Approach to dyspnea. Case based discussion.

2. DYSPNEA
(MEDICAL EMERGENCY)
Presentation By DR KANWAL.
(HOUSE OFFICER)

3. INTRODUCTION
■ DEFINITION:
■ IT IS SUBJECTIVE EXPERIENCE OR PERCEPTION OF
■ UNCOMFORTABLE BREATHING.

4. AETIOLOGY
■ CARDIAC
■ Congestive cardiac
failure
■ Coronary artery disease
■ Cardiomyopathy
■ Valvular dysfunction
■ pericarditis
• PULMONARY
• Copd
• Asthma
• Restrictive lung disease
• Pneumothorax

5. ■ CARDIOPULMONARY
■ COPD with pulmonary
HTN and cor pulmonale.
■ Chronic pulmonary
emboli.
■ Non-
cardiopulmonary
■ Metablic condition
(acidosis)
■ Anemia
■ Pain in chest wall
■ Neuromuscular disorders
■ Otorhiolaryngeal
disorders
■ Others...

6. 1.ONSET AND COURSE:
ACUTE CAUSES(WITHIN MINUTES)
CARDIAC
■ Acute MI
■ Congestion
■ Pericardial temponate
■ Acute valvular
insufficiency
■ Aortic dissection
■ Complete heart block
RESPIRATORY
• Acute exacerbation of
Asthma
• Pneumothorax
• Pulmonary emboli
• Foreign body
• Laryngeal edema.
HISTORY

7. WITHIN HOURS WITHIN DAYS WITHIN
WEEKS
Asthma Pneumonia Pleural effusion
Left heart
failure
ARDS Anemia
Pneumonia Left Heart Failure Muscle weakness
Tumors
■
SUBACUTE
HISTORY

8. AIRWAYS PLEURAL PARENCH
YMAL
VASCULAR
• COPD
• Asthma
• Chronic
bronchitis
• Emphysema
• Cystic
fibrosis
• Effusion
• Malignancy
• Fibrosis
• Interstitial
lung
disease
• Vasculitis
• AV-
malformati
on
CHRONIC PULMONARY CAUSES
HISTORY

9. 2.POSITION OF DYSPNEA
■ ORTHOPNEA:
Shortness of breath
which occurs when lying
flat.
Causes
■ CCF
■ Left ventricular
failure
■ COPD
■ Bronchial asthma
■ Massive pleural
effusion
■ Ascites
■ PLATYPNEA:
Shortness of breath that
is relieved when lying
down.
■ Left atrial myxoma
■ Massive pulmonary
emboliqsm
■ Paralysis of
intercoastal
■ HeptatoPulmonary
syndrome.
HISTORY

10. ■ TREPOPNEA:
Shortness of breaath
that is sensed while
lying on one side but not
on other .
Causes
■ Disease of one lung or
bronchi
■ CCF
HISTORY

11. 3.TIMING OF DYSPNEA
■ Nocturnal onset
Causes
■ CCF
■ Bronchial asthma
■ COPD
■ Sleep apnea
■ Post prandial
Causes
■ GERD
■ Aspiration
■ Food Allergy
HISTORY

13. ■ PRECIPITATING
FACTORS
■ Exercise
■ Exposure(cigarette,
Allergen
■ Occupational
■ Obesity
■ Medication.
■ RELIEVING FACTORS
■ Rest
■ Medication.
HISTORY

14. ■ ASSOCIATED SYMPTOMS
■ Chest pain
■ Wheeze
■ Fever
■ Cough (sputum-color)
■ Change in pitch of voice
■ Palpitations
■ Hemoptypsis
■ Dysphagia
■ Heartburn
■ Bone pain
■ OTHER RELEVANT
HX
■ Past medical
■ Past surgical
■ Occupation
■ Smoking
HISTORY

15. ■ GENERAL INSPECTION
■ Anxiety
■ Ability to speak
■ Audible wheeze
■ Pt position
■ Cynosis or pallor
PHYSICAL
EXAMINATION
VITALS:
• Pulse=Usually
tachycardia,
BRADYCARDIA in severe
hypoxemia
• R.R=usually tachypnea
DANGER>35-40 or <10-
12.
• Temp= febrile
• B.P = Increase if dyspnea
is significant , decrease
may indicate life

16. WHAT TO LOOK FOR?
■ Clubbing
■ Cynosis
■ Cold Extremities
■ Nasal polyps
■ Septal deviation
■ Post nasal discharge
■ JVP
■ Lower linb edema
PHYSICAL
EXAMINATION
• SYSTEMIC EXAMINATION
• Respiratory
• CVS
• CNS
• Abdominal.

17. ■ Baselines(CBC, ESR, CRP, LFT,U/C/E, AntiHCV. HbsAg, PT, APTT,)
■ ABGs
■ Chest x-ray
■ Sputum AFB, DR
■ Blood and urine Dr ,C/S
■ ECG
■ ECHO
■ Spirometry
■ D-dimer
INVESTIGATIO
N

18. ■ Unstable pt:
■ Oxygen therapy
■ Intubation(gasping, apneic, non responsive)
■ Establish IV line and fluid resuscitation in case
■ Thoracocentesis(tension pneumothorax)
■ Bronchodilators(obstructive pulmonary disease)
■ Pulmonary edema(IV/IM furosemide)
MANAGEMENT

19. ■ If patient is stabilized
■ Reassess Airway, mental status, breathing efforts)
■ Check vitals.
■ Pulmonary physiotherapy
■ Treat underlying cause.
■ Treat Infections
■ Pleural effusion
■ Pnemothorax
■ Pulmonary emboli
■ Foreign body
■ CCF
■ Etc...

21. PNEUMONIA

24. RBS = 465mg/dl

25. DIABETIC
KETOACIDOSIS

28. PNEUMOTHORAX

30. COPD