Acute dyspnea

Workup

CXR

ECG

CBC

Chem 7

Consider:

BNP

D-dimer

Troponin

ABG

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

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

3/7/06 DONALDSON (adapted from Rosen)

Authors: