Acute dyspnea: Difference between revisions
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{{Adult top}} [[acute dyspnea (peds)]].'' | |||
==Background== | ==Background== | ||
==Clinical Features== | ==Clinical Features== | ||
===Emergent Pattern Recognition=== | ===Emergent Pattern Recognition=== | ||
{| class="wikitable" | {| class="wikitable" | ||
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| align="center" style="background:#f0f0f0;"|'''Contraindicated''' | | align="center" style="background:#f0f0f0;"|'''Contraindicated''' | ||
|- | |- | ||
| [[Pulmonary Edema]]||Bilateral rales||Interstitial fluid||Normal/abnormal||R/O AMI, [[lasix]], nitrates, [[ACEi]], [[ | | [[Pulmonary Edema]]||Bilateral rales||Interstitial fluid||Normal/abnormal||R/O AMI, [[lasix]], nitrates, [[ACEi]], [[BiPAP]]||[[IVF]]; ?[[albuterol]]; ?[[Beta-blockers]] | ||
|- | |- | ||
| [[Bronchoconstriction]]||Wheezes||Clear/hyperinflated||Normal/ | | [[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 | | [[Pneumonia]]||Focal ronchi/decreased breath sounds||Infiltrate/effusion||Normal||[[IVF]], [[antibiotics]]||Rate control; diuresis | ||
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| [[Pulmonary embolism]]||Clear||Clear (most) or Westrmark/Hampton hump||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||[[ | | [[Pneumothorax]]/[[Hemothorax]]||Unequal||Pneumo/hemo||Normal||Needle [[thoracentesis]]/[[chest tube]]||Rate control | ||
|- | |- | ||
| [[Dysrythmia]]||Clear/pulmonary edema||Clear/ | | [[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]] | | [[ACS]]||Clear/pulmonary edema||Clear/pulmonary edema||Normal/abnormal||[[Aspirin]]; nitrates, anticoagulation, ?[[beta-blockers]], +/- [[thrombolytics]]||[[Albuterol]]; ?[[IVF]] | ||
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{{SOB DDX}} | {{SOB DDX}} | ||
== | ==Evaluation== | ||
*CXR | [[File:PulmEdema.png|thumb|Pulmonary edema with small pleural effusions on both sides.]] | ||
*ECG | *[[CXR]] | ||
*[[ECG]] | |||
*CBC | *CBC | ||
*Chem-7 | *Chem-7 | ||
*BNP? | *[[BNP]]? | ||
*D-dimer? | *[[D-dimer]]? | ||
*Troponin? | *[[Troponin]]? | ||
*ABG? | *[[ABG]]? | ||
*Bedside [[ultrasound]]? | *Bedside [[ultrasound]]? | ||
{{BLUE Protocol}} | |||
==Management== | ==Management== | ||
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==See Also== | ==See Also== | ||
*[[Hypoxemia]] | *[[Hypoxemia]] | ||
*[[Shortness of breath (peds)]] | |||
==Video== | |||
{{#widget:YouTube|id=O2-TFCkSN8E}} | |||
==References== | ==References== | ||
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[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Pulmonary]] | [[Category:Pulmonary]] | ||
[[Category:Symptoms]] |
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
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
- Other Associated with ↓ Respiratory Effort
Non-Emergent
- ALS
- Ascites
- Uncorrected ASD
- Congenital heart disease
- COPD exacerbation
- Fever
- Hyperventilation
- Interstitial lung disease
- Neoplasm
- Obesity
- Panic attack
- Pleural effusion
- Polymyositis
- Porphyria
- Pregnancy
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
- URI
Evaluation
Bedside Lung Ultrasound in Emergency (BLUE) Protocol[1]
- 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
{{#widget:YouTube|id=O2-TFCkSN8E}}
References
- ↑ http://ccm.anest.ufl.edu/files/2012/08/BLUELung.pdf Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure - The BLUE Protocol