Medical

We'll be adding various topics here to raise awareness and discussion. Please reach out to share your thought or with any questions/clarifications/comments through the contacts at the bottom of the page.

Know the Differences between Respiratory Distress and Respiratory Failure!

This was added to the upcoming new edition of OEC 7 so that OEC technicians can recognize the differences.

I feel that it was not clearly distinguished in OEC 6 and many of my fellow patrollers did not know the differences. 

It's really important to recognize the differences because it affects the management and how well we sign out to EMS personnel before their evaluation of our patients.

The EMS curriculum clearly distinguishes the differences between both in which OEC should do as well. We need to talk and perform the same language/evaluation/management which will provide the best care to our patients.  

I would refer to respiratory distress as a compensated mechanism (which requires urgent management) and respiratory failure as a decompensated mechanism (which requires emergent management). Just like compensated versus decompensated shock that we have learned about. It follows a continuum.   

OEC technicians need to know the signs and symptoms of respiratory distress and respiratory failure. These findings help identify the severity of the patient's condition and underlying hypoxia. First, respiratory distress occurs when the patient cannot maintain normal gas exchange, becomes hypoxic, and compensates by working harder to breathe and to keep up with gas exchange. If unrecognized or not appropriately treated, this can progress to respiratory failure which is a life-threatening condition in which gas exchange and mental status become severely impaired and respiratory support is required.

More details will be provided in the upcoming OEC 7 edition, but in the meantime, there is a website that I think will be helpful to you after review:  https://promedcert.com/blog/respiratory-distress-vs-respiratory-failure

Know the Meaning of Pinpoint Pupils and Respiratory Failure in an Unresponsive Patient!

At our OEC refresher, we had a patient scenario who was unresponsive and had respiratory failure (rate of 12 and O2 saturation of 82%) from fentanyl overdose.

I was the OEC instructor at this station and I also had a similar case on my EMT skills exam so I can relate to being on both sides of this scenario.

This proved to be a difficult case to many so why the blog here. 

In an unresponsive patient, the only pertinent objective information that you can quickly obtain is the following- the ABCs and pupils. 

If you see pinpoint pupils that are not reactive to light, then suspect opioid overdose like fentanyl. 

Fentanyl causes pinpoint pupils and respiratory depression by over-activating the parasympathetic nervous system. Stimulants like methamphetamine do the exact opposite. 

Of course, the management is to administer Naloxone (Narcan) and provide respiratory support (BVM) with ventilations given this is a respiratory drive problem. 

Contact the Medical Advisors with any questions