Acute dyspnea: Difference between revisions
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[[File:PulmEdema.png|thumb|Pulmonary edema with small pleural effusions on both sides.]]
[[File:PulmEdema.png|thumb|Pulmonary edema with small pleural effusions on both sides.]]
===Emergent Pattern Recognition===
===Emergent Pattern Recognition===
#[[Pulmonary Edema]]
{| class="wikitable"
#*lungs: b/l rales
| align="center" style="background:#f0f0f0;"|'''Diagnosis'''
#*CXR: interstitial fluid
| align="center" style="background:#f0f0f0;"|'''Lungs'''
#*Tx: ECG (R/O AMI), lasix, nitrates, ACE, BIPAP
| align="center" style="background:#f0f0f0;"|'''CXR'''
#[[Bronchoconstriction]]
| align="center" style="background:#f0f0f0;"|'''ECG'''
#*lungs: wheezes
| align="center" style="background:#f0f0f0;"|'''Treatment'''
#*CXR: neg/hyperinflated
| align="center" style="background:#f0f0f0;"|'''Contraindicated'''
#*Tx: albuterol, atrovent, steroids, consider anaphylaxis (epi)
|-
#[[Pneumonia]]
| [[Pulmonary Edema]]||Bilateral rales||Interstitial fluid||Nl/abnormal||R/O AMI, lasix, nitrates, ACE, BIPAP||IVF; ?albuterol; ?Beta-blockers
#*lungs: focal ronchi/dec BS
|-
#*CXR: infiltrate/effusion
| [[Bronchoconstriction]]||Wheezes||Neg/hyperinflated||Normal/pulm strain||Albuterol, atrovent, steroids, consider anaphylaxis (epi)||Beta-blockers; ?aspirin
#*Tx: abx
|-
#[[PE]]
| [[Pneumonia]]||Focal ronchi/dec BS||Infiltrate/effusion||Normal||IVF, antibiotics||Rate control; diuresis
#*lungs: clear
|-
#*CXR: clear/Westrmrk/Hmptn
| [[Pulmonary embolism]]||Clear||Clear/Westrmrk/Hmptn||Normal/S1Q3T3||Anticoagulate/thrombolytics||Rate control
#*Tx: ECG, D-dimer and/or CT; anticoagulate/thrombolytics
|-
#[[Pneumothorax]]/Hemothorax
| [[Pneumothorax]]/[[Hemothorax]]||Unequal||Pneumo/hemo||Normal||Needle/chest-tube||Rate control
#*lungs: unequal
|-
#*CXR: pneumo/hemo
| [[Dysrythmia]]||Clear/pulm edema||Clear/pulm edema||Abnormal||Type dependent||Albuterol; ?IVF
#*Tx: needle/chest-tube
|-
#[[Dysrythmia]]
| [[ACS]]||Clear/pulm edema||Clear/pulm edema||Nl/abnormal||Aspirin; nitrates, anticoag, ?beta-blockers, +/- thrombolytics||Albuterol; ?IVF
#*lungs: clear/pulm edema
|}
#*CXR: clear/pulm edema
#*ECG: abnl
#*Tx: rate dependent
#[[Cardiac Ischemia]]
#*lungs: clear/pulm edema
#*CXR: clear/pulm edema
#*ECG: nl/abnl
#*Tx: B-block, nitrates, anticoag, +/- thrombolytics


==Differential Diagnosis==
==Differential Diagnosis==

Revision as of 20:45, 31 March 2015

Background

Diagnosis

Pulmonary edema with small pleural effusions on both sides.

Emergent Pattern Recognition

Diagnosis Lungs CXR ECG Treatment Contraindicated
Pulmonary Edema Bilateral rales Interstitial fluid Nl/abnormal R/O AMI, lasix, nitrates, ACE, BIPAP IVF; ?albuterol; ?Beta-blockers
Bronchoconstriction Wheezes Neg/hyperinflated Normal/pulm strain Albuterol, atrovent, steroids, consider anaphylaxis (epi) Beta-blockers; ?aspirin
Pneumonia Focal ronchi/dec BS Infiltrate/effusion Normal IVF, antibiotics Rate control; diuresis
Pulmonary embolism Clear Clear/Westrmrk/Hmptn Normal/S1Q3T3 Anticoagulate/thrombolytics Rate control
Pneumothorax/Hemothorax Unequal Pneumo/hemo Normal Needle/chest-tube Rate control
Dysrythmia Clear/pulm edema Clear/pulm edema Abnormal Type dependent Albuterol; ?IVF
ACS Clear/pulm edema Clear/pulm edema Nl/abnormal Aspirin; nitrates, anticoag, ?beta-blockers, +/- thrombolytics Albuterol; ?IVF

Differential Diagnosis

Acute dyspnea

Emergent

Non-Emergent

Workup

  1. CXR
  2. ECG
  3. CBC
  4. Chem-7
  5. BNP?
  6. D-dimer?
  7. Troponin?
  8. ABG?
  9. Bedside ultrasound?

Treatment

  • Oxygen
  • Treat underlying cause

Source

  • Rosen
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