Emergency shortness of breath
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Differential Diagnosis
There are loads:
- Lungs - pneumonia, pneumothorax, pleural effusion, hyperventilation, pulmonary embolism
- Lower airways- acute asthma, acute exacerbation of COPD, bronchiectasis, fibrosis, anaphylaxis, foreign body in airway
- Upper airways - anaphylaxis, epiglottitis, foreign body in airway, lung cancer, airway trauma
- Cardiac - acute heart failure, myocardial infarction, cardiac tamponade
- Systemic - drugs e.g. salicylate overdose, shock (causes 'air hunger'), metabolic acidosis (specifically DKA)
Clinical and Associated Features
In a emergency situation, you basically need a quick way to be able to differentiate between the different causes of shortness of breath.
Wheeze
- Acute asthma - breathless, hyperventilating, wheezing, history of asthma.
- Severe - peak flow 33-50%; RR>25; HR<110; inability to complete sentences
- Life-threatening - peak flow <33%; Sats<92%; PaO2<8kPa; silent chest; cyanosis; poor respiratory effort; bradycardia; hypotension; confusion; coma
- Acute exacerbation of COPD - breathless; increasing cough; wheeze; decreased exercise capacity; home oxygen, smoking, exercise capacity all help in deciding management
- Anaphylaxis - breathlessness, oedema (larynx, lids, lips, tongues), cyanosis, wheeze, urticaria
- Acute heart failure (severe pulmonary oedema)