Shortness of breath resident survival guide: Difference between revisions
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*[[Hyperventilation]] | *[[Hyperventilation]] | ||
::It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide. | ::It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide. | ||
*[[Dyspnea on exertion]] | *[[Dyspnea on exertion]] | ||
::Dyspnea caused by physical effort or exertion. | ::Dyspnea caused by physical effort or exertion. | ||
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:* [[Pneumothorax]] and [[pneumomediastinum]] | :* [[Pneumothorax]] and [[pneumomediastinum]] | ||
:* [[Pulmonary infection]] | :* [[Pulmonary infection]] | ||
:* [[Adult Respiratory Distress Syndrome | :* [[Adult Respiratory Distress Syndrome]] | ||
:* [[Direct pulmonary injury]] | :* [[Direct pulmonary injury]] | ||
:* [[Pulmonary hemorrhage]] | :* [[Pulmonary hemorrhage]] | ||
* Life-threatening cardiac causes | * Life-threatening cardiac causes | ||
:* [[Acute coronary syndrome]] | |||
:* [[Acute decompensated heart failure]] | |||
:* Flash pulmonary edema | |||
:* High output heart failure | |||
:* [[Cardiomyopathy]] | |||
:* [[Cardiac arrhythmia] | |||
:* [[Valvular dysfunction]] | |||
:* [[Cardiac tamponade]] | |||
* Life-threatening neurologic causes | |||
:* [[Stroke]] | |||
:* [[Neuromuscular disease]] | |||
* Life-threatening toxic and metabolic causes | |||
:* [[Poisoning]] | |||
:* [[Salicylate poisoning]] | |||
:* [[Carbon monoxide poisoning]] | |||
:* Toxin related metabolic acidosis | |||
:* [[Diabetic ketoacidosis]] | |||
:* [[Sepsis]] | |||
:* [[Anemia]] | |||
:* Acute chest syndrome- in patients with sickle cell disease | |||
===Miscellaneous Causes=== | ===Miscellaneous Causes=== | ||
* [[Lung cancer]] | * [[Lung cancer]] | ||
* [[Pleural effusion]] | |||
* Intraabdominal processes | |||
* [[Ascites]] | |||
* [[Pregnancy]] | |||
* Massive obesity | |||
* Hyperventilation and anxiety | |||
==FIRE== | ==FIRE== | ||
Revision as of 16:45, 3 March 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven Bellm, M.D. [2]
| Shortness of breath resident survival guide Microchapters |
|---|
| Overview |
| Classification |
| Causes |
| FIRE |
| Diagnosis |
| Treatment |
| Do's |
| Dont's |
Overview
Dyspnea is a symptom, it must generally be distinguished from signs that clinicians typically invoke as evidence of respiratory distress, such as tachypnea, use of accessory muscles, and intercostal retractions.[1]
Respiratory discomfort may arise from a wide range of clinical conditions, but also may be a manifestation of poor cardiovascular fitness in our increasingly sedentary population. Diagnosis and treatment of the underlying cause of dyspnea is the preferred and most direct approach to improve this symptom, but there are many patients for whom the cause is unclear or for whom dyspnea persists despite optimal treatment.[2]
Definitions
- A subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.[3]
- A respiratory rate greater than normal.
- Increased minute ventilation to meet metabolic requirements.
- It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide.
- Dyspnea caused by physical effort or exertion.
- Dyspnea caused by a recumbent position.
- Dyspnea that starts suddenly while reclining at night.
- Dyspnea that starts in an upright position.
- Dyspnea that starts in one lateral decubitus position as opposed to the other.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Life-threatening causes of the upper airway
- Tracheal foreign objects
- Angioedema
- Anaphylaxis
- Infections of the pharynx and neck
- Airway trauma
- Life-threatening pulmonary causes
- Life-threatening cardiac causes
- Acute coronary syndrome
- Acute decompensated heart failure
- Flash pulmonary edema
- High output heart failure
- Cardiomyopathy
- [[Cardiac arrhythmia]
- Valvular dysfunction
- Cardiac tamponade
- Life-threatening neurologic causes
- Life-threatening toxic and metabolic causes
- Poisoning
- Salicylate poisoning
- Carbon monoxide poisoning
- Toxin related metabolic acidosis
- Diabetic ketoacidosis
- Sepsis
- Anemia
- Acute chest syndrome- in patients with sickle cell disease
Miscellaneous Causes
- Lung cancer
- Pleural effusion
- Intraabdominal processes
- Ascites
- Pregnancy
- Massive obesity
- Hyperventilation and anxiety
FIRE
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.
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Complete Diagnostic Approach
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Treatment
shown
hidden
Do's
Dont's
References
- ↑ Campbell ML (2008). "Psychometric testing of a respiratory distress observation scale". J Palliat Med. 11 (1): 44–50. doi:10.1089/jpm.2007.0090. PMID 18370892.
- ↑ Desbiens NA, Mueller-Rizner N, Connors AF, Wenger NS (1997). "The relationship of nausea and dyspnea to pain in seriously ill patients". Pain. 71 (2): 149–56. PMID 9211476.
- ↑ "Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society". Am J Respir Crit Care Med. 159 (1): 321–40. 1999. doi:10.1164/ajrccm.159.1.ats898. PMID 9872857.