Acute dyspnea: Difference between revisions
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| [[Pulmonary Edema]]||Bilateral rales||Interstitial fluid||Normal/abnormal||R/O AMI, [[lasix]], nitrates, [[ACEi]], [[BIPAP]]||[[IVF]]; ?[[albuterol]]; ?[[Beta-blockers]] | | [[Pulmonary Edema]]||Bilateral rales||Interstitial fluid||Normal/abnormal||R/O AMI, [[lasix]], nitrates, [[ACEi]], [[BIPAP]]||[[IVF]]; ?[[albuterol]]; ?[[Beta-blockers]] | ||
|- | |- | ||
| [[Bronchoconstriction]]||Wheezes||Clear/hyperinflated||Normal/ | | [[Bronchoconstriction]]||Wheezes||Clear/hyperinflated||Normal/pulmonary strain||Albuterol, atrovent, steroids, consider anaphylaxis (epi)||Beta-blockers; ?aspirin | ||
|- | |- | ||
| [[Pneumonia]]||Focal ronchi/decreased breath sounds||Infiltrate/effusion||Normal||[[IVF]], [[antibiotics]]||Rate control; diuresis | | [[Pneumonia]]||Focal ronchi/decreased breath sounds||Infiltrate/effusion||Normal||[[IVF]], [[antibiotics]]||Rate control; diuresis | ||
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| [[Pneumothorax]]/[[Hemothorax]]||Unequal||Pneumo/hemo||Normal||[[Needle thoracentesis]]/[[chest tube]]||Rate control | | [[Pneumothorax]]/[[Hemothorax]]||Unequal||Pneumo/hemo||Normal||[[Needle thoracentesis]]/[[chest tube]]||Rate control | ||
|- | |- | ||
| [[Dysrythmia]]||Clear/pulmonary edema||Clear/ | | [[Dysrythmia]]||Clear/pulmonary edema||Clear/pulmonary edema||Abnormal||Type dependent||[[Albuterol]]; ?[[IVF]] | ||
|- | |- | ||
| [[ACS]]||Clear/pulmonary edema||Clear/pulmonary edema||Normal/abnormal||[[Aspirin]]; nitrates, anticoagulation, ?[[beta-blockers]], +/- [[thrombolytics]]||[[Albuterol]]; ?[[IVF]] | | [[ACS]]||Clear/pulmonary edema||Clear/pulmonary edema||Normal/abnormal||[[Aspirin]]; nitrates, anticoagulation, ?[[beta-blockers]], +/- [[thrombolytics]]||[[Albuterol]]; ?[[IVF]] | ||
Revision as of 12:12, 30 July 2016
Background
Clinical Features
Emergent Pattern Recognition
| Diagnosis | Lungs | CXR | ECG | Treatment | Contraindicated |
| Pulmonary Edema | Bilateral rales | Interstitial fluid | Normal/abnormal | R/O AMI, lasix, nitrates, ACEi, BIPAP | IVF; ?albuterol; ?Beta-blockers |
| Bronchoconstriction | Wheezes | Clear/hyperinflated | Normal/pulmonary strain | Albuterol, atrovent, steroids, consider anaphylaxis (epi) | Beta-blockers; ?aspirin |
| Pneumonia | Focal ronchi/decreased breath sounds | Infiltrate/effusion | Normal | IVF, antibiotics | Rate control; diuresis |
| Pulmonary embolism | Clear | Clear (most) or Westrmark/Hampton hump | Normal/S1Q3T3 | Anticoagulate/thrombolytics | Rate control |
| Pneumothorax/Hemothorax | Unequal | Pneumo/hemo | Normal | Needle thoracentesis/chest tube | Rate control |
| Dysrythmia | Clear/pulmonary edema | Clear/pulmonary edema | Abnormal | Type dependent | Albuterol; ?IVF |
| ACS | Clear/pulmonary edema | Clear/pulmonary edema | Normal/abnormal | Aspirin; nitrates, anticoagulation, ?beta-blockers, +/- thrombolytics | Albuterol; ?IVF |
Differential Diagnosis
Acute dyspnea
Emergent
- Pulmonary
- Airway obstruction
- Anaphylaxis
- Angioedema
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute exacerbation
- Cystic fibrosis exacerbation
- Cardiac
- Other Associated with Normal/↑ Respiratory Effort
- Other Associated with ↓ Respiratory Effort
Non-Emergent
- ALS
- Ascites
- Uncorrected ASD
- Congenital heart disease
- COPD exacerbation
- Fever
- Hyperventilation
- Interstitial lung disease
- Neoplasm
- Obesity
- Panic attack
- Pleural effusion
- Polymyositis
- Porphyria
- Pregnancy
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
- URI
Evaluation
- CXR
- ECG
- CBC
- Chem-7
- BNP?
- D-dimer?
- Troponin?
- ABG?
- Bedside ultrasound?
Management
- Oxygen
- Treat underlying cause