View source for Emergency shortness of breath

This page is about emergency shortness of breath. If you're after the more bog-standard symptom go to: [[shortness of breath]].
==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%; [[ABG|''P''<sub>a</sub>O<sub>2</sub>]]<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]]) - breathless, [[orthopnoea]] ([[PND]]), pink frothy sputum, pale, sweaty, tachycardia, tachypnoea, pulsus alternans (alternating weak and strong pulse), raised JVP, fine crackles, [[gallop rhythm]], wheeze
====Stridor====
*If it's a '''foreign body''', hopefully, that'll be in the history.
*'''[[Epiglottitis]]''' - '''if suspected, do not examine the throat'''. Call an anaesthetist and get airway access immediately. The child will be quiet and not moving in order to maintain the airway.
*'''[[Anaphylaxis]]''' - see [[#Wheeze|above]]
*Airway '''trauma''' will hopefully be evident with a history of trauma.

====Crackles====
*'''Acute heart failure''' - see [[#Wheeze|above]]
*'''[[Pneumonia]]''' - breathless, crackles, [[fever]], productive [[cough]], [[confusion]], tachypnoea, [[haemoptysis]], [[malaise]], [[rigors]], [[pleuritic]] [[chest pain]]
*[[Bronchiectasis]] and [[fibrosis]]. Don't really know anything about these.

====Percussion====
*'''Pneumothorax: ''hyperesonant''''' - ''respiratory'':shortness of breath, pleuritic [[chest pain]], diminished breath sounds, reduced chest expansion; ''cardiac'': tachycardia, hypotension; ''neck'': deviated trachea, distended neck veins
*'''Pleural effusion: ''"stony dull"''''' - breathless, dull [[chest pain]], tracheal deviation (away from effusion), reduced chest expansion on affected side, reduced vocal fremitus, absent/reduced breath sounds,

====Clear Chest====
Now you've ruled out a large proportion of respiratory causes, you go on to what can in this description be called "the rest".
*'''Pulmonary embolism''' - breathless, tachynpnoea, tachycardia, pleuritic [[chest pain]], [[haemoptysis]], [[syncope]], [[hypotension]], [[gallop rhythm]], raised JVP, right ventricular heave, [[pleural rub]]. ''Risk factors'': cancer, recent surgery, immobility, the [[Pill]], [[DVT]], previous [[thromboembolism]], [[thrombophilia]]
*'''Hyperventilation syndrome''' - due to [[panic attack]]. Acute anxiety, chest tightness, [[paraesthaesia]] in fingers, [[numbness]]
*'''DKA''' - breathlessness; history of [[diabetes]]; [[coma]]; [[vomiting]]; [[dehydration]]; [[abdominal pain]]; [[shock]]; [[drowsiness]]; tachycardia
*Metabolic acidosis - depends on cause
*[[Anaemia]], [[shock]] and certain drugs ([[aspirin]]) can cause dyspnoea too.