Respiratory problems simplified/explained please

jedirye

jedirye

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Hello,
After reading my own paramedic textbook (Nancy Caroline Version) and also reading another school's textbook (Mosby) concerning the various respiratory emergencies commonly found in the field (ie. CHF, pulmonary edema, cor pulmonale, COPD, asthma, bronchitis, combination of all of the above, etc), I am having a hard time grasping the physiological problems and therefore solutions to the aforementioned. Is there a website that can explain all of them to me and exactly why the treatment treatment methods work? I am wondering why I am not grasping this part of the lecture for some reason... It is almost like I understand right after I read it, but then quickly forget (quite possibly because I didn't understand it to begin with?). If it takes up too much time for someone, I can continue my search online and rearrange some phrases, throw in some different words, etc. Appreciate all and any help!

-rye
 
I've never found a simple way. It takes a lot of study. Start with asking yourself how well you understand how the body works when it is working properly. Both the respiratory and cardiac systems. Not just the blood goes here and the air goes there. But the detail of how the O2 moves accross from cell to cell. How does air move into the lungs when we breath by pressure differential. If you know the detail then things like CPAP or PEEP become easier to understand. As to pharmacology, its in the details of how the drugs work at a cellular level. Don't just look at the "Paramedic" texts look at some detailed Anatomy & Physiology & Pathophysiology texts as well. I have Marieb's "Human Anatomy & Physiology" & Thibodeau & Patton's "Anatomy & Physiology" as well as Heuther & McCance's "Understanding Pathophysiology" which I have found to be good, dry reading but good.

There was a thread with some posts where several people wrote about what books they used about 2 - 3 months ago. Do a search for " Paramedic books" you may find some useful info there. Mostly, for me anyway, its been long hard hours of studying.
Keep your nose to the grindstone and I wish you the best.
 
There's your first problem is using the late Nancy Caroline as a background. Seriously, it is written at a fifth to sixth grade level (Sidney Sinus.. etc). Take the suggestions of others and locate a well founded anatomy and medical physiology text.

Use Google and do a search, there is ton's of good web sites out there.

R/r 911
 
Thanks for the sites, guys, I'll give them a look over after my clinical!


Ridryder911- I have no control over which textbook my college uses. Are you aware they recently overhauled it and just released a new version last year, which prompted my college to switch from their usual Mosby book to this? Surely, there must be some sound reason for that. I, however, have no opinion over which because this textbook is the only one I have any exerience with.


Also, Sidney Sinus??

-rye
 
jedirye said:
Thanks for the sites, guys, I'll give them a look over after my clinical!


Ridryder911- I have no control over which textbook my college uses. Are you aware they recently overhauled it and just released a new version last year, which prompted my college to switch from their usual Mosby book to this? Surely, there must be some sound reason for that. I, however, have no opinion over which because this textbook is the only one I have any exerience with.


Also, Sidney Sinus??

-rye
Click to expand...

Yeah, I am aware they "over hauled it" or made another addition (I actually was one of the reviewers). Are you aware Nancy Caroline M.D. died several years ago? So that information has to be "older". Alike all textbooks, they are usually out of date by the time they are published. It takes at least 3 years to get one reviewed and published. This is a natural problem.

I understand not being in control for your school, but I would look at other texts. Caroline is the same thing as the NHTSA curriculum only watered down. She had the NHTSA contract for years before she died, and published an almost duplication of it. If possible, I would look Bledsoe's Paramedic books (the series, NOT the one textbook). As well as many other anatomy and physiology books.. there are tons out there.

The reason for schools to change is simple $$$$. As an educator, I can tell you it is a simple trick to get students to buy books. If you use the same text over & over, students will purchase "used" versions, and give old texts away. Schools make money as well, and they make a LOT of their money per selling books...

You will probably see them changing either next year or every two years. Again, a widely common practice in schools. Unfortunately, most instructors do not always get to control.

R/r 911
 
Rid,

Have you seen Nancy Caroline's UK version? I was wondering if it was different in any way?

I used her 1st edition in 1979. But, we also had college A&P x 2 plus Dubin's EKG book to supplement the weak parts.
 
