Monday, June 12, 2017

Approach to A Patient Presenting With Difficulty In Breathing ( Dyspnea)



The normal adult respiratory rate is 11–18/min, with a tidal volume of 400–800mL. Acute dyspnoea That is difficult or labored breathing is a common presenting symptom.

Common causes of Acute Dyspnoea
Cardiac
• Cardiogenic pulmonary oedema.
• MI .
• Pulmonary embolism.
• Arrhythmias .
Respiratory
• Asthma  or exacerbation of COPD
• Pneumonia .
• Pleural effusion .
• Pneumothorax
Trauma
• Aspiration of foreign body or vomit .
• Pneumothorax/haemothorax .
• Flail chest .
• Drowning incident .
Others
• Hypovolaemia or fever from any cause.
• Hyperventilation syndrome .
• Respiratory compensation for metabolic acidosis (DKA, salicylate overdose).
Psychological
• Anxiety
• Panic attack



Approach
Follow the ABC approach and resuscitate as necessary. The main aim of treatment is to correct life-threatening hypoxia.

Ask about

  • speed of onset of dyspnoea, 
  • past medical history and 
  • associated symptoms (cough, haemoptysis, fever, wheezing, chest pain). 
Examine carefully, paying attention to the respiratory rate, depth, and pattern.
Apply a pulse oximeter. (Remember that a normal oxygen saturation does not exclude significant lung pathology )
Get a ECG done to rule out life threatening cardiac cause.
A Chest X ray may help identify underlying respiratory causes.
Treat according to the identified cause.

2 comments:

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