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EMSWORLD.com | JULY 2016 51 » Stridor: Stridor is a high-pitched sound commonly heard on inspiration without a stethoscope that is indicative of an upper airway obstruction typically caused by infection, anaphylaxis or foreign body obstruction. » Pleural rub: A pleural rub is the hallmark of pleurisy. It is best described as a creaking sound heard over the affected area of the lung. Abdomen—A distended abdomen may indicate ascites. This finding can be associated with CHF. Lower extremities—Routinely examine the lower extremities in patients with a chief complaint of SOB. Pitting edema bilaterally is common in CHF. A one-sided swollen leg can indicate DVT, which would raise the likelihood that pulmonary embolism is the cause of the dyspnea. In addition, the presence of pressure sores would indicate a patient who is nonambulatory. Both pneumonia and pulmonary embolism are more likely in nonambulatory patients. Respiratory Emergencies Quickly diagnosing respiratory emergencies can significantly impact a patient's outcome. Life-threatening respiratory medical emergen- cies include pulmonary embolism, CHF, pneumonia, spontaneous pneumothorax, exacerbations of COPD and asthma. Pulmonary embolism—Pulmonary embolism typically presents as a triad of sudden onset of shortness of breath, tachycardia and hypoxia. Pleuritic chest pain and hemoptysis can also occur. Large pulmonary emboli can cause hypotension, syncope and cardiac arrest. The following patients are at increased risk for a pulmonary embolus: patients with a previous DVT or PE, recent hip or knee surgery, leg pain/swelling, immobility (bedridden, long-distance travel via car or plane) or pregnancy, including up to 6 weeks postpartum. Differential diagnosis: acute coronary syndromes, spontaneous pneumothorax, pneumonia and hyperventilation syndrome. Spontaneous pneumothorax—Spontaneous pneumothorax pres- ents with a sudden onset of respiratory distress and/or pleuritic chest pain and dyspnea on exertion. Breath sounds are diminished or absent on the affected side. Because a collapsed lung cannot fully inf late, there may be a decrease in chest wall movement on the affected side depending on the size of the pneumothorax. Carefully monitor patients for the development of a tension pneumothorax: severe respiratory distress, hypotension, cyanosis, JVD, altered mental status and tracheal deviation. Tall, thin adolescent males and activities with changes in altitude (e.g., scuba diving, f lying, hiking in high altitudes) increase the risk for a spontaneous pneumothorax. Look for a history of previ- ous spontaneous pneumothorax, COPD, cystic fibrosis, asthma, tuberculosis, pneumonia, lung cancer and/or Marfan's syndrome. Differential diagnosis: Acute coronary syndromes, pulmonary embolus. COPD—Emphysema is a chronic condition characterized by shortness of breath secondary to damage of the alveoli. Damaged Applying Traction Is Easy When you have the right splint Use the Sager Traction Scale to set the amount of traction needed—Sager Splints do the rest. The Sager's dynamic function permits traction to decrease automatically as the muscle spasm releases. Your patient will always have the correct amount of safe, secure, traction. It's that easy! One-person application. Safely treats Proximal Third and Mid-Shaft fractures. Ensures optimal patient care. Learn how easy Sager Splints are to use / for details on Sager Splint models visit www.sagersplints.com Email: sagersales@aol.com / Call 800.642.6468 for the name of Your Authorized Distributor. 20270 Charlanne Drive Redding, CA, 96002-9223 For More Information Circle 38 on Reader Service Card