Acute dyspnea: Difference between revisions

Revision as of 17:09, 2 March 2011

Workup

CXR
ECG
CBC
Chem 7

Consider:

BNP
D-dimer
Troponin
ABG

Diagnosis

EMERGENT PATERN RECOGNITION

Pulmonary edema
- lungs: bilat rales
- CXR: interstitial fluid
- Tx: ECG (R/O AMI), lasix, nitrates, ACE, BIPAP
Bronchoconstriction
- lungs: wheezes
- CXR: neg/hyperinflated
- Tx: albuterol, atrovent, steroids, consider anaphylaxis (antihistamines, epi)
Pneumonia
- lungs: focal ronchi/dec BS
- CXR: infiltrate/effusion
- Tx: abx, goal directed,
PE
- lungs: clear
- CXR: clear/Westrmrk/Hmptn
- Tx: ECG, D-dimer and/or spiral CT; anticoagulate/thrombolise
Pneumo/Hemo-Thorax
- lungs: unequal
- CXR: pneumo/hemo
- Tx: needle/chest-tube
Dysrythmia
- lungs: clear/pulm edema
- CXR: clear/pulm edema
- ECG: abnl
- Tx: rate dependent
Cardiac Ischemia
- lungs: clear/pulm edema
- CXR: clear/pulm edema
- ECG: nl/abnl
- Tx: B-block, nitrates, anticoag, +/- thrombolitics

Consider ABG

DDX

EMERGENT

A. Pulmonary

    1) Airway obstruction

    2) PE

    3) Noncardiogenic edema

    4) Anaphylaxis

    5) Spont pneumothorax

    6) Asthma

    7) Cor pulmonale

    8) Aspiration

    9) PNA

B. Cardiac

    1) Pulmonary edema (CHF)

    2) MI

    3) Cardiac tamponade

    4) Pericarditis

C. Other Associated with Nl/Increased Resp Effort

    1) Toxic ingestion

    2) DKA

    3) Epiglotitis

    4) Tension PNTX

    5) Cardiac tamponade

    6) Flail chest

    7) CO poisoning

    8) Abd distension

    9) Sepsis

    10) Hypotension

    11) Renal failure

    12) Electrolyte abnl

    13) Metabolic acidosis

    14) PNA

    15) Pneumo/hemo-thorax

    16) Diaphragmatic rupture

    17) Anemia

D. Other Associated with Decreased Resp Effort

    1) CVA

    2) Organophosphate poisoning

    3) MS

    4) Guillian-Barre

    5) Tick paralysis

Non-Emergent

1) Pleural effusion

2) Neoplam

3) PNA

4) COPD

5) Congenital heart dz

6) Pregnancy

7) Ascites

8) Obesity

9) Hypterventilation

10) Panic attack

11) Fever

12) Thyroid dz

13) Rib fx

14) ALS

15) Polymyositis

16) Porphyria

Source

3/7/06 DONALDSON (adapted from Rosen)

Authors:

@@ Line 1: / Line 1: @@
 ==Workup==
+# CXR
-CXR
+# ECG
+# CBC
-ECG
+# Chem 7
-CBC
-Chem 7
 Consider:
+* BNP
-BNP
+* D-dimer
+* Troponin
-D-dimer
+* ABG
-Troponin
-ABG
@@ Line 31: / Line 19: @@
 EMERGENT PATERN RECOGNITION
-) Pulmonary edema
+#Pulmonary edema
+#*lungs: bilat rales
-     -lungs: bilat rales
+#*CXR: interstitial fluid
+#*Tx: ECG (R/O AMI), lasix, nitrates, ACE, BIPAP
-     -CXR: interstitial fluid
+#Bronchoconstriction
+#*lungs: wheezes
-     -Tx: ECG (R/O AMI), lasix, nitrates, ACE, BIPAP
+#*CXR: neg/hyperinflated
+#*Tx: albuterol, atrovent, steroids, consider anaphylaxis (antihistamines, epi)
-) Bronchoconstriction
+#Pneumonia
+#*lungs: focal ronchi/dec BS
-     -lungs: wheezes
+#*CXR: infiltrate/effusion
+#*Tx: abx, goal directed,
-     -CXR: neg/hyperinflated
+#PE
+#*lungs: clear
-     -Tx: albuterol, atrovent, steroids, consider anaphylaxis (antihistamines, epi)
+#*CXR: clear/Westrmrk/Hmptn
+#*Tx: ECG, D-dimer and/or spiral CT; anticoagulate/thrombolise
-) Pneumonia
+#Pneumo/Hemo-Thorax
+#*lungs: unequal
-     -lungs: focal ronchi/dec BS
+#*CXR: pneumo/hemo
+#*Tx: needle/chest-tube
-     -CXR: infiltrate/effusion
+#Dysrythmia
+#*lungs: clear/pulm edema
-     -Tx: abx, goal directed,
+#*CXR: clear/pulm edema
+#*ECG: abnl
-) PE
+#*Tx: rate dependent
+#Cardiac Ischemia
-     -lungs: clear
+#*lungs: clear/pulm edema
+#*CXR: clear/pulm edema
-     -CXR: clear/Westrmrk/Hmptn
+#*ECG: nl/abnl
+#*Tx: B-block, nitrates, anticoag, +/- thrombolitics
-     -Tx: ECG, D-dimer and/or spiral CT; anticoagulate/thrombolise
-) Pneumo/Hemo-Thorax
-     -lungs: unequal
-     -CXR: pneumo/hemo
-     -Tx: needle/chest-tube
-) Dysrythmia
-     -lungs: clear/pulm edema
-     -CXR: clear/pulm edema
-     -ECG: abnl
-     -Tx: rate dependent
-) Cardiac Ischemia
-     -lungs: clear/pulm edema
-     -CXR: clear/pulm edema
-     -ECG: nl/abnl
-     -Tx: B-block, nitrates, anticoag, +/- thrombolitics
+Consider ABG
-*Consider ABG