BODIES - a violation of the frequency, rhythm or depth of breathing, accompanied, as a rule, a feeling of lack of air. It may be associated with a violation in any part of the act of breathing, which involves the cerebral cortex, respiratory center, spinal nerves, chest muscles, diaphragm, lungs, cardiovascular system, as well as blood transporting gases. If the nervous regulation of respiration is not impaired, the dyspnea is of a compensatory nature, i.e. it is aimed at filling the lack of oxygen and removing excess carbon dioxide.
Dyspnea of the central type is associated with a disorder of cortical regulation of respiration or primary lesion of the respiratory center. With neuroses (most often hysterical), shortness of breath is characterized by abrupt tachypnea, that is, frequent shallow breathing, sometimes up to 50-70 breathing movements per minute (“dog breathing”). The task of the paramedic is to calm the patient down, shift his attention, try to make him hold his breath, and then breathe deeply and slowly. At the same time, they give sedatives: a valerian tincture (1 teaspoon per 30 ml of water), 2 ml of a 2.5% solution of pipolfen are injected intramuscularly.
Lesions of the respiratory center, especially in case of poisoning with hypnotics or drugs, usually manifest as respiratory depression (decrease in its depth and frequency) and impaired respiratory rhythm. In these cases, agents that excite the respiratory center are used — intravenous cordiamine 5 ml (for morphine poisoning, nalorphine 1 ml of a 0.5% solution), caffeine sodium benzoate 2 ml of a 20% solution subcutaneously, or aminophylline 10 ml of a 2.4% solution with 10 ml of 40% glucose solution intravenously.
Dyspnea in thoracodiaphragmatic respiratory disorders occurs in the event of a significant impairment, mobility of the diaphragm or chest (meteorism, kyphosis , scoliosis, chest pain, etc.) or with a large accumulation of fluid in the pleural cavity (for example, hydrothorax). The depth of breathing decreases and the frequency increases; during physical exertion, tachypnea develops rapidly. The signs of the main process (bloated belly, kyphosis , scoliosis, etc.) help to diagnose. The treatment is aimed at eliminating the cause of dyspnea - puncture of the pleura with hydrothorax, the introduction of the vent tube during meteorism, etc.
Pulmonary dyspnea may be associated with a decrease in the surface and insufficient tensile properties (restriction) of the lung tissue, impaired bronchial patency (obstruction) or diffusion of gases in the alveoli. Restrictive type of dyspnea (usually with pneumosclerosis, pulmonary fibrosis) is characterized by difficulty in breathing (inspiratory dyspnea) and short exhalation. Due to the decrease in the vital capacity of the lungs, the boundaries of the lungs are high, the depth of inhalation is limited. In the lungs, wheezing is often heard.
Diffusion insufficiency of the lungs, often combined with a restrictive process (pneumosclerosis), is characterized by severe dyspnea with tachypnea and pronounced “black” cyanosis of the skin and mucous membranes. Dyspnea and cyanosis increase markedly with the slightest exertion. Treatment is aimed at eliminating the cause of dyspnea and, along with other therapeutic measures, includes oxygen inhalation.
Most often, pulmonary dyspnea is associated with impaired bronchial patency due to spasm of the bronchi, their edema, or obstruction by sputum. Since the degree of bronchial obstruction is variable, shortness of breath is unequally expressed on different days: sometimes it disappears completely, sometimes it reaches the degree of suffocation. Characterized by prolonged and difficult exhalation (expiratory dyspnea), swelling on the exhalation of the neck veins (due to increased pressure in the chest cavity) and signs of emphysema. Most patients with such shortness of breath, unlike patients with shortness of heart, may lie low in bed; limbs are usually warm. In case of bronchial asthma in the lungs, wheezing dry wheezing on the exhale, sometimes heard from a distance, is heard.
Treatment - bronchodilators: ephedrine hydrochloride , 0.025 g or belladonna, 0.015 g orally, or teofedrin, 1/2 - 1 tablet orally, or euphyllinum 1 ml of a 24% solution intramuscularly (an individual selection of medication and dose is necessary); with difficult sputum expectoration.
Cardiac dyspnea develops due to insufficiency of the left parts of the heart, leading either to a decrease in cardiac output, libra to congestion of blood in the lungs, or a combination of the two. With a small cardiac output, the nutrition of the brain is disturbed and shortness of breath develops, similar to that of the central type, but in contrast to it increases with physical exertion. Blood stasis in the pulmonary veins disrupts gas exchange and conditions of ventilation of the lungs. This increases the frequency and depth of breathing; the patient is forced to take a sitting position to ease breathing. Such shortness of breath may occur at night in a dream, but more often after exercise. Cardiac dyspnea is often combined with edema, acrocyanosis, cold skin of the hands and feet. In the lungs, finely bubbling and medium-bubbling wheezes are often heard, and during the development of pulmonary edema, also big-bubbling wheezes . Due to the variety of mechanisms that form cardiac dyspnea, its treatment should be complex, including digitalis preparations, diuretics. In urgent cases, the paramedic should give the patient a half-sitting position, calm him down, give oxygen for breathing; slowly inject 0.5 ml of a 0.05% solution of strophanthin with 10 ml of a 40% glucose solution (if the patient has not received digitalis preparations) into the vein, give 40 mg of lasix orally.
Hematogenous dyspnea due to the effect on the respiratory center of acidic substances during acidosis or metabolic products, such as kidney failure or liver failure. Acidosis causes a significant increase in the frequency and depth of breathing (polypnoea). In severe cases (for example, in diabetic coma), breathing becomes noisy (Kussmaul’s large and noisy breathing). The treatment is to combat acidosis.
Often in patients with heart and lung diseases, the pathogenesis of dyspnea is mixed (for example, cardiac dyspnea may be complicated by a decrease in respiratory excursions due to flatulence, ascites, hydrothorax, etc.), which should be considered during treatment.