DR.MUHAMMAD ALJOHANI
ER CONSULTANT
SBEM-ABEM
 Dyspnea: unpleasant, subjective sensation of abnormal respiration.
 Labored breathing - physical presentation of respiratory distress/ dyspnea

Dyspnea of exertion (DOE)


Orthopnea


Exertion-induced SOB
Recumbent-induced SOB
Paroxysmal nocturnal dyspnea (PND)

Sudden SOB after recumbent
 Eupnea - normal breathing
 Bradypnea - decreased breathing rate
 Tachypnea – breathing very fast. Pt not always aware of it.
 Apnea – not breathing at all
 Hyperpnea - faster and/or deeper breathing
 Hyperventilation - rapid breathing with hypocarbia
Organ System
Pulmonary
Critical Diagnoses
Airway obstruction
Pulmonary embolus
Noncardiogenic edema
Anaphylaxis
Tension pneumothorax
Cardiac
Pulmonary edema
AMI
Tamponade
Associated with normal or increased respiratory effort
Abdominal
Emergent Diagnoses
Spontaneous pneumothorax
Asthma
Cor pulmonale
Aspiration
Pneumonia
pericarditis
Nonemergent Diagnoses
Pleural effusion
Neoplasm
COPD
Congenital heart disease
Valvular heart disease
cardiomyopathy
Mechanical interference
Pregnancy
intraabdominal sepsis
Ascites
Bowel obstruction
Pickwikian
Inflammatory/infectious process
Hypotension
viscerothorax
Psych
Hyperventilation syndrome
Met/Endocrine
DKA
Panic attack
fever
Thyroid disease
Infectious
Trauma
Epiglottitis
Tension pneumothorax
Cardiac tamponade
Flail chest
Hematologic
Associated with decreased respiratory effort
Neuromuscular
CVA
Toxicologic
organophosphate poisoning
CO poisoning
Toxic ingestion
Renal failure
Electrolyte abnormality
Metabolic acidosis
pneumonia
Simple pneumothorax
hemothorax
Diaphragm rupture
anemia
MS
Guillan Barre
Tick paralysis
Rib fracture
ALS
Polymyositis
porphyria
TOOLS TO EVALUATE DYSPNEA
 Suspicion / Clinical knowledge. “If you don’t think of it, you will never find it.”
 History
 PE including
 Vital Signs, pulse ox, PEF
 Formal Studies
 Ability to speak
 Patient position
 Cyanosis
 Central vs. peripheral (acrocyanosis)
 Mental status
 Altered MS - hypoxemia/hypercapnia
 Pulmonary
 Use of accessory muscles
 Intercostal retractions
 Abdominal-thoracic discoordination
 Presence of stridor
 Cardiac
 Check neck for presence of JVD
 Inspection
 Use of accessory muscles
 Splinting
 Intercostal retractions
 Percussion
 Hyper-resonance vs. dullness
 Unilateral vs. bilateral
 Auscultation
 Air entry
 Stridor = upper airway obstruction
 Breath sounds
 Normal
 Abnormal
 Wheezing, rales, rhonchi, etc.
 Unilateral vs. bilateral
 ABG
 Vidas d-Dimer
 BNP
 Basic Metabolic Panel
 Cardiac Enzymes
 What else, and why?
 Asthma
 Pneumonia
 Acute Pulmonary Edema
 Pulmonary Embolism
 Emphysema
 Pneumo / hemothorax
 Carbon Monoxide (CO)
 Cyanide poisoning
 ANAPHYLAXIS
1.Age start in young age
2. Family History
3. H/O Allergic Rhinitis
4.Physical exam
5.barrel shape chest
6.X-ray chest
7. ABG
 Symptoms:
 Sudden onset; respiratory distress,
 Rales, ronchi. Foamy sputum. Sometimes blood tinged.
 Blood pressure high (vasoconstriction) usually 240/120.
a)
Previous H/O Heart Disease
b)
Hyperthyroidism
c)
Rheumatic Heart disease (ms)
Sign of LVF
a)
Tachycardia
b)
Pulses alternan
c)
Basal criptation
d)
ECG change
e)
X-ray Chest ( cardiomegaly)
f)
Echo
1.Fever with chills
2.Pleuratic chest pain
3. purulent sputum
4. History of upper respiratory symptoms
5.signs of consolidation
6.x-ray chest
7. CBC
8. Blood culture
1.Suden chest pain
2. dyspnea,caugh
3. H/O asthma
4.COPD
5.Examination, trachea, shifted to opposite side
absent breath sound
6 x-ray chest
a)
Previous H/O Heart Disease
b)
Hyperthyroidism
c)
Rheumatic Heart disease (ms)
Sign of LVF
a)
Tachycardia
b)
Pulses alternan
c)
Basal criptation
d)
ECG change
e)
X-ray Chest ( cardiomegaly)
f)
Echo
a)
History of prolonged remobilization
b)
pelvic surgery
c)
contraceptive pills
d)
cyanosis
e)
ECG
f)
x-ray chest
g)
ABG
h)
ECHO
i)
PIQ study