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DYSPNEA

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BREATHING - violation of the frequency, rhythm or depth of breath, accompanied, as a rule, by a feeling of lack of air. It may be associated with a violation in any part of the act of breathing, in which the cerebral cortex, respiratory center, spinal nerves, chest muscles, diaphragm, lungs, cardiovascular system, and blood transporting gases participate. If the nervous regulation of respiration is not disturbed, shortness of breath is of a compensatory nature, that is, it is aimed at filling the lack of oxygen and eliminating excess carbon dioxide.

Dyspnea of ​​the central type is associated with a disorder of cortical regulation of breathing or a primary lesion of the respiratory center. With neurosis (most often hysterical), shortness of breath is characterized by sharp tachypnea, that is, frequent shallow breathing, sometimes up to 50 - 70 respiratory movements in 1 min ("dog breathing"). The task of the medical assistant is to calm the patient, turn his attention, try to force him to hold his breath, and then breathe deeply and slowly. At the same time, sedatives are given: tincture of valerian (1 teaspoon per 30 ml of water), 2 ml of a 2.5% pipolfen solution are intramuscularly injected.

Lesions of the respiratory center, especially in case of poisoning with sleeping pills or drugs, are usually manifested by respiratory depression (a decrease in its depth and frequency) and respiratory rhythm disturbance. In these cases, respiratory center stimulants are used - Cordiamine 5 ml intravenously (for morphine poisoning - Nalorphine 1 ml 0.5% solution), sodium caffeine-benzoate 2 ml 20% solution subcutaneously or aminophylline 10 ml 2.4% solution with 10 ml of a 40% glucose solution intravenously.

Shortness of breath with thoracodiaphragmatic breathing disorders occurs in the event of a significant violation, mobility of the diaphragm or chest (flatulence, kyphosis , scoliosis, chest pain, etc.) or with a large accumulation of fluid in the pleural cavity (for example, with hydrothorax). At the same time, the depth of breathing decreases, and the frequency increases; with physical exertion, tachypnea develops rapidly. Diagnosis is assisted by signs of the main process (bloated abdomen, kyphosis , scoliosis, etc.). Treatment is aimed at eliminating the causes of dyspnea - pleural puncture with hydrothorax, the introduction of a vent pipe during flatulence, etc.

Pulmonary dyspnea may be associated with a decrease in the surface and insufficient extensibility (restriction) of the lung tissue, impaired bronchial patency (obstruction), or gas diffusion in the alveoli. The restrictive type of dyspnea (usually with pneumosclerosis, pulmonary fibrosis) is characterized by difficulty breathing (inspiratory dyspnea) and short exhalation. Due to the decrease in lung capacity, the boundaries of the lungs are high, the inspiration depth is limited. In the lungs, wheezing is often heard.

Diffuse lung failure, often combined with a restrictive process (pneumosclerosis), is characterized by severe shortness of breath with tachypnea and severe “black” cyanosis of the skin and mucous membranes. Shortness of breath and cyanosis increase markedly at the slightest exertion. The treatment is aimed at eliminating the causes of shortness of breath and, along with other therapeutic measures, includes oxygen inhalation.

Most often, pulmonary dyspnea is associated with impaired bronchial obstruction due to spasm of the bronchi, their edema or obstruction by sputum. Since the degree of bronchial obstruction is variable, shortness of breath is not equally pronounced on different days: sometimes it disappears completely, sometimes it reaches a degree of suffocation. It is characterized by elongated and difficult exhalation (expiratory dyspnea), swelling on the exhalation of the cervical veins (due to increased pressure in the chest cavity) and signs of emphysema. Most patients with such shortness of breath, unlike patients with cardiac dyspnea, can lie low in bed; limbs are usually warm. With bronchial asthma, wheezing, dry wheezing on the exhale, sometimes heard from a distance, is heard in the lungs.

Treatment - bronchodilators: ephedrine hydrochloride at 0.025 g or belladonna at 0.015 g inside, or theofedrine 1/2 - 1 tablet inside, or aminophylline 1 ml of a 24% solution intramuscularly (requires individual selection of medication and dose); with difficult separation of sputum - expectorants.

Cardiac dyspnea develops as a result of insufficiency of the left parts of the heart, leading either to a decrease in cardiac output, libra to stagnation of blood in the lungs, or to a combination of both. With a small cardiac output, the nutrition of the brain is disturbed and shortness of breath develops, similar to shortness of breath of the central type, but, in contrast to it, increases with physical exertion. Stagnation of blood in the pulmonary veins disrupts gas exchange and ventilation conditions. In this case, the frequency and depth of breathing increase; the patient is forced to take a sitting position to facilitate breathing. Such shortness of breath can occur at night in a dream, but more often after exercise. Cardiac dyspnea is often combined with edema, acrocyanosis, cooling of the skin of the hands and feet. In the lungs, fine bubbling and medium bubbling rales are often heard, and with the development of pulmonary edema, coarse bubbling rales are also heard. Due to the variety of mechanisms that form cardiac dyspnea, its treatment should be comprehensive, including digitalis preparations, diuretics. In urgent cases, the paramedic should give the patient a half-sitting position, calm him, give oxygen for inhalation; inject 0.5 ml of a 0.05% solution of strophanthin into a vein with 10 ml of a 40% glucose solution (if the patient has not received digitalis preparations), give 40 mg of lasix inside.

Hematogenous dyspnea is caused by the influence of acidic substances on the respiratory center during acidosis or metabolic products, for example, with kidney or liver failure. Acidosis causes a significant increase in the frequency and depth of breathing (polypnoea). In severe cases (for example, with a diabetic coma), breathing becomes noisy (large and noisy Kussmaul breathing). The treatment is to fight acidosis.

Often in patients suffering from heart and lung diseases, the pathogenesis of dyspnea is mixed (for example, heart dyspnea can be complicated by a decrease in respiratory excursions due to flatulence, ascites, hydrothorax, etc.), which should be considered during treatment.