Acute dyspnea: Difference between revisions

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# CBC
# CBC
# Chem-7
# Chem-7
# BNP?
Consider:
# D-dimer?
# BNP
# Troponin?
# D-dimer
# ABG?
# Troponin
# ABG


==Diagnosis==
==Diagnosis==

Revision as of 17:19, 20 May 2013

Workup

  1. CXR
  2. ECG
  3. CBC
  4. Chem-7
  5. BNP?
  6. D-dimer?
  7. Troponin?
  8. ABG?

Diagnosis

Emergent Pattern Recognition

  1. Pulmonary edema
    • lungs: b/l rales
    • CXR: interstitial fluid
    • Tx: ECG (R/O AMI), lasix, nitrates, ACE, BIPAP
  2. Bronchoconstriction
    • lungs: wheezes
    • CXR: neg/hyperinflated
    • Tx: albuterol, atrovent, steroids, consider anaphylaxis (epi)
  3. Pneumonia
    • lungs: focal ronchi/dec BS
    • CXR: infiltrate/effusion
    • Tx: abx
  4. PE
    • lungs: clear
    • CXR: clear/Westrmrk/Hmptn
    • Tx: ECG, D-dimer and/or CT; anticoagulate/thrombolytics
  5. Pneumo/Hemothorax
    • lungs: unequal
    • CXR: pneumo/hemo
    • Tx: needle/chest-tube
  6. Dysrythmia
    • lungs: clear/pulm edema
    • CXR: clear/pulm edema
    • ECG: abnl
    • Tx: rate dependent
  7. Cardiac Ischemia
    • lungs: clear/pulm edema
    • CXR: clear/pulm edema
    • ECG: nl/abnl
    • Tx: B-block, nitrates, anticoag, +/- thrombolytics

DDX

EMERGENT

  • Pulmonary
    1. Airway obstruction
    2. PE
    3. Noncardiogenic edema
    4. Anaphylaxis
    5. Spont pneumothorax
    6. Asthma
    7. Cor pulmonale
    8. Aspiration
    9. PNA
  • Cardiac
    1. Pulmonary edema (CHF)
    2. MI
    3. Cardiac tamponade
    4. Pericarditis
  • Other Associated with Nl/Increased Resp Effort
    1. Toxic ingestion
    2. DKA
    3. Epiglotitis
    4. Tension PNTX
    5. Cardiac tamponade
    6. Flail chest
    7. CO poisoning
    8. Abd distension
    9. Sepsis
    10. Hypotension
    11. Renal failure
    12. Electrolyte abnl
    13. Metabolic acidosis
    14. PNA
    15. Pneumo/hemo-thorax
    16. Diaphragmatic rupture
    17. Anemia
  • Other Associated with Decreased Resp Effort
    1. CVA
    2. Organophosphate poisoning
    3. MS
    4. Guillian-Barre
    5. Tick paralysis

Non-Emergent

  1. Pleural effusion
  2. Neoplam
  3. PNA
  4. COPD
  5. Congenital heart dz
  6. Pregnancy
  7. Ascites
  8. Obesity
  9. Hypterventilation
  10. Panic attack
  11. Fever
  12. Thyroid dz
  13. Rib fx
  14. ALS
  15. Polymyositis
  16. Porphyria

Source

3/7/06 DONALDSON (adapted from Rosen)