Shortness of breath

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Pulmonary edema with small pleural effusions on both sides.

Emergent Pattern Recognition

Diagnosis Lungs CXR ECG Treatment Contraindicated
Pulmonary Edema Bilateral rales Interstitial fluid Normal/abnormal R/O AMI, lasix, nitrates, ACEi, BIPAP IVF; ?albuterol; ?Beta-blockers
Bronchoconstriction Wheezes Clear/hyperinflated Normal/pulm strain Albuterol, atrovent, steroids, consider anaphylaxis (epi) Beta-blockers; ?aspirin
Pneumonia Focal ronchi/decreased breath sounds Infiltrate/effusion Normal IVF, antibiotics Rate control; diuresis
Pulmonary embolism Clear Clear (most) or Westrmark/Hampton hump Normal/S1Q3T3 Anticoagulate/thrombolytics Rate control
Pneumothorax/Hemothorax Unequal Pneumo/hemo Normal Needle thoracentesis/chest tube Rate control
Dysrythmia Clear/pulmonary edema Clear/pulm edema Abnormal Type dependent Albuterol; ?IVF
ACS Clear/pulmonary edema Clear/pulmonary edema Normal/abnormal Aspirin; nitrates, anticoagulation, ?beta-blockers, +/- thrombolytics Albuterol; ?IVF

Differential Diagnosis

Shortness of breath




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


  • Oxygen
  • Treat underlying cause

See Also


  • Rosen