definition,etiology,clinical features ,diagnosis,management

1. Dyspnea

2. Definition
It is the feeling of an
uncomfortable need to breathe.
It is most common complaint of
patients with cardiopulmonary
diseases.

3. Causes of Acute Dyspnea
Pulmonary causes :
Pneumothorax- the presence of
air or gas in the cavity between
the lungs and the chest wall,
causing collapse of the lung.

4. Pulmonary edema,
excess fluid in the lungs.
fluid collects in the numerous air
sacs in the lungs, making it
difficult to breathe.
In most cases, heart problems
cause pulmonary edema.

5. pulmonary embolus,
Pulmonary embolism (PE) is a
blockage of an artery in the lungs by a
substance that has traveled from
elsewhere in the body through the
bloodstream (embolism).
PE usually results from a blood clot in
the leg that travels to the lung.

6. Acute severe Asthma,
a respiratory condition marked by
attacks of spasm in the bronchi of
the lungs, causing difficulty in
breathing.
It is usually connected to allergic
reaction or other forms of
hypersensitivity.

7. COPD,
Chronic obstructive pulmonary
disease (COPD) is a lung disease
characterized by chronic
obstruction of lung airflow that
interferes with normal breathing
and is not fully reversible.

8. Pneumonia,
lung inflammation caused by
bacterial or viral infection, in
which the air sacs fill with pus and
may become solid.

9. Foreign body,
toxic inhalation.

10. Cardiac: Acute pulmonary edema
Metabolic acidosis:
Diabetic ketoacidosis,
Diabetic ketoacidosis is a serious
complication of diabetes that
occurs when your body produces
high levels of blood acids called
ketones.

11. lactic acidosis,
uremia,

12. Psychogenic: Anxiety, panic attack

13. Pathophysiology
Due to etiology
imbalance between perceived need to
breathe and perceived ability to
breathe.
CO2 build-up and oxygen deprivation are
the critical factors
that result in dyspnea.

14. Diagnostic Evaluation of Acute
Dyspnea
History and Clinical examination:
Recent trauma,
Hemothora

15. Pneumothorax Risk factors :
severe breathlessness,
chest pain,
Pleurisy- inflammation of the
pleurae.
syncope*
dizziness

16. *Massive Pulmonary embolus
(with signs of central cyanosis,
 raised JVP*,
absence of signs in the lung*,
shock).

17. History of Asthma,
asthma medications,
wheeze……

18. Acute severe Asthma
(signs: tachycardia,
pulsus paradoxus, - is an abnormally
large decrease in stroke volume, systolic
blood pressure and pulse wave amplitude
during inspiration.
The normal fall in pressure is less than
10 mmHg.
JVP normal*, wheeze*)

19. Previous episodes*,
smoker,
prolonged expiration,
may be drowsy…..

20. Acute exacerbation of COPD
(signs: cyanosis, hyperinflation*,
signs of CO2 retention—flapping
tremor,
bounding pulses- pulse will
probably feel strong and powerful.

21. Prodromal illness*,
fever*,
Pleurisy.
Pneumonia (signs: fever,
confusion, pleural rub*,
consolidation*, cyanosis-if severe.)

22. Chest pain, orthopnea,
palpitations, cardiac history*.
 Acute Pulmonary edema. ( signs:
of central cyanosis, raised JVP,
sweating, cool extremities,
crackles*)

23. Evidence of Diabetes mellitus, or
renal disease, aspirin or ethylene
glycol overdose.
Metabolic acidosis (signs: Ketones,
hyperventilation without heart and
lung signs*, dehydration*, Air hunger)

24. Psychogenic (signs: no cyanosis, no
heart or lung signs, carpopedal
spasm)

25. In children, the possibility of
inhalation of a foreign body or acute
epiglottitis should always be
considered.

28. Investigations:

30. Management:
Treatment is directed at the cause.
Non-drug Treatment
-Positioning… sitting up
-Relaxation
-Humidified Air
-Non invasive positive pressure mask
Quit smoking

31. Opioids(drug of choice)... morphine
5mg IV every 5-10 mins until relief
Oxygen..5-6L/min (not always
helpful)
Specific treatment:

32.  Pneumothorax----Aspiration,
Chest tube,
 pleurodesis - Pleurodesis is a
medical procedure in which the
pleural space is artificially
obliterated. It involves the
adhesion of the two pleurae.
 thoracoscopy

33. Massive pulmonary embolism----
High dose unfractionated heparin,
Dopamine or dobutamine with
norepinephrine for PE related
shock, open surgical embolectomy,
catheter thrombectomy.

34.  Acute Asthma exacerbation----
inhaled anticholinergic drugs with
beta2 agonists in children,
systemic corticosteroids

35.  Acute exacerbation of COPD----
Beta2 agonists, corticosteroids,
antibiotics, oxygen, ventilator
support
 Pneumonia---- IV antibiotics,
oxygen therapy, IV fluids.

36.  Pulmonary edema----keep oxygen
saturation greater than 90%,
intubation, preload reducers
(nitroglycerine, diuretics) afterload
reducers (nitroprusside), ultrafiltration

37.  Metabolic Acidosis----severe
cases(pH <7.2)- bicarbonate
therapy, treat underline cause

38. Psychogenic Dyspnea----
anxiolytics.

39.  Foreign body---- Heimlich maneuver,
 a first-aid procedure for dislodging an
obstruction from a person's windpipe
in which a sudden strong pressure is
applied on their abdomen, between
the navel and the ribcage.

40.  supportive measures(oxygen, pulse
oximetry), epinephrine as
temporary measure until
bronchoscopy can be done.

41. Acute epiglottitis---- intubation
(difficult if laryngeal edema
present) , antibiotics.

42. Thank You