SOB
Diagnosis
Signs and
Symptoms
Diagnostic tests
Can’t Miss and/or Surgical Emergencies
MI
PE
Pneumothorax
Sudden onset,
Sudden onset,
Sudden onset,
constant chest
either no pain or
pleuritic pain, non
pain, possible
pleuritic chest
radiating constant
radiating left arm pain (increases
pain, breath
pain, severe pain
with respiration), sounds
(sometimes
non-radiating and diminished or
localized to the
non-exertional,
absent on affected
left upper thorax, cough and
side, resonant to
sometimes
hemoptysis may
percussion,
diffuse)
ensue, lungs clear absence of CV
sometimes
to auscultation
history, could
increased on
and tympany on
follow trauma,
exertion, lungs
percussion, look
clear to
for history of
auscultation and
DVT or
tympany on
prolonged sitting
percussion, look
for history of CV
disease
EKG and cardiac chest CT or X-ray Chest X-ray
enzymes, possibly
catheterization
Pneumonia
Progressive nonsudden onset of
pleuritic pain that
increases with
exertion, breath
sounds
characteristic for
crackles, rhales,
rhonchi, or
tubular breath
sounds indicative
of consolidation,
should be dull to
percussion, can be
associated with
cough (productive
or non
productive), fever,
fatigue, myalgias
chest X-ray,
sputum analysis,
blood work
Tumor
Could have no
symptoms or any
combination of all
of the above
symptoms, history
of environmental
exposure,
smoking history
Chest X-ray or
CT, blood work
Diagnosis
Asthma
Signs and
Symptoms
Acute onset,
tightness of
chest/throat ,
exacerbation due
to exercise or
infection, less to
no direct “pain”,
lungs sounds
characteristic for
wheezing
bilaterally and
resonant to
percussio, history
of allergen
exposure
Diagnostic tests
Spirometry,
resolution of
symptoms with a
bronchodilator
Other Possibilities
CHF
Anemia
progressive onset,
worsens on
exertion or lying
supine, low to no
chest pain, lungs
could be clear or
indicative of
crackles,
percussion of
lungs should be
clear unless
extremely severe
case, history of
heart disease,
possible LE
edema, associated
with cough,
orthopnea,
paroxysmal
nocturnal
dyspnea,
catheterization for
chamber pressure
analysis with
complete cardiac
exam
COPD
progressive,
no associated
chest pain,
lungs clear to
percussion
and
auscultation,
generalized
weakness and
fatigue, easy
bruising
progressive, worsens
on exertion, possible
diffuse chest pain,
productive cough than
bronchitis/ nonproductive cough than
emphysema, with
emphysema wheezing
or diminished breath
sounds also resonant to
percussion/ with
bronchitis: crackles,
rales, or rhonchi are
possible and dullness
depending on severity
of bronchitis, history of
smoking,
environmental
exposure
Blood Test
(check
Hematocrit,
normal
around 40)
Chest X-ray, CT, Lung
Function Tests
(spirometry)
Anxiety with
hyperventilation
sudden onset,
possible
radiating pain
(focused at
chest), lungs
clear to
auscultation and
tympany on
percussion,
lightheadedness,
increased
respiratory rate
usually
associated with
stressful
situation, history
of anxiety
attacks,
diminished when
breathing into
paper bag
Check blood
gases (low CO2,
low Ca2+)