Deep Breath

[Kn.ght1]

Hello!

Easy Question! I'm feeling frustrated. Working were I do our service mostly responds to trauma, overdoses and alcohol related incidents. When we respond to medical calls it usually catches me off guard! The other day we responded to a SOB call. On arrival the patient was sitting at the kitchen table with a NRB on with 10LPM running as there was first repsonders on scene. During my first impression I was thinking for sure a NEB, then during my assessment of the patients air entry I didn't find any wheezes. The patient wasn't able to taken deep breaths due to feeling restricted but I was able to hear quiet, clear air entry, or so I thought. We moved the patient into the ambulance and by time we got there (which was only 2min from the house to the ambulance) she had audible wheezes. I'm feeling mildly frustrated about not starting a NEB in the house, I feel like I completely missed the wheezes and patient treatment.

How can I improve recognizing different auscultated lung sounds? Would you have started a NEB in the house? I've looked up online a couple of audio clips but going over them with a couple of my paramedic partners they seem to have different diagnoses than what the sites are saying. Any suggestions on good reliable audio clip sites?

Also my partner is saying that most people use rhonchi and wheezes interchangeably what do you guys think? Any suggestions would be greatly appreciated.

Kn.ght1

[chbare]

Ronchi is often not really used as there is so much confusion. It is a coarse and sometimes rattling sound often caused by secretions and mucous in the larger airways.

If there were no indications of obstructive pathology, then a beta agonist was not indicated until you appreciated the wheezing. I cannot say as I was not there. Do you have the ability to monitor exhaled CO2 using a waveform? Changes in the waveform are often quite reliable at identifying the presence of obstructive pathology.

[Just Plain Ruff]

My thoughts are that if you are that unsure of yourself, a good quality refresher course might be in order.

OR.... if you know of a particular kind of patient that you are specifically haivng issues with, why not schedule some time with some specialist that you trust and work out some specific scenarios.

I was specifically troubled by sick respiratory peds patients and I set up some time with a pediatric resp therapist and shadowed him for a couple of shifts and he put together some really good educational materials for me.

It worked wonders.

That's if you can get access to this type of thing. I would bet your medical director could help you out in this.