3d • EMT Talk
Pink puffer or Blue bloater?
Pink Puffer = Emphysema-dominant COPD
Why “pink”?
- These patients maintain near-normal oxygenation (pink skin) early in the disease.
- They compensate with increased respiratory rate → less cyanosis.
Why “puffer”?
- They breathe with pursed lips to keep airway pressure up and prevent alveolar collapse.
- They are thin, barrel-chested, and work hard to breathe (air trapping).
Key physiology
- Loss of alveolar walls → decreased elastic recoil
- Destruction of alveoli → “pink puffer”
Blue Bloater = Chronic Bronchitis–dominant COPD
Why “blue”?
- Chronic bronchitis leads to poor oxygenation → cyanosis
- Low O₂ + high CO₂ → “blue”
Why “bloater”?
- Chronic hypoxia → pulmonary vasoconstriction → cor pulmonale (right-sided CHF)
- This causes fluid retention, edema, and a “bloated” appearance.
Key physiology
- Chronic cough + mucus production for ≥3 months for 2 consecutive years
- Airways filled with mucus → V/Q mismatch → cyanosis and hypercapnia
🚨 Modern EMS / medicine perspective
These terms are outdated and overly simplistic because:
- Many COPD patients have a mixture of chronic bronchitis and emphysema.
- Not everyone fits the “pink” or “blue” image.
But for exams, they still test well, and the physiology holds.
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Pink puffer or Blue bloater?
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