Acute dyspnea: Difference between revisions

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EMERGENT
EMERGENT


A. Pulmonary
*Pulmonary
 
*#Airway obstruction
    1) Airway obstruction
*#PE
 
*#Noncardiogenic edema
    2) PE
*#Anaphylaxis
 
*#Spont pneumothorax
    3) Noncardiogenic edema
*#Asthma
 
*#Cor pulmonale
    4) Anaphylaxis
*#Aspiration
 
*#PNA
    5) Spont pneumothorax
*Cardiac
 
*#Pulmonary edema (CHF)
    6) Asthma
*#MI
 
*#Cardiac tamponade
    7) Cor pulmonale
*#Pericarditis
 
*Other Associated with Nl/Increased Resp Effort
    8) Aspiration
*#Toxic ingestion
 
*#DKA
    9) PNA
*#Epiglotitis
 
*#Tension PNTX
B. Cardiac
*#Cardiac tamponade
 
*#Flail chest
    1) Pulmonary edema (CHF)
*#CO poisoning
 
*#Abd distension
    2) MI
*#Sepsis
 
*#Hypotension
    3) Cardiac tamponade
*#Renal failure
 
*#Electrolyte abnl
    4) Pericarditis
*#Metabolic acidosis
 
*#PNA
C. Other Associated with Nl/Increased Resp Effort
*#Pneumo/hemo-thorax
 
*#Diaphragmatic rupture
    1) Toxic ingestion
*#Anemia
 
*Other Associated with Decreased Resp Effort
    2) DKA
*#CVA
 
*#Organophosphate poisoning
    3) Epiglotitis
*#MS
 
*#Guillian-Barre
    4) Tension PNTX
*#Tick paralysis
 
    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
Non-Emergent


1) Pleural effusion
#Pleural effusion
 
#Neoplam
2) Neoplam
#PNA
 
#COPD
3) PNA
#Congenital heart dz
 
#Pregnancy
4) COPD
#Ascites
 
#Obesity
5) Congenital heart dz
#Hypterventilation
 
#Panic attack
6) Pregnancy
#Fever
 
#Thyroid dz
7) Ascites
#Rib fx
 
#ALS
8) Obesity
#Polymyositis
 
#Porphyria
9) Hypterventilation
 
10) Panic attack
 
11) Fever
 
12) Thyroid dz
 
13) Rib fx
 
14) ALS
 
15) Polymyositis
 
16) Porphyria
 


==Source==
==Source==

Revision as of 17:12, 2 March 2011

Workup

  1. CXR
  2. ECG
  3. CBC
  4. Chem 7

Consider:

  • BNP
  • D-dimer
  • Troponin
  • ABG


Diagnosis

EMERGENT PATERN RECOGNITION

  1. Pulmonary edema
    • lungs: bilat 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 (antihistamines, epi)
  3. Pneumonia
    • lungs: focal ronchi/dec BS
    • CXR: infiltrate/effusion
    • Tx: abx, goal directed,
  4. PE
    • lungs: clear
    • CXR: clear/Westrmrk/Hmptn
    • Tx: ECG, D-dimer and/or spiral CT; anticoagulate/thrombolise
  5. Pneumo/Hemo-Thorax
    • 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, +/- thrombolitics

Consider ABG


DDX

EMERGENT

  • Pulmonary
    1. Airway obstruction
    2. PE
    3. Noncardiogenic edema
    4. Anaphylaxis
    5. Spont pneumothorax
    6. Asthma
    7. Cor pulmonale
    8. Aspiration
    9. PNA
  • Cardiac
    1. Pulmonary edema (CHF)
    2. MI
    3. Cardiac tamponade
    4. Pericarditis
  • 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
  • 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)

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