Acute dyspnea: Difference between revisions

(Text replacement - "==Treatment==" to "==Management==")
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{{Adult top}} [[acute dyspnea (peds)]].''
==Background==
==Background==


==Clinical Features==
==Clinical Features==
[[File:PulmEdema.png|thumb|Pulmonary edema with small pleural effusions on both sides.]]
===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]], [[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||Clear/hyperinflated||Normal/pulm strain||Albuterol, atrovent, steroids, consider anaphylaxis (epi)||Beta-blockers; ?aspirin
| [[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||[[Needle thoracentesis]]/[[chest tube]]||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]]
| [[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}}


==Diagnosis==
==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

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

{{#widget:YouTube|id=O2-TFCkSN8E}}


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