Dyspnea resident survival guide

Dyspnea Resident Survival Guide Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Milan C. Mathew, M.D., M.P.H. [2]

Overview

Dyspnea is the uncomfortable awareness of one's own breathing. It is a common symptom of numerous medical disorders.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Acute heart failure
• Acute coronary syndrome
• Acute papillary muscle rupture
• Acute respiratory distress syndrome
• Anaphylaxis
• Aortic dissection
• Bronchospasm
• Cardiac tamponade
• Foreign body aspiration
• Glottic edema
• Pneumothorax
• Pulmonary embolism
• Pulmonary edema

Common Causes

• Acute heart failure
• Acute coronary syndrome
• Asthma
• Anemia
• COPD
• Interstitial lung disease
• Pulmonary embolism
• Pneumonia
• Respiratory tract infection

Click here for the complete list of causes.

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

Rapid assessment ❑ Circulation ❑ Airway ❑ Breathing

Is the patient in acute cardiopulmonary arrest

No

Yes

Activate ACLS

Does the patient have any of the following signs and symptoms that require urgent management ❑ Altered mental status ❑ Abnormal vital signs ❑ Fever ❑ Hypothermia ❑ Tachycardia ❑ Bradycardia ❑ Hypotension ❑ Tachypnea ❑ Hypopnea ❑ Hypoxia ❑ Fever ❑ Wheezes ❑ Crackles ❑ Jugular venous distension ❑ Stridor ❑ Tracheal deviation ❑ Absent breath sounds ❑ Distant heart sounds

Yes

No

Continue with complete diagnostic approach below

Order stat tests ❑ CBC ❑ CMP ❑ D-dimer ❑ Cardiac enzymes ❑ NT-proBNP ❑ ABG ❑ Blood Cultures (fever) ❑ CXR ❑ EKG

Acute heart failure

Acute coronary syndrome

Acute respiratory distress syndrome

Anaphylaxis

Aortic dissection

Cardiac tamponade

Aspiration

Pneumothorax

Pulmonary embolism

Pneumonia

Asthma

COPD

Complete Diagnostic Approach

A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention

Do's

Don'ts

References