hyperventilationn whats your pre hospital care???

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Permalink Reply by asysin2leads on October 27, 2009 at 12:43am

Just a gentle reminder, doing any procedure you have not been specifically trained for that could have or did result in injury to patient can and will place you and your service in a position of liability. We now return you to your regularly scheduled program.

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Permalink Reply by TheCannulator on October 27, 2009 at 8:24am

Great idea.

I'm not sure about the dopamine bit to be honest. More importantly it is females who tend to breathe with their chests moreso than males who are better abdominal breathers.

Jennifer Everett said:

I watched a doctor do the following and have used it myself with great success.
Have the patient lie down with head slightly elevated. Place a small book/box of kleenex or anything that they can see move that is not heavy.
Coach them through breathing and have them raise their stomach at the end of exhalation enough to move the box/book, eyes must be open as you talk them through this. By using their stomach muscles to breathe (adults are not belly breathers and babies are and supposedly have less stress ) they are releasing dopamine naturally and it causes/help them calm down. It really works, don't laugh or knock it till you try it. I have used it a number of times and only met one person so far that it did not help. (the mother in the room may have contributed to this not working)
This is after you have assessed and ruled out a more serious cause for the hyperventilation.

Okay got my sheild up! let me have it !
AFTER you try it on your next hyperventilating patient and it works let me know.

Jen

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Permalink Reply by Bob Brotchie on October 27, 2009 at 10:37am

Good sound advice from most here, but then we have all had a heck of a lot of experience, haven't we?
A word of caution around getting 'up close and personal'. I have been employing this 'technique', dependant on the patient, for about 16 years. Earlier this year, and in the most unlikely of locations, a world famous cathedral, I received a 'forceful' punch to the head, right out of left field, out of my view!!

Aside from that, I agree that reducing the stimulus, where identified, advising sufferers to keep eyes open, as they will insist on getting back to 'that' world of fear, etc.

Nathan said:

Sending everyone out of the room is about reducing stimuli and "making their world smaller". Beyond this and the other great ideas moving to their level and placing your face close to theirs also "makes their world smaller". (you might be surprised how well that works) Basically Im talking about getting in their face, within a few inches. This may not work in all situations but it does work well for many. Pay attention to your tone of voice speak softly and calmly. Then there's the ones who have just completely lost it and I dont think there's anything wrong with a little Valium. If you dont want to give Valium for whatever reason remember, eventually they'll pass out and their breathing will slow down!

Why is it common to female??? Um, well. There's these things called hormones, their great in the right amounts but if they get a little out of whack.....
Its also a "more acceptable" means of getting attention for females than it is for males.

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Permalink Reply by Tom Bouthillet on October 27, 2009 at 2:09pm

Dr. Ray Fowler uses DKA in one of his capnography lectures and is pretty adamant that a low CO2 does not rule out DKA.

http://www.doctorfowler.com/www/lectures/capnographyforEMSToday2008... (BIG FILE)

Slide 102-104.

Tom

blair4630 said:

Franc...

1) oxygen doesn't hurt, if you're using the cannula, it's not going to help her re-breathe CO2 to help end the panic attack. On the other hand, if you're using the mask, using the O2 is no problem, as SpO2 and EtCO2 are completely different animals...SpO2 is effected by O2 therapy....EtCO2 is effected by ventilations, either hers or yours (BVM)

2) Capnography is a great tool here to help nail down your diagnosis of hyperventilation as opposed to effortless tachypnea from DKA, or as others mentioned dyspnea from other causes. If she is hypercanpneic with hyperventilations, then think metabolic acidiosis, she is compensating with the tachypnea, don't inhibit that, look for the cause. History, history, history. Also, if you're like me and don't have sidestream capnoghraphy, remember to look for the parasthesias circumoral, extremities, carpalpedal spasms....if you don't see those, that's another red flag, I'd again be thinking metabolic acidosis or a cause of dyspnea.

3) Many have said about getting them to control their breathing by concentrating on controlling the inpiration and expiration. I sometimes engage them in conversation and have them constantly talking, which causing them to have to slow their breathing to get sentences out. Granted, they will be short sentences at first, and this takes several minutes, but it gets their mind off of everything. Once they are starting to slow down a bit, I show them how much progress they've made, which usually puts them at ease, and then I start to coach the breathing. Either way works, figure out your own preference. Be patient, this usually takes 5-10 minutes, but you'll get them there.

