Acute dyspnea - Revision history

Danbot: Add peer-reviewed reference

2026-03-22T10:09:06Z

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	{{AdultPage\|acute dyspnea (peds)}}		{{AdultPage\|acute dyspnea (peds)}}
	==Background==		==Background==
	*Dyspnea (shortness of breath) is one of the most common ED chief complaints		*Dyspnea (shortness of breath) is one of the most common ED chief complaints<ref>Mueller C, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med. 2004;350(7):647-654. PMID 14960741</ref>
	*Can be life-threatening — rapid assessment for immediately dangerous causes is essential		*Can be life-threatening — rapid assessment for immediately dangerous causes is essential
	*The approach should focus on pattern recognition using vital signs, lung exam, CXR, and ECG to quickly narrow the differential		*The approach should focus on pattern recognition using vital signs, lung exam, CXR, and ECG to quickly narrow the differential

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2026-03-22T09:55:47Z

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	**Low-risk PE (if outpatient anticoagulation pathway available)		**Low-risk PE (if outpatient anticoagulation pathway available)
	**Anxiety-related dyspnea after exclusion of organic causes		**Anxiety-related dyspnea after exclusion of organic causes

			== Calculators ==
			{{Aa Gradient Calculator}}

	==See Also==		==See Also==

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2026-03-22T09:23:55Z

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	==Management==		==Management==
	*'''Oxygen:''' Titrate to SpO2 >94% (88-92% if COPD/CO2 retainer); use high-flow nasal cannula, [[BiPAP]], or intubation as needed		*'''Oxygen:''' Titrate to SpO2 >94% (88-92% if COPD/CO2 retainer); use high-flow nasal cannula, [[BiPAP]], or intubation as needed
	*~~'''~~Immediate life threats:~~'''~~		*Immediate life threats:
	**[[Tension pneumothorax]]: Needle decompression then chest tube		**[[Tension pneumothorax]]: Needle decompression then chest tube
	**[[Anaphylaxis]]: [[Epinephrine]] IM		**[[Anaphylaxis]]: [[Epinephrine]] IM
	**[[Cardiac tamponade]]: Pericardiocentesis		**[[Cardiac tamponade]]: Pericardiocentesis
	**Massive [[PE]]: Systemic thrombolytics		**Massive [[PE]]: Systemic thrombolytics
	*~~'''~~Common causes:~~'''~~		*Common causes:
	**[[CHF]] exacerbation: [[Nitroglycerin]], [[BiPAP]], [[furosemide]]		**[[CHF]] exacerbation: [[Nitroglycerin]], [[BiPAP]], [[furosemide]]
	**[[Asthma]]/[[COPD exacerbation]]: [[Albuterol]], ipratropium, systemic steroids		**[[Asthma]]/[[COPD exacerbation]]: [[Albuterol]], ipratropium, systemic steroids
	**[[Pneumonia]]: Antibiotics, IVF		**[[Pneumonia]]: Antibiotics, IVF
	**[[PE]]: Anticoagulation		**[[PE]]: Anticoagulation
	*~~'''~~Airway management:~~'''~~		*Airway management:
	**[[BiPAP]] for CHF or COPD exacerbation (avoids intubation in many cases)		**[[BiPAP]] for CHF or COPD exacerbation (avoids intubation in many cases)
	**Intubation if impending respiratory failure, GCS decline, or refractory hypoxia		**Intubation if impending respiratory failure, GCS decline, or refractory hypoxia

	==Disposition==		==Disposition==
	*~~'''~~Admit to ICU:~~'''~~		*Admit to ICU:
	**Intubated or on BiPAP with impending respiratory failure		**Intubated or on BiPAP with impending respiratory failure
	**Massive or submassive PE		**Massive or submassive PE
	**Hemodynamic instability		**Hemodynamic instability
	**Severe asthma/COPD unresponsive to initial treatment		**Severe asthma/COPD unresponsive to initial treatment
	*~~'''~~Admit to floor:~~'''~~		*Admit to floor:
	**CHF exacerbation requiring IV diuresis		**CHF exacerbation requiring IV diuresis
	**Pneumonia with hypoxia or significant comorbidities		**Pneumonia with hypoxia or significant comorbidities
	**New PE on anticoagulation		**New PE on anticoagulation
	*~~'''~~Discharge:~~'''~~		*Discharge:
	**Asthma/COPD exacerbation with adequate response to ED treatment and baseline PEF restored		**Asthma/COPD exacerbation with adequate response to ED treatment and baseline PEF restored
	**Mild CHF exacerbation with adequate response to diuresis and stable vitals		**Mild CHF exacerbation with adequate response to diuresis and stable vitals

Danbot: Comprehensive expansion of Evaluation, Management, and Disposition sections with EM-focused approach

2026-03-20T23:09:10Z

Comprehensive expansion of Evaluation, Management, and Disposition sections with EM-focused approach

← Revisión anterior		Revisión del 23:09 20 mar 2026
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	{{AdultPage\|acute dyspnea (peds)}}		{{AdultPage\|acute dyspnea (peds)}}
	==Background==		==Background==
			*Dyspnea (shortness of breath) is one of the most common ED chief complaints
			*Can be life-threatening — rapid assessment for immediately dangerous causes is essential
			*The approach should focus on pattern recognition using vital signs, lung exam, CXR, and ECG to quickly narrow the differential
			*Key question: Is this cardiac, pulmonary, or other?
	[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]		[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]

