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