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VentMedic said:
Rid,

Have you seen Nancy Caroline's UK version? I was wondering if it was different in any way?

I used her 1st edition in 1979. But, we also had college A&P x 2 plus Dubin's EKG book to supplement the weak parts.
Click to expand...

No, but like to. the one they sent me to review (very primary) was a little more in-depth than her original version but still just as transparent like others. Alike Bledsoe texts in Canada and our friends in Africa is different than U.S., not as watered down..

Shame, the will produce a higher level for U.S. residents.

R/r 911
 
If were a student asking me that in the back of a truck, I would tell you to approach it from a why and how perspective.

How does oxygen get to the action area? A ventilation versus respiration view. Air moves in and out through the tubes - the brochi and bronchioles. Conditions like COPD and asthma constrict that flow therefore treatments focus on reopening the tubes, bronchodilators like albuterol.

Respiration is where the O2 and CO2 is exchanged at the alveoli/capillaries level. Conditions like CHF/pulmonary edema mean that too much fluid gets in the way of gas exchange therefore treatments focus on getting the fluid out of the way. CPAP increases pressure to push it aside, in a way, and diuretics pull the fluid out of the way.

Break it down to how the lungs work and why things go wrong.
 
So. IL Medic said:
If were a student asking me that in the back of a truck, I would tell you to approach it from a why and how perspective.

How does oxygen get to the action area? A ventilation versus respiration view. Air moves in and out through the tubes - the brochi and bronchioles. Conditions like COPD and asthma constrict that flow therefore treatments focus on reopening the tubes, bronchodilators like albuterol.

Respiration is where the O2 and CO2 is exchanged at the alveoli/capillaries level. Conditions like CHF/pulmonary edema mean that too much fluid gets in the way of gas exchange therefore treatments focus on getting the fluid out of the way. CPAP increases pressure to push it aside, in a way, and diuretics pull the fluid out of the way.

Break it down to how the lungs work and why things go wrong.
Click to expand...

If it only was that easy it Respiratory Thereapists wouldn't need 2 - 4 years of colleges.

COPD and Asthma are both very complex disease processes. One might be able to relieve some bronchospasm providing they are actually bronchospastic and responsive ot bronchodilators. That is why many need thorough Pulmonary Function Testing to determine what is the mechanism of their breathing problem and if it can be reversed by bronchodilators.

CPAP can also explained in such oversimplified terms to which then one is not taught the true hemodynamic properties that affect the cardiopulmonary systems. The student will then not have a good understanding of why things work or don't work as expected. There are many different physiological processes that can be affected by something that seems so simple as CPAP. So many disease processes are not taught at either the EMT or Paramedic levels for the student to even have a good overview. Thus, if one does not get a least the basic physiological processes during their education, their therapeutic interventions will be stictly from memorization from a recipe book for "like" symptoms.

If you want a good education on any body system and the diseases that affect it, you will have to seek many more references outside of the Paramedic text. To this date there is not a Paramedic text written with the intent of giving more than an overview of the simplified basics.

To continue to understand diseases and pharmacological/therapeutic effects on the lungs is a career long learning process. I'm attending a 4 day seminar on just the new Asthma/COPD medications that have come out since the CFC/HFA change in the U.S. I still have several more educational seminars both inside and outside of the hospital to attend besides my yearly "skills" competencies to maintain.

Being good at what you do and doing what is expected at your level of education is never ending but are necessary journeys for knowledge and career enhancement which not only benefit your employer but also one's sense of accomplishment. I also would like to see the Paramedic functioning higher in education then the expected level of 6 months training or 700 hours.

My advice is for the OP to get enrolled into a couple of college A&P classes. A student needs to understand how the whole body works in order to understand the effects of the disease processes in just one system. Many of the disorders mentioned in the OP are "symptoms" that also stem from the renal, digestive and endocrine systems.
 
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So. IL Medic said:
Break it down to how the lungs work and why things go wrong.
Click to expand...

That's basically how I'm trying to learn it. If you know the "why and how" then you can deduce from that how you would treat it. It takes a lot of work (and I'm no pro at it yet by any stretch). I held on to my A&P textbook with all of my markup and all of my notes from my A&P class to refer back to.