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	==Evaluation==		==Evaluation==
	[[File:PulmEdema.png\|thumb\|Pulmonary edema with small pleural effusions on both sides.]]		[[File:PulmEdema.png\|thumb\|Pulmonary edema with small pleural effusions on both sides.]]
	*[[CXR]]		===Immediate===
	*[[~~ECG~~]]		*Pulse oximetry (continuous)
	*CBC		*[[ECG]] — arrhythmia, ischemia, RV strain
	*~~Chem~~-7		*[[CXR]] — pneumothorax, effusion, pulmonary edema, consolidation, widened mediastinum
	*[[~~BNP~~]]?		*[[Point-of-care ultrasound\|Bedside ultrasound]] — pneumothorax, pleural effusion, B-lines (pulmonary edema), pericardial effusion, RV dilation, cardiac contractility
	*[[D-dimer]]?
	*~~[[Troponin]]?~~		===Labs (guided by clinical suspicion)===
	*[[ABG~~]]?~~		*[[BNP]]/NT-proBNP — helps differentiate cardiac from pulmonary dyspnea
	*~~Bedside~~ [[~~ultrasound~~]]?		*[[Troponin]] — if ACS suspected
			*[[D-dimer]] — if PE suspected and low-to-moderate pretest probability
			*CBC — anemia, infection
			*BMP — metabolic acidosis (consider DKA, sepsis, toxic ingestion)
			*VBG/ABG — acid-base status, pCO2, carboxyhemoglobin, methemoglobin
			*Lactate — if sepsis or shock suspected

			===Advanced Imaging===
			*[[CT-PA]] — if pulmonary embolism suspected
			*CT chest — if parenchymal disease, mass, or empyema suspected
			*CT angiography — if aortic dissection suspected

	{{BLUE Protocol}}		{{BLUE Protocol}}

	==Management==		==Management==
	*Oxygen		*'''Oxygen:''' Titrate to SpO2 >94% (88-92% if COPD/CO2 retainer); use high-flow nasal cannula, [[BiPAP]], or intubation as needed
	*~~Treat underlying cause~~		*'''Immediate life threats:'''
			**[[Tension pneumothorax]]: Needle decompression then chest tube
			**[[Anaphylaxis]]: [[Epinephrine]] IM
			**[[Cardiac tamponade]]: Pericardiocentesis
			**Massive [[PE]]: Systemic thrombolytics
			*'''Common causes:'''
			**[[CHF]] exacerbation: [[Nitroglycerin]], [[BiPAP]], [[furosemide]]
			**[[Asthma]]/[[COPD exacerbation]]: [[Albuterol]], ipratropium, systemic steroids
			**[[Pneumonia]]: Antibiotics, IVF
			**[[PE]]: Anticoagulation
			*'''Airway management:'''
			**[[BiPAP]] for CHF or COPD exacerbation (avoids intubation in many cases)
			**Intubation if impending respiratory failure, GCS decline, or refractory hypoxia

	==Disposition==		==Disposition==
	*~~Depends~~ on ~~underlying diagnosis~~		*'''Admit to ICU:'''
			**Intubated or on BiPAP with impending respiratory failure
			**Massive or submassive PE
			**Hemodynamic instability
			**Severe asthma/COPD unresponsive to initial treatment
			*'''Admit to floor:'''
			**CHF exacerbation requiring IV diuresis
			**Pneumonia with hypoxia or significant comorbidities
			**New PE on anticoagulation
			*'''Discharge:'''
			**Asthma/COPD exacerbation with adequate response to ED treatment and baseline PEF restored
			**Mild CHF exacerbation with adequate response to diuresis and stable vitals
			**Low-risk PE (if outpatient anticoagulation pathway available)
			**Anxiety-related dyspnea after exclusion of organic causes

	==See Also==		==See Also==

Ostermayer at 00:38, 16 January 2026

2026-01-16T00:38:25Z

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	{{~~Adult top}} [[~~acute dyspnea (peds)~~]].''~~		{{AdultPage\|acute dyspnea (peds)}}
	==Background==		==Background==
	[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]		[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]

Rossdonaldson1: /* Background */

2024-04-24T18:38:59Z

Background

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	{{Adult top}} [[acute dyspnea (peds)]].''		{{Adult top}} [[acute dyspnea (peds)]].''
	==Background==		==Background==
			[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Disposition */

2024-04-24T17:53:32Z

Disposition

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	==Disposition==		==Disposition==
			*Depends on underlying diagnosis

	==See Also==		==See Also==

Rossdonaldson1: /* Video */

2024-03-27T22:45:46Z

Video

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	*[[Hypoxemia]]		*[[Hypoxemia]]
	*[[Shortness of breath (peds)]]		*[[Shortness of breath (peds)]]

	~~==Video==~~
	~~{{#widget:YouTube\|id=O2-TFCkSN8E}}~~


	==References==		==References==

Rossdonaldson1: /* Differential Diagnosis */

2020-07-01T16:09:42Z

Differential Diagnosis

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	==Differential Diagnosis==		==Differential Diagnosis==
	~~''See also [[Shortness of breath (peds)]] for pediatric-specific differential''~~
	{{SOB DDX}}		{{SOB DDX}}

Rossdonaldson1 at 16:09, 1 July 2020

2020-07-01T16:09:24Z

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			{{Adult top}} [[acute dyspnea (peds)]].''
	==Background==		==Background==