3h • Paramedic Talk
COPD vs CHF
COPD vs CHF: EMS Quick Guide
Main Difference
COPD: lung problem
- Air gets trapped.
- Patient has trouble exhaling.
CHF: heart problem
- Heart pump fails.
- Fluid backs up into the lungs.
COPD Clues
Think COPD when you see:
- History of COPD/smoking
- Wheezing or diminished lung sounds
- Prolonged exhalation
- Productive cough
- Pursed-lip breathing
- Barrel chest
- Tripod position
COPD EMS Treatment
- Sit upright
- Oxygen if hypoxic or in distress
- Bronchodilator: albuterol/ipratropium per protocol
- CPAP if severe and tolerated
- Assist ventilations if tiring or altered
CHF Clues
Think CHF when you see:
- History of CHF/heart disease
- Crackles/rales
- Orthopnea: cannot lie flat
- JVD
- Pedal edema
- Pink frothy sputum
- Hypertension, especially early
- Pale, cool, diaphoretic skin
CHF EMS Treatment
- Sit upright
- Oxygen if hypoxic or in distress
- CPAP if severe and tolerated
- Nitroglycerin if BP allows and protocol permits
- 12-lead ECG if ALS
- Avoid unnecessary fluid boluses
Common NREMT Traps
- Do not withhold oxygen from a hypoxic COPD patient.
- Wheezing does not always mean COPD; CHF can wheeze too.
- Crackles are not always pneumonia; they may be pulmonary edema.
- CPAP can help both COPD and CHF when indicated.
- Treat the patient’s breathing first, then narrow down the cause.
Simple Memory Aid
COPD = can’t get air out. CHF = fluid backs up into lungs.
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COPD vs CHF
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