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EMSWORLD.com | JULY 2016 47 "flash" pulmonary edema over a matter of minutes. The shorter the onset of illness, the less likely it is pneumonia. Vital signs can give clues as well. Blood pressure values tend to be higher in CHF than pneumonia. Flash pulmonary edema cases typically have extremely high systolic pressures, often over 200. Using these tricks of the trade can give paramedics a shortcut to the diagnosis, but only if CHF and pneumonia are the exclu- sive etiologies to consider. While both are common, there can be more to SOB than just these two problems. Therefore, the skilled medic will have a good understand- ing of how to perform a focused history and physical examination for the chief com- plaint of shortness of breath. Respiratory H&P; Because the respiratory and cardiovascular systems are so closely related, chief com- plaints such as SOB, dyspnea on exertion (DOE), wheezing and coughing must be carefully assessed to determine the correct body system responsible so that an accurate prehospital diagnosis can be made and the correct treatment administered. To be proficient in conducting the H&P;, your process must be organized and sys- tematic. Practice makes perfect. Utilize the following outline as a guide for short- ness of breath assessments and a template for writing patient care reports. Explore the following categories in patients with a complaint of SOB: 1. Chief complaint: the main reason 9-1-1 was called; 2. History (present illness, past medical, social, family); 3. Review of systems; 4. Physical exam; 5. Form the prehospital and differential diagnosis. History Chief complaint—The chief complaint sets up the framework for the rest of the ques- tions to discover the diagnosis. With a chief patient complaint of shortness of breath, the paramedic should immediately consider the life threats associated with that complaint and organize questioning to help refine or narrow down the possible etiologies. Information obtained from the chief complaint must be expanded to include the onset, palliative/provocative factors, quality, radiation, severity, timing and associated symptoms (OPQRSTA). This framework ensures a thorough explora- tion of the chief complaint and should be completed prior to moving on to the next section of the history. The answers obtained from this section will point to a more specific etiology as the cause of the shortness of breath. Past medical history—Questions regard- ing past medical history are very important when it comes to a chief complaint of SOB. If the patient has any of these pre-existing conditions, the odds greatly increase that the current episode is an exacerbation of a prior disease process. Ask about the presence of: » Asthma; » COPD/emphysema; Automated Chest Compression System for Professionals For use as an adjunct to manual CPR 1 Kleinman ME, et al. Circulation (2015); 132:S414. Provides victims of sudden cardiac arrest the precision needed for high-quality and continuous CPR associated with better survival 1 Removable Compression Module allows for quick deployment, enhanced usability A rigid backboard with a stiff frame of single-piece design facilitates operation without unwanted fex Be it on the ground, in an ambulance cot, a moving vehicle, or intra-hospital transport, the Lifeline ARM is your solution for uninterrupted CPR. www.defbtech.com VISIT US AT EMS WORLD BOOTH #239 www.monumedical.com MKT-GD154-120-EN For More Information Circle 35 on Reader Service Card