Acute dyspnea

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