Acute dyspnea

Workup

1. CXR
2. ECG
3. CBC
4. Chem-7
5. BNP?
6. D-dimer?
7. Troponin?
8. ABG?

Diagnosis

Emergent Pattern Recognition

1. Pulmonary edema
   • lungs: b/l rales
   • CXR: interstitial fluid
   • Tx: ECG (R/O AMI), lasix, nitrates, ACE, BIPAP
2. Bronchoconstriction
   • lungs: wheezes
   • CXR: neg/hyperinflated
   • Tx: albuterol, atrovent, steroids, consider anaphylaxis (epi)
3. Pneumonia
   • lungs: focal ronchi/dec BS
   • CXR: infiltrate/effusion
   • Tx: abx
4. PE
   • lungs: clear
   • CXR: clear/Westrmrk/Hmptn
   • Tx: ECG, D-dimer and/or CT; anticoagulate/thrombolytics
5. Pneumothorax/Hemothorax
   • lungs: unequal
   • CXR: pneumo/hemo
   • Tx: needle/chest-tube
6. Dysrythmia
   • lungs: clear/pulm edema
   • CXR: clear/pulm edema
   • ECG: abnl
   • Tx: rate dependent
7. Cardiac Ischemia
   • lungs: clear/pulm edema
   • CXR: clear/pulm edema
   • ECG: nl/abnl
   • Tx: B-block, nitrates, anticoag, +/- thrombolytics

DDX

EMERGENT

• Pulmonary
  1. Airway obstruction
  2. PE
  3. Noncardiogenic edema
  4. Anaphylaxis
  5. Spont pneumothorax
  6. Asthma
  7. Cor pulmonale
  8. Aspiration
  9. PNA
• Cardiac
  1. Pulmonary edema (CHF)
  2. MI
  3. Cardiac tamponade
  4. Pericarditis
• Other Associated with Nl/Increased Resp Effort
  1. Toxic ingestion
  2. DKA
  3. Epiglotitis
  4. Tension PNTX
  5. Cardiac tamponade
  6. Flail chest
  7. CO poisoning
  8. Abd distension
  9. Sepsis
  10. Hypotension
  11. Renal failure
  12. Electrolyte abnl
  13. Metabolic acidosis
  14. PNA
  15. Pneumo/hemo-thorax
  16. Diaphragmatic rupture
  17. Anemia
• Other Associated with Decreased Resp Effort
  1. CVA
  2. Organophosphate poisoning
  3. MS
  4. Guillian-Barre
  5. Tick paralysis

Non-Emergent

1. Pleural effusion
2. Neoplam
3. PNA
4. COPD
5. Congenital heart dz
6. Pregnancy
7. Ascites
8. Obesity
9. Hypterventilation
10. Panic attack
11. Fever
12. Thyroid dz
13. Rib fx
14. ALS
15. Polymyositis
16. Porphyria

Source

3/7/06 DONALDSON (adapted from Rosen)