now here's our first lung sound this is rails some people call it crackles so what rails is we have fluid in the lungs so I'm going to show you how we combat that in EMS in a moment let's break this down we hear rails the big question is is it bilateral rails on both sides of the lungs or is it just on one side so if we hear it on both sides we can pretty much with good Cerny think more and lean towards more this being CHF heart failure we'll talk about a few more key factors too on the other side rails could also be an early onset of pneumonia layer stage ammonia would be more rock I talk about that later but we want to think rails there's fluid or blood there's wet lungs going on right now right so how do we differentiate CHF and ammonia well pneumonia has fever has chills there could be some body aches right because there's an infection pathway green yellow sputum they're coughing up right so that's more the pneumonia side but also could you have bilateral pneumonia yes but it's not as common as one side of pneumonia is so we're just here on one side nothing on the other at all then we are leading towards pneumonia right okay now with CHF the big key pink frothy sputum because you're coughing up that's feed on that very cough of blood right and the other thing we look at is hypertension and then jvd right remember I always say blood backs up right so with CHF that's something we want to look out in this case you have blood backing up in the system in the body could be like Peter ledema jbd but in this case we are rails backing up into the lungs so if we have a CHF what do we do well a few things that can help Okay positive pressure ventilations could help of course if your patient needs to be ventilated but in reality your patient is going to be usually awakened talking to you we're gonna do CPAP and then Nitro Nitro is going to decrease the preload in the patient of course you want to do an EKG but CPAP is our main treatment for this CHS now a pneumonia the biggest thing is pneumonia usually is going to lower your oxygen levels so you want to give oxygen to that patient and then continuing to assess how severe they are what else are we going to do do we hear a wheeze where we might want to give them Albuterol for example right so we consider these things with this patient yep that is wheezing now with a wheezing patience what we have is tight lungs the bronchioles are being constricted so your patient has a hard time breathing maybe they're in the tripod position right maybe they're only speaking in one or two word sentences what causes brown constriction the Demonic to remember this the memorization tool is AAC asthma anaphylaxis COPD there go to weeds and have bronchoconstriction issues tight lungs frog constriction how do we treat this we know what it sounds like how do we treat this well a few medications so albuterol is going to open up the tight Airways so there's asthma especially there is kind of a ranking where you'll see a patient who's having an asthma attack and you're kind of put them on continuous nebs and they do well so we give them albuterol we could give them in continuous albuterol I have a tropium dries up secretions so with this wheezing especially with asthma and flax is COPD you can have also hyperfectration as well going on in the lung Fields so that is why the drug ibotropium can be given and as a dual nib via nebulizer now epinephrine we know epic like an EpiPen that's given automatically for anaphylaxis but we can also give Epi for severe asthma right so if we get a severe as a patient the vital signs are unstable with the patient right we can give an Epi IM right so that's going to be epinephrine what's epinephrine going to do above the lungs so epinephrine acts on your beta 2 receptor and when the beta 2 receptor is activated it causes bronchodilation the same receptor albuterol axon the Epi gives a little more punch is full stronger say a Medrol well think about this we have an inflammatory process going on right now so we can use a steroid anti-inflammatory like cymedral a steroid to help with that it's not going to help immediately but if you want to start that as soon as you can it's going to help that process then finally here we have magnesium now magnesium if you don't know can be used in cardiac OBGYN cases and respiratory because magnesium is a smooth muscle relaxant so kind of the last stage here let's say you got a really severe as a patient you give continuous nabs give Epi give cell your Medrol you're transporting maybe if you have a long transport time the patient's pretty critical you could do a magnesium drip remember magnesium is measured in grams not milligrams or micrograms grams magnesium and you would drip that in over a period of time follow your protocol and that can help your wheezing think patient I don't hear anything do you what if we hear and we listened and we hear an absent chest first check your scope make sure it's working dang the injection material is working you can hear it you're tapping as I mean you hear it we have an absent chest there's two things we gotta bake things we're gonna look out for so really the question is do we hear apps and sounds no sounds or diminish sounds if you will you may have heard the word diminished or absent sounds diminished we can barely hear absent hear nothing if we hear diminish your apps and sounds on both sides both sides bilaterally I'm thinking more of severe constriction with severe brought it so bad I can't even hear a wheeze right this is again treated nebs epimag cyan Medrol but what if I'm at a traumatic patient so this