Another thing that I found to be helpful is getting another angle on the issue. In addition to looking at other paramedic textbooks you might want to look at some nursing or other medical materials/textbooks (I actually found this to be very helpful). Many schools also purchase subscriptions to online journals and databases that might also be helpful. Your school library should have those sorts of resources available and if not check out other colleges in the area, often they will allow people to get library cards even if they are not currently a student.

Sometimes meeting with the instructor or another student helps too. Hope that this helps :)
 
Vent. Agreed any area of pathophysiology is complex and requires a broader understanding. The question was for an approach and I chose not to answer with a monogram. :-)

As for 6 months and 700 hrs for paramedic training...around here it is two additional years, 1200 hrs along with A&P, Intro Pharm, etc for a degree program, not just a cert. I agree with the approach of additional hrs and coursework.

What puzzles me is that our state reguires 240hrs continuing ed for re-cert while the ER nurses have 0 hrs....outside of ALS and PALS
 
So. IL Medic said:
What puzzles me is that our state reguires 240hrs continuing ed for re-cert while the ER nurses have 0 hrs....outside of ALS and PALS
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Nurses and other professionals may be required to get other professional certifications such as CCRN and/or other lengthy courses which require many more CEUs than one can imagine to keep current and for renewal. Many RNs and RRTs will get 100 - 150 hours easily each year of CEUs just to stay current besides the mandatory inservices on all of the latest technology and medications as well as state mandated CEUs. Their base education is 2 years and may be required to continue to Bachelors and Masters for even a supervisor position, CCT, Specialty or Flight. Some professions such as RRT are now requiring recredentialing every 5 years with the National Board on all of the possible specialty professional certications on can hold within that certification. That again is besides the extra certifications from other professional organizations and not the testing boards.

EMS needs to lose the "hours" mentality to measure their program. If the clinical or "ride" time is less than quality with minimum patient contact, some of those hours may be meaningless. It is good that you are required college level A&P and Pharmacology provided it is the same classes that are transferrable to a nursing or RT program. Many colleges have lessened the degree requirements for Paramedics and are offering the survey A&P and EMS pharmacology instead of the traditional classes which may have their own prerequisites.

RNs and RRTs may spends 1000 - 1600 hours in just clinicals with multiple patient contacts besides the many college science and core courses for just the Associates.

If other professions obtained their education in the same format as some EMS programs, an RN or RRT degree would take over 6 years for the clock hours of an Associates.

So has Illinois mandated a 2 year degree for the Paramedic or is this just the program that happens to be near you?
 
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VentMedic said:
So has Illinois mandated a 2 year degree for the Paramedic or is this just the program that happens to be near you?
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The state has moved to the latest national registry requirments but not all have programs have become degree programs, unfortunately, although that is the push from IDPH. The local program is part of the college of nursing so the prerequisite courses are all the same. Easy to transfer over which is what the college encourages.:rolleyes:
 
So. IL Medic said:
What puzzles me is that our state reguires 240hrs continuing ed for re-cert while the ER nurses have 0 hrs....outside of ALS and PALS
Click to expand...

Okay, if the hospital is JCAHO in which most are, the general requirement for any nursing is usually at least 150 to 200 hours alike what Vent described.. that is again just to work there, not including specialty units which requires more. You may not see a card or even an abbreviation for each course... nurses are not into that as much as EMS is. Even in my hospital ACLS cards are not issued anymore as they are optional, if the nurse wants one they can purchase it otherwise it is on file.

To keep up most Board Certifications alike my CCRN, CEN, etc.. I have to have contact hours.. in other words in a conference may only be 1.5 for four hour lecture. As well there are different areas I am required to obtain. Unlike EMS, they want you to be more exposed and have diversity in your speciality. For example I am required to have so much in research, administration, and of course clinical areas.. but again a diversity to make one have a broader understanding and exposure of new and additional materials.

I am glad that EMS requires CEU's since the education of most is dismissal. However; I would like to see that similar to other professionals as I mentioned. Focus on pediatrics, cardiology, neuro and management, education, etc...

R/r 911
 
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