Acute dyspnea: Difference between revisions

Revision as of 20:49, 31 March 2015

Background

Diagnosis

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	Neg/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

Acute dyspnea

Emergent

Pulmonary
- Airway obstruction
- Anaphylaxis
- Angioedema
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute exacerbation
- Cystic fibrosis exacerbation
Cardiac
Other Associated with Normal/↑ Respiratory Effort
- Abdominal distension
- Anemia
- CO Poisoning
- Salicylate toxicity
- Diabetic ketoacidosis (DKA)
- Diaphragm injury
- Electrolyte abnormalities
- Epiglottitis
- Flail chest
- Hypotension
- Metabolic acidosis
- Pneumonia
- Pneumothorax/hemothorax
- Renal Failure
- Sepsis
- Toxic ingestion
Other Associated with ↓ Respiratory Effort

Non-Emergent

Workup

CXR
ECG
CBC
Chem-7
BNP?
D-dimer?
Troponin?
ABG?
Bedside ultrasound?

Treatment

Oxygen
Treat underlying cause

Source

Rosen

Authors:

@@ Line 7: / Line 7: @@
 | align="center" style="background:#f0f0f0;"|'''Diagnosis'''
 | align="center" style="background:#f0f0f0;"|'''Lungs'''
-| align="center" style="background:#f0f0f0;"|'''CXR'''
+| align="center" style="background:#f0f0f0;"|'''[[CXR]]'''
-| align="center" style="background:#f0f0f0;"|'''ECG'''
+| align="center" style="background:#f0f0f0;"|'''[[ECG]]'''
 | align="center" style="background:#f0f0f0;"|'''Treatment'''
 | align="center" style="background:#f0f0f0;"|'''Contraindicated'''
 |-
-| [[Pulmonary Edema]]||Bilateral rales||Interstitial fluid||Nl/abnormal||R/O AMI, lasix, nitrates, ACE, BIPAP||IVF; ?albuterol; ?Beta-blockers
+| [[Pulmonary Edema]]||Bilateral rales||Interstitial fluid||Normal/abnormal||R/O AMI, [[lasix]], nitrates, [[ACEi]], [[BIPAP]]||[[IVF]]; ?[[albuterol]]; ?[[Beta-blockers]]
 |-
 | [[Bronchoconstriction]]||Wheezes||Neg/hyperinflated||Normal/pulm strain||Albuterol, atrovent, steroids, consider anaphylaxis (epi)||Beta-blockers; ?aspirin
 |-
-| [[Pneumonia]]||Focal ronchi/dec BS||Infiltrate/effusion||Normal||IVF, antibiotics||Rate control; diuresis
+| [[Pneumonia]]||Focal ronchi/decreased breath sounds||Infiltrate/effusion||Normal||[[IVF]], [[antibiotics]]||Rate control; diuresis
 |-
-| [[Pulmonary embolism]]||Clear||Clear/Westrmrk/Hmptn||Normal/S1Q3T3||Anticoagulate/thrombolytics||Rate control
+| [[Pulmonary embolism]]||Clear||Clear (most) or Westrmark/Hampton hump||Normal/S1Q3T3||Anticoagulate/[[thrombolytics]]||Rate control
 |-
-| [[Pneumothorax]]/[[Hemothorax]]||Unequal||Pneumo/hemo||Normal||Needle/chest-tube||Rate control
+| [[Pneumothorax]]/[[Hemothorax]]||Unequal||Pneumo/hemo||Normal||[[Needle thoracentesis]]/[[chest tube]]||Rate control
 |-
-| [[Dysrythmia]]||Clear/pulm edema||Clear/pulm edema||Abnormal||Type dependent||Albuterol; ?IVF
+| [[Dysrythmia]]||Clear/pulmonary edema||Clear/pulm edema||Abnormal||Type dependent||[[Albuterol]]; ?[[IVF]]
 |-
-| [[ACS]]||Clear/pulm edema||Clear/pulm edema||Nl/abnormal||Aspirin; nitrates, anticoag, ?beta-blockers, +/- thrombolytics||Albuterol; ?IVF
+| [[ACS]]||Clear/pulmonary edema||Clear/pulmonary edema||Normal/abnormal||[[Aspirin]]; nitrates, anticoagulation, ?[[beta-blockers]], +/- [[thrombolytics]]||[[Albuterol]]; ?[[IVF]]
 |}