Respiratory Distress

[johnrsemt]

If you had a patient that was in respiratory distress with severe pain medium to deep breaths and coughing, laughing, sneezing or hiccuping; would you give Pain Meds during transport? either Morphine or Fentanyl?
Doesn't matter how long the transport, although in this case it was 92 miles Thinking was pneumonia, and if it wasn't it would be unless patient started taking deeper breaths.

 

[Underoath87]

Lung sounds?

 

[johnrsemt]

wheezing, some stridor. SPO2 90% room air, HR 100-110, BP 140/90 (normally 100/60). Deep breathing on demand for lung sounds, but the pain would make the patient go pale in face and neck

 

[Akulahawk]

I'm going to need more info about the pain/discomfort... OPQRST the pain and would I be correct in assuming from post #3 that it increases with deep inspiration? Is it superficial or deep?

 

[Clare]

Interesting. If the pain was severe then yes I suppose so. Hmm, I wonder if it might be more effective to try CPAP.

 

[TXmed]

I actualy had a call similar to this , pt was diagnosed with severe bronchitis several days before , wheezing and pain upon breathing I gave him fentanyle and It helped his breathing. He ended having a pneumo and got a chest tube.

 

[johnrsemt]

Pain started 24 hours earlier at bottom of ribs, front left upon Inhalation (deep), coughing etc, at time of transport was 8/10 on deep breaths, and was across entire bottom of rib cage, front

 

[Akulahawk]

I'd probably take a multi-faceted approach with this patient. I'm going to consider treating the lung constriction (wheezing/stridor), providing some supplemental oxygen to get the SpO2 >92%, and I'll consider using fentanyl in small increments to decrease the pain to something tolerable during deep inspiration, but I don't want to affect the respiratory rate/effort negatively. I'd also want to be tracking the EtCO2 before I start doing any pain control measures. At this point, I think I might hold off on using CPAP for support as it doesn't appear the patient is so bad off that using that modality is necessary.

 

[bizzy522]

I would think Fentanyl would be more appropriate over Morphine for a patient with respiratory distress. Start on the low end as stated earlier and titrate.

 

[TransportJockey]

I'd probably take a multi-faceted approach with this patient. I'm going to consider treating the lung constriction (wheezing/stridor), providing some supplemental oxygen to get the SpO2 >92%, and I'll consider using fentanyl in small increments to decrease the pain to something tolerable during deep inspiration, but I don't want to affect the respiratory rate/effort negatively. I'd also want to be tracking the EtCO2 before I start doing any pain control measures. At this point, I think I might hold off on using CPAP for support as it doesn't appear the patient is so bad off that using that modality is necessary.

This. This would be my preferred treatment for this patien