high risk condition of dyspnea
TRANSCRIPT
HIGH RISK CONDITION OF DYSPNEA
Adib Mursyidi Iskandar MirzaA&E Department
DEFINITION/ETIOLOGY/EPIDEMIOLOGY
Perception of inability to breathe comfortably
In ED, 2-3% of all visit complain of respiratory distress may have conjunction with other symptoms e.g. diaphoresis, chest pain, palpitation, cough, fever
Goal in ED: detection of life threatening causes of dyspnea
EVALUATION History:
Timing: acuity and duration (onset, acute, chronic, recurring?)
Patient description (SOB, breathlessness, trouble breathing, suffocating, chest tightness, etc.)
Severity (using Borg scale) Associated symptoms (any special concern
e.g. chest pain, fever, cough) Past medical history/Medication/Social history
PHYSICAL EXAMINATION Vital sign (hypotensive, RR, HR) Head and neck (oral cavity, jugular vein,
Kussmaul sign, stridor) Pulmonary exam (recession, accessory
muscle, subcutaneous emphysema) Cardiac exam (murmurs) Extremity exam (cyanosis, edema,
clubbing) Skin (diaphoresis)
DIAGNOSTIC TESTING Pulse oximetry Chest radiography ECG (ischemia, atrial fibrillation) Lab study
ABG Hb/Hct, cardiac test (trop, CK) Echo (effusion, valvular dysfunction, wall
motion)
TREATMENT/DISPOSITION Patient with rapid respiratory distress need
rapid evaluation of airway Altered mental status, inability to speak,
inadequate ventilation may required airway management
Sit the patient in upright position maximize accessory muscle use and decrease pulmonary congestion
Do not discharge pt with unexplained dyspnea
PULMONARY EMBOLISM Most cases of fatal PE unrecognized Isolated dyspnea is one of most
common symptoms (1/3 report dyspnea without chest pain)
2/3 of patient with PE had painful dyspnea (with/out + hemoptysis)
Diagnosis difficult in view of variable presentation
Pt may had normal pO2 by pulse oximetry of ABG
CXR: common infiltrate and pleural effusion
THANK YOU References
Dyspnea: Fear, Loathing and Physiology, Emergency Medicine Practice, Jeffery A. Kline, MD
Shirley Ooi 2nd edition: Acute breathlessness