Acute dyspnea: Difference between revisions

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{{Adult top}} [[acute dyspnea (peds)]].''
==Background==
==Background==



Revision as of 16:09, 1 July 2020

This page is for adult patients. For pediatric patients, see: acute dyspnea (peds).

Background

Clinical Features

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/pulmonary 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/pulmonary 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

See also Shortness of breath (peds) for pediatric-specific differential

Acute dyspnea

Emergent

Non-Emergent

Evaluation

Pulmonary edema with small pleural effusions on both sides.

Bedside Lung Ultrasound in Emergency (BLUE) Protocol[1]

Algorithm for the Use of Ultrasound in the Evaluation of Dyspnea
  • Predominant A lines + lung sliding = Asthma/COPD
  • Multiple predominant B lines anteriorly with lung sliding = Pulmonary Edema
  • Normal anterior profile + DVT= PE
  • Anterior absent lung sliding + A lines + lung point = Pneumothorax (PTX)
  • Anterior alveolar consolidations, anterior diffuse B lines with abolished lung sliding, anterior asymmetric interstitial patterns, posterior consolidations or effusions with out anterior diffuse B lines = Pneumonia

Management

  • Oxygen
  • Treat underlying cause

Disposition

See Also

Video

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References

  1. http://ccm.anest.ufl.edu/files/2012/08/BLUELung.pdf Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure - The BLUE Protocol