# Pulmonary Fibrosis



## Hockey (Jan 1, 2012)

Had a call for a 60 yr old female with severe respiratory distress.  *Patient just diagnosed with Pulmonary Fibrosis.  *Her BP was about 190/110.  HR 120.  96% on NRB.  Couldn't get an IV until almost to the hospital (22 in the hand)

We ended up hitting her with a duoneb with no relief.  As we were doing that (and we had her on a NC as she was getting the duoneb) she dropped down to 85%

I had to drive since it was just two of us so I wasn't able to be in the back for the full trip.

My partner ended up pushing 5mg of morphine with no relief.  

They ended up tubing her within 10 or so minutes of being in the ER.  

So...I'm not familiar with Pulmonary Fibrosis to be honest.  Not something common around here.  

For those that are familiar with Pulmonary Fibrosis in the prehospital setting, what do you recommend for treatment?  The ER said there wasn't much more we could have done.

How about CPAP? My partner and I thought about it, but I would think with PF, the risk for pneumothroax outweighs any benefit from CPAP?

Just trying to learn from this call as much as I can and online research just points to hospital care


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## JPINFV (Jan 1, 2012)

For pulmonary fibrosis, there's often not much that works even at the hospital level short of a transplant. Prevention is key.


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## Hockey (Jan 1, 2012)

JPINFV said:


> For pulmonary fibrosis, there's often not much that works even at the hospital level short of a transplant. Prevention is key.



Right, thats what I kind of figured.  Transplant is the end fix it seems like for that case.  By the time we got her in the hospital she was down to 74%.  And it didn't help that she got her IV tangled up in the cords and when I was trying to untangle I pulled the IV...ugh.  At that point she was panicking and trying to hit me.  Just kind of feel bad


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## MSDeltaFlt (Jan 1, 2012)

Hockey said:


> Had a call for a 60 yr old female with severe respiratory distress.  *Patient just diagnosed with Pulmonary Fibrosis.  *Her BP was about 190/110.  HR 120.  96% on NRB.  Couldn't get an IV until almost to the hospital (22 in the hand)
> 
> We ended up hitting her with a duoneb with no relief.  As we were doing that (and we had her on a NC as she was getting the duoneb) she dropped down to 85%
> 
> ...



PF/CF pts get daily nebs with CPT's/flutter valve treatments forever until they get transplants.  I believe that they also get a pulmonary scrubbing every now and then on bad flare ups and they're admitted.  In which they're intubated, bronch'd, and they Get a sterile wire brush and scrub the bronchi.  That is unless things Have changed.  Basically there isn't hardly anything you can do in the prehospital setting other than support and code prevention.  That's About it.


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## Aidey (Jan 2, 2012)

I've asked about CPAP in CF pts before, and was told by both the er docs and the rt that it may help, and if it is a choice between CPAP and Intubated you can try CPAP while you get the tube ready.


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## JPINFV (Jan 2, 2012)

I think it's important to differentiate cystic fibrosis from other forms of pulmonary fibrosis since the pathophysiology and pathology dictates different treatments. A patient with "usual interstitial pneumonia" (UIP, a type of pulmonary fibrosis) isn't going to have the issues with clearing bronchial secretions and isn't going to be able to be treated with things like nebulized hypertonic saline or DNase like CF patients can be.


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## usalsfyre (Jan 2, 2012)

What was her cardiac history?


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## Hockey (Jan 2, 2012)

usalsfyre said:


> What was her cardiac history?



If I recall correctly, she didn't have one.  If she did, nothing stood out to me.  It was hard to get a decent 12 lead since she was tossing all around.  First one had some elevation but one 30 seconds later didn't.  Tons of artifact.  Nothing was going right on the call


When we got to the hospital she was spitting a LOT.  Any idea why?


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## usalsfyre (Jan 2, 2012)

Was just thinking the B/P made it sound like flash edema. A trial of NTG and CPAP might have been worthwhile.

There's always a risk of pneumothorax with PPV, but it's much greater with a tube than NIPPV, and hypoxia is more deadly than pneumothorax.

What was she spitting up?


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## Hockey (Jan 3, 2012)

usalsfyre said:


> Was just thinking the B/P made it sound like flash edema. A trial of NTG and CPAP might have been worthwhile.
> 
> There's always a risk of pneumothorax with PPV, but it's much greater with a tube than NIPPV, and hypoxia is more deadly than pneumothorax.
> 
> What was she spitting up?



Saliva thats it


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