is more medical right what if I met with a car accident patient and I hear or anyone who it could be medical too because remember pneumothorax yes it's trauma but tall lanky people Kevin medical pneumothorax too what ifs on one side I hear absent or diminished the other side's fine then we start looking for signs and symptoms of a tension pneumothorax or an unsimple pneumodorax jvd remember that jugular reading extension neck trigid deviation the trachea is off its position it's moving high heart rate low blood pressure how do we treat that at the BLS EMT level give high for auction rapid transport paramedic level needle decompression what happens in pneumothorax is we have air that entered inside the chest and this air is compressing up and collapsing the long the long basically has a puncture in it right which is causing the lung to get smaller it's more and smaller because it's being pushed by air in the pearl space your lung is literally collapsing so this air that's pushing on the lung we put a knitting on the chest it allows that air to escape and the long mouth can reinflate in what a feeling that is that is now able to be reinflated you literally saved your patient in hospital they're going to put a chest tube in there to maintain that for even longer and on a really long transport you may have heard you might need a needle once and then needle again if it gets worse so just a quick Purl that is rockeye say it with me Raga you got Junk in your lungs you hear wrong guy he got Junk in your lung for always remember that rest your career Ronka you got Junk in your lungs this infection pathway I think about pneumonia illness infection green yellow sputum could be a cough could could be painful to Breathe Right do do you think do they need Airway support where are they at do they need ventilation uh do they need other Airway devices to assist them that's what we want to look at here we're evaluating this patient how far along are they with his infection I was speaking in one or two word says is how laborers are breathing what sort of two sap give oxygen as needed chills fever body aches infection bronchi's infections remember you could have pneumonia on both sides but it's usually on one side but you could have bilateral pneumonia it's def possible but if you're on one side wrong guy you might have pneumonia think about these things [Music] that is Strider now wait a second there's the lung sound video all right Strider is upper Airway you're lungs down here in the lower airway so Strider is an upper Airway sound but I want to include it for you here so it's Strider we gotta think that the upper Airway is closing is enlarged it is tightening of the upper Airways that's Strider it is a major major medical emergency okay now one thing I did put on here is I said medical this could be caused by trauma so a little bonus here I put in here is let's just say for example you could have Strider from direct trauma to your upper Airway so that's a little bonus tip but here are the main five so first is going to be croup croup and epigua Titus these are pediatric conditions the key to remember is this Croup is more gradual epiglottitis is more instance with croup you have a barking cough epiglottitis you have drooling you it's it's painful croup you have that classic barking cough croup happens to people around four years old epiglottitis can happen to anyone even an adult epiglottitis is simply put if inflammation of the epiglottis so Croup is an infection some of the epiglottitis can be an infection as well but think about these things that differentiate right the other thing we have is Airway inhalation Burns so if someone's involved in a fire we can have an inhalation burn of the upper Airway that causes Strider look for any soot or anything on the face that may call you in or if they're involved in a fire then we obviously cool it FBO as a foreign body Airway obstruction so legitimately do we have a partially occluded anyway right if we are Strider it's still it's partially included if we hear nothing and it's absolutely not breathing well they could have a full Airway obstruction at the paramedic level assuming call I'll put a picture of McGill four steps so what you would do is use the rotoscope blade you'd open the airway you'd visualize the obstruction and then take it out if it was a full obstruction right we want to try and help the patient clear it and or cough it and try to get it down if it's partially or if we have to get it we can still go get it then air full access so anaphylaxis obviously is two or more body systems being affected by an allergen so for example nausea vomiting wheezing hives identification right so anaphylaxis can also cause Strider and wheezing as well so watch out for that and of course with that pathway Benadryl Epi nabs usually are nauseous like Zofran stuff so those things you want to look for with anaphylaxis patients now a lot of you asked in the comments about how to prepare for school how to get through school and how to pass nremt the first link in the description is a study tool that I give to all my students to accomplish all of that it's called The Video Vault inside the Video Vault it's over 480 videos of content audio files worksheets practice quizzes or community group what I do in the video vault is take all the concepts you need to know to pass school at nremt and I break them down simply for you so that way you just follow along with the videos you'll follow the study plan and you pass I give my students lifetime access and the first link in description and I'll see you on the inside