Dyspnea

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Workup

  1. CXR
  2. ECG
  3. CBC
  4. Chem-7
  5. BNP?
  6. D-dimer?
  7. Troponin?
  8. ABG?

Diagnosis

Emergent Pattern Recognition

  1. Pulmonary Edema
    • lungs: b/l rales
    • CXR: interstitial fluid
    • Tx: ECG (R/O AMI), lasix, nitrates, ACE, BIPAP
  2. Bronchoconstriction
    • lungs: wheezes
    • CXR: neg/hyperinflated
    • Tx: albuterol, atrovent, steroids, consider anaphylaxis (epi)
  3. Pneumonia
    • lungs: focal ronchi/dec BS
    • CXR: infiltrate/effusion
    • Tx: abx
  4. PE
    • lungs: clear
    • CXR: clear/Westrmrk/Hmptn
    • Tx: ECG, D-dimer and/or CT; anticoagulate/thrombolytics
  5. Pneumothorax/Hemothorax
    • lungs: unequal
    • CXR: pneumo/hemo
    • Tx: needle/chest-tube
  6. Dysrythmia
    • lungs: clear/pulm edema
    • CXR: clear/pulm edema
    • ECG: abnl
    • Tx: rate dependent
  7. Cardiac Ischemia
    • lungs: clear/pulm edema
    • CXR: clear/pulm edema
    • ECG: nl/abnl
    • Tx: B-block, nitrates, anticoag, +/- thrombolytics

DDX

EMERGENT

Non-Emergent

  1. Pleural Effusion
  2. Neoplasm
  3. PNA
  4. COPD
  5. Congenital Heart Disease
  6. Pregnancy
  7. Ascites
  8. Obesity
  9. Hypterventilation
  10. Panic attack
  11. Fever
  12. Thyroid Disease
  13. Rib fx
  14. ALS
  15. Polymyositis
  16. Porphyria

Source

  • Rosen