Shortness of breath resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven Bellm, M.D. [2]
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| 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
- Pulmonary embolism
- COPD
- Asthma
- Pneumothorax and pneumomediastinum
- Pulmonary infection
- [[Adult Respiratory Distress Syndrome [ARDS]]]
- Direct pulmonary injury
- Pulmonary hemorrhage
- Life-threatening cardiac causes
Miscellaneous Causes
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
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Do's
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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.