21. Dyspnea Flashcards
Definition of dyspnoea
Uncomfortable sensation of breathlessness
Definition of high resp rate/tachypnea
Better than 44 in a newborn and greater than 18 in an adult
Definition of the ventilation
A minute ventilation that exceeds metabolic demand
What is the control of normal breathing?
Central – inspiratory control centre in the medulla oblongata, and preferably chemo receptors near the carotid bodies
Other sensory mechanisms include pulmonary stretch, receptors in the mechanical receptors in the diaphragm and skeletal muscles
Name 10 critical diagnoses for acute shortness of breath
Airway obstruction
Pulmonary embolism.
Non-cardiac pulmonary edema.
Anaphylaxis
Ventilator failure
Pulmonary edema.
Myocardial infraction
Cardiac tamponade
Toxic congestion.
DKA
Glottitis
Tension reflex
Cardiac Taana.
Fail chest
Carbon monoxide or cyanide poisoning.
Acute chest syndrome.
CVA intracranial insult.
Organic phosphate poisoning
Name 10 emergent causes of shortness of breath
Spontaneous pneumothorax
Asthma
Cor pulmonale
Aspiration,
Pneumonia
Pericarditis
Mechanical interference.
Hypertension or sepsis from rapture, viscous, bowel obstruction, inflammatory or infectious process
Renal failure
Electrolyte abnormalities.
Metabolic acidosis
Simple, pneumothorax or hemothorax.
Diaphragm ruptured.
Neurological injury,
Anemia
MS
GBS
Tick paralysis
Name 10 non-emergent diagnosis of shortness of
Plural effusion
Neoplasm.
Pneumonia with a cap score less than 70
COPD
C HD
Valvular heart disease
Cardiomyopathy
Pregnancy
Ascites or obesity
Hyperventilation syndrome.
Somatic disorder.
Panic attack.
Fever.
Thyroid disease.
Rib fractures
ALS
Polymyositis
Porphyria
Name three different diseases that can present with clubbing
Chronic hypoxia
Cardiac shunt.
Pulmonary vascular anomaly
And five diseases that can present with strider
Upper airway edema.
Upper airway infection
Foreign body.
Traumatic injury.
Anaphylaxis
Vocal cord disfunction
What are the best ancillary tests for the patient with shortness of breath?
Pulse oxymetry
VBG
Waveform capnography
Complete blood count
ECG
Plus minus echo
Chest x-ray
Plus or minus CTA, pulmonary geography, MRI
Plus or minus soft tissue neck radiograph
Plus or minus bronchoscopy or laryngoscopy
What disease has a classic shark fin waveform on capnography?
Bronchospasm consistent with significant asthma
List the criteria for well DVT
Active cancer
Bedridden recently greater than three days or major surgery within 12 weeks.
Calf, swelling greater than 3 cm compared to the other leg (measured 10 cm below the two tuberosity)
Collateral non-varicose superficial veins present.
Entire leg is swollen.
Localized tenderness along the DVT system
Pitting oedema confined to symptomatic leg.
Paralysis, Parises, or recent plaster mobilization in the lower extremity.
Previously documented DVT
Alternative diagnosis of DVT is as likely or more likely
List the well criteria and their score
Active cancer, bedridden recently greater than three days or major surgery within 12 weeks, calf, swelling, greater than 3 cm compared to the other leg, collateral, superficial veins, present, entire legs, swollen, localized tenderness, along the deep pain system, pitting, edema, confined to the symptomatic leg, paralysis/Parisis or recent plaster mobilization of the lower extremity, previously documented DVT All are one point
Alternative diagnosis as likely or more likely is -2
Well score moderate versus high risk for DVT
Low risk -2 to 0
1-2
Three or higher high risk
Describe the components of the PERC rule for pulmonary embolism
Any score greater than one cannot rule out:
Age, greater than equal to 50
Heart rate greater than or equal to 100
Oxygen saturation room air less than 95%
Unilateral leg swelling
Hemoptysis
Recent surgery or trauma, particularly in the last or equal to four weeks Requiring treatment with general anesthesia.
Prior PE or DVT
Hormone use, including oral contraceptives hormone replacement or oestrogen hormones in male or female patients
