Chapter 25 - Dyspnea

Question 1

Define dyspnea?

Answer 1

uncomfortable sensation of breathlessness, air hunger

Question 2

Define: 
tachypnea
hyperpnea 
hyperventilation 
dyspnea on exertion 
paroxysmal nocturnal dyspnea

Answer 2

1) tachypnea
RR> normal (18bpm)

2)Hyperpnea
Greater than normal minute ventilation to meet metabolic requirements

3) Hyperventilation – Minute ventilation exceeding metabolic demand
- > ABG showing normal PaO2

+ Uncompensated respiratory alkalosis

+ Elevated pH

examples: panic attacks, salicyclate poisoning
4) Dyspnea on Exertion (DOE) – Dyspnea provoked by physical effort
5) Orthopnea – Dyspnea in a recumbent position
6) Paroxysmal Nocturnal Dyspnea (PND) – Sudden SOB at night

Question 3

List 10 critical causes of dyspnea?

Answer 3

determine first if it’s cardio-pulmonary vs. toxic -metabolic related

Pulmonary:

1) Airway obstruction (FB)
2) PE
3) non cardiogenic pulmonary edema
4) anaphylaxis
5) respiratory failure
6) tension pneumothorax +/- flail chest (severe respiratory distress, hypoxia, hypotension; Mx: finger/needle thoracostomy

Cardiac:

1) CHF related pulmonary edema
2) MI
3) cardiac tamponade

Other:

1) toxic ingestions (organophosphate ingestion)
2) DKA
3) CO poisoning
4) epiglotittis
5) aacute chest syndrome in sickle cell disease
6) CVA/intracranial catastrophe

Question 4

Outline your approach to the acutely dyspneic patient

Answer 4

MOVIE

1) monitors
2) oxygen
3) full set of vital signs (including glucose)
4) IV access
5) equipment - i.e. intubation, IV nitro etc)

Initiate management based on exam:

    Trauma
    Anaphylaxis
    Foreign body
    Infectious causes
    Cardiac causes (dysrhythmia, ischemic, CHF)
    PE
    Asthma / COPD

Tests to consider:

• Vitals with SPO2 however know when it is unreliable
  
  • ABG
  • ECG
  • Beside U/S
  • CXR
  • Labs – rule out anemia, infection, electrolyte abnormalities, or renal failure
• Imaging for soft tissue lateral neck x-ray: for upper airway processes (i.e FB, epiglottitis)
• CT chest (i.e. PE, pneumonia )

Question 5

Name at least 6 uncommon causes of dyspnea

Answer 5

1) valvular heart disease
2) cardiomyopathy
3) mechanical interference (pregnancy, ascites, obesity, hiatal hernia)
4) ruptured diaphragm
5) thyrotoxicosis \
6) guillain- barre syndrome
7) Tick paralysis
8) MS
9) ALS