CVA, head trauma)
- Anxiety/Hyperventilation (panic attack)
Now, I know that we don't give patient's CO2. That isn't what I am implying. Instead, I am referring to the body's physiological need to maintain a PH balance. CO2 is an essential ingredient to maintain homeostasis. I'll explain:
Not on there is oxygen & carbon dioxide. It is important to know that CO2 is acidic, and O2 is alkaline.
The healthy body will react according to the PH(depending on the amount) of what enters the body. The body uses it's metabolic and respiratory systems to assist in maintaing a normal acid-bas balance. Consequently, respiratory alkalosis will not appropriately fix metabolic acidosis, and visa versa; even though the body will sometimes try to attempt this type of regulation, it's a feeble attempt.
It's not going to be the end of your career or anything if you don't memorize the equation. It is important, however, to remember that CO2 is a vital ingrediant to maintain homeostasis. This image describes how the buffering system works. The most basic thing we usually remember is that O2 is used by the body and CO2 is the waste product. Well, the hyperventilating patient teaches us something else. Some of that CO2 is needed!!
We have all seen the paper bag breathers. These people are attempting to rebreath their expired CO2 to self-regulate their CO2 level. This sounds like a good treatment and may even work.
In Part 2 I will describe why this isn't the best course of action. I will also give a detailed description of hyperventilation syndrome and how to develop a differential diagnosis.
If you have any questions or find something incorrect with the information I provide, please let me know.