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Dyspnea
Dr. Ghulam Hussain Baloch
Associate Professor of Medicine
LUMHS, Jamshoro
Definition
Hyperventilation
Signing breath
In ability to take deep breath
Dyspnea
Definitions
Orthopnea
Exertion-induced SOB
Recumbent-induced SOB
Case 1
Case 2
28 year male presented with high grade fever,
cough on examination bronchial breathing
a) Diagnosis
b) Investigation & Mangement
Dyspnea
Rapid Assessment
ABCs
Mental status
Presence of cyanosis
Dyspnea
Initial Interventions
IV assess
Cardiac monitor
Oxygenation
Ventilation
Treatment Suction, medications
Dyspnea
History
Is it sudden or gradual
Dyspnea
History
Smoking Hx?
Medications?
Cause
Acute
Bronchial asthma
Pneumonia
Pneumothorax
thromboembolic disease
Cardiac
Pulmonary oedema
Non cardiac pulmonary oedema
psychogenic
Chronic
Pulmonary Cause
1. COPD
Chronic Bronchial Asthma
Emphysema Chronic Bronchitis
2. Restrictive Lung Disease
Sarcoidosis
Rheumatoid lung
fibrosing alveolitis
Pneumoconosis
Dyspnea
Etiologies
Dyspnea
Etiologies: Pulmonary Causes
Dyspnea
Common Pulmonary Causes
Asthma/COPD
Pneumonia
Pulmonary embolism
Pneumothorax
Dyspnea
Asthma/COPD
Pneumonia
Pulmonary embolism
Pneumothorax
Dyspnea
Etiologies: Nonpulmonary
Causes
Dyspnea
Common Cardiac Causes
CHF
Dysrhythmias
Dyspnea
Common Cardiac Causes
CHF
Dysrhythmias
Dyspnea
Common Miscellaneous
Metabolic acidemias
Causes
Severe anemia
Pregnancy
Hyperventilation syndrome
Dyspnea
Physical Examination: Vital
Signs
BP
Pulse
if dyspnea significant
= life-threatening problem
Usually
Bradycardia - severe hypoxemia
Respiratory rate
Dyspnea
Physical Examination: Observation
Ability to speak
Patient position
Cyanosis
Mental status
Altered MS - hypoxemia/hypercapnia
Dyspnea
Physical Examination
Pulmonary
Cardiac
Signs of severe
respiratory
distress
Dyspnea
Physical Examination: Pulmonary
Inspection
Percussion
Dyspnea
Physical Examination: Pulmonary
Auscultation
Air entry
Breath sounds
Normal
Abnormal
Dyspnea
Physical Examination: Cardiac
Neck
? JVD
Auscultation
Abnormal S2 splitting
Present of S3 and/or S4
Rubs
Murmurs
What does
clubbing suggest?
Chronic Hypoxemia
Pneumonia
1.Fever with chills
2.Pleuratic chest pain
3. purulent sputum
4. History of upper respiratory symptoms
5.signs of consolidation
6.x-ray chest
7. CBC
8. Blood culture
9. ABG acute bronchial asthma age startedat
childhood
Pneumothorax
1.Suden chest pain
2. dyspnea,caugh
3. H/O asthma
4.COPD
5.Examination, trachea, shifted to opposite side
absent breath sound
6 x-ray chest
Pulmonary Embolism
a)
b)
c)
d)
e)
f)
g)
h)
i)
Case 1
History
Case 1
Physical Examination
Case 1
Heart failure
? ACS
Dyspnea
Diagnostic Adjuncts
CXR
Case 1
Dyspnea
Diagnostic Adjuncts
ECG
Case 1
Dyspnea
Diagnostic Adjuncts
ABG
Troponin
Dyspnea
Treatment
Cornerstone of Rx
Assuring oxygenation/ventilation
Supplemental O2
Dyspnea
Special Considerations: Pediatrics
Infection
Croup
Retropharyngeal abscess
Epiglottitis
Dyspnea
Special Considerations: Pediatrics
Anaphylaxis
Asthma
Bronchiolitis
Bronchopulmonary dysplasia
Cystic fibrosis
Foreign body aspiration
Pneumonia
Dyspnea
Special Considerations: Pregnant
Patient
Venous thrombosis/pulmonary embolism
Asthma
3/1000 pregnancis
Risk continues to the postpartum period
Heparin outpatient treatment of choice
Rule of 1/3
Rx same as non-pregnant patient
Pulmonary edema
Preeclampsia
Postpartum cardiomyopathy
Case
Conclusion
Treatment
IV nitroglycerin
IV furosemide