Acute dyspnea
Vicken Y. Totten MD MS,
FACEP FAAFP
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Definition
• Dyspnea: Subjective sensation
of abnormal / insufficient
respiration.
• Unpleasant, concomitant
with excessive respiratory
effort
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Goals of this presentation
• Initial evaluation of selected causes of
dyspnea:
severe asthma
pneumothorax
pulmonary embolism
acute pulmonary edema.
• Initial pediatric assessment
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Tools to evaluate dyspnea
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index of suspicion
Stethoscope / Physical Exam
Possibly CO & CO2 monitors
pulse oximeter
peak flow meter
chest radiograph
Ultrasound
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Subjective vs Objective evidence
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PNEUMOTHORAX
CHIEF COMPLAINT
•
28 yo man. 2 d SOB
1 ppd
sings in church
denies asthma or trauma, malaise, fever or URI symptoms
pain is right-sided and respirophasic
CLINICAL MANIFESTATIONS
Tall, slender, alert and a bit anxious.
Palpation does not reproduce the pain.
auscultation suggests decreased breath sounds on R
no wheezes, rales or ronchi
pulse oximetry reading is 93%.
Scratch test + (What is this?)
Scratch Test
Place stethoscope on mediastinum, gently scratch the anterior chest wall alternate sides, equidistant
EPIDEMIOLOGY
unilateral respirophasic chest pain & dyspnea.
incidence 1.7 to 18 per 100,000
more common in males, especially tall, slender young men, half < 40
80% are smokers
if over 50, COPD
Recurrence
1/3 develop a second episode
if 2 episodes, 1/2 suffer a third episode
Classification
by etiology: spontaneous vs traumatic
by severity: ‘small’, ‘medium’ or ‘large.’
Spontaneous: primary (idiopathic) or secondary
Secondary
minimal barotrauma
changes in ambient air pressure
commercial air travel.
prolonged breath holding:
Straining,
valsalva
straining at stool
emesis
lifting
cocaine or marijuana
Infections
necrotizing infections
streptococcal pneumonia or tuberculosis
Due to underlying defects
Rupture of weak pulmonary connective tissue
Marfan’s
syndrome
sarcoidosis
pulmonary
fibrosis
occasionally neoplasms
RISK FACTORS
smoking, asthma, barotrauma
positive pressure breathing
breath holding, straining
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