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Permalink Reply by Rob Theriault on October 27, 2009 at 11:36pm

I love this question! It's one of my favorites.

My short answer would be: 1. Giving oxygen will do no harm and may in fact be critically important, regardless of the etiology. 2. Never give the patient a bag or an oxygen mask without oxygen with which to re-breath their CO2. This is what most of us have been taught to do, but there have a been a few cases of fatalities assosciated with this approach. There are better ways.

Have a listen to my Podcast at the link below and see if you agree. It's a little long but I make the argument at the end for what I just stated and I think you'll want to hear the entire Podcast understand the argument.

https://sas.elluminate.com/site/external/jwsdetect/playback.jnlp?ps...

cheers
Rob (my blog)

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Permalink Reply by Drummond Figg on October 29, 2009 at 11:21pm

Franc,
Venturing out on the slippery slope of online medicine my first thought would be to asses oximetry and capnography values. Completing the picture with baseline values established, one may venture into the zen of treating a twelve year old. As Blair4630 and Mr. Sullivan established in their posts, these values may assist you in your treatment modalities. While many EMS systems do not specifically address hyperventillation they do have protocols for "patients that fall outside the protocols". When in doubt, research the various answers presented to you, mix in a little of your voodoo and pose the question to one of your friends in the ED. This situation will arise many times in your career and each time it will be different. I remember the "brown paper bag days", the rebreather mask days and other tried and true attempts at talking the twelve year old off the brink of emotional collapse. Today we are surrounded with technology that assist us in our treatments, sometimes this high tech stuff is not around and you may have to wing it- so go with the flow and work on your street medicine.

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Permalink Reply by AWALKER on October 30, 2009 at 12:01am

I try to clam the pt and place a NRB at 10 lpm also spo2 reading talk to the pt and get them to laugh at me and back the down on the o2 to 4 lmp on NC and than on o2 and this seems to work.

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Permalink Reply by franc on October 30, 2009 at 10:52am

Yes Sir thanks to the information hehehe well some doctors dont really mind us some entertain us well those are MDs are oriented regarding Prehospital treatmet of EMS.. Well i post this question cause its been really un issue in here cause sosme doctors here still recommend Brown bag huhu but me i use to instrcut the patient to brath normally and explain whats happeninh to him o her.. and breathing exercise such as deep and purse lip breathing.. and low flow o2 is this sfe to practice?? well thanks for the links sure i will watch nit thanks.

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Permalink Reply by Randy VanderHeiden on October 30, 2009 at 12:33pm

I would echo many of the previous comments. My suggestions:

1) Lots of conditions cause hyperventilation. Don't focus only on anxiety or stress reactions.
2) Use capnography as only one tool.
3) Break the cycle.
a. Anxiety/Breathe Fast/Feel Funny/Breathe Faster/Feel Dizzy/More Anxiety/Breathe Faster/Getting Tingly/Breathe Fast/Chest Tightness/Am I Going To Die?/Anxiety/Breathe Faster/ STOP!!!!
b. Explain to the patient why they are all tingly and having carpal pedal spasms.
c. Ever notice that the patient almost always has their eyes closed? Tell the patient to keep their eyes open and bring them back to reality.
d. Got the gift of gab? Distract the patient with conversation. Turn their focus away from the hyperventilation. If they are holding a conversation, their breathing slows down.
4) Low CO2 is the problem. Have the patient do something that creates more. Increase muscle activity. Remove them from the stressful situation, take them for a short walk.
5) If all else fails, you can still fall back on sedation and transport.

Remember, you can still get burned. True case of mine: 15-20 years ago I had a 30 yo female patient in "conversation" with husband regarding loss of job, no money, losing home, having to move, etc. Onset of tingling in hands and around the face, 911 called. Patient had increased respiratory rate and low CO2. Seemed straight forward. All the tricks worked and patient returned to normal without complaints. Later found out that symptoms returned a few hours later, she went to the ED by POV and was admitted for a small stroke. Ouch. She recovered without deficits but I won't forget.

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