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CPR Exam 2 > Dyspnea DSA > Flashcards

Dyspnea DSA Flashcards

1
Q

How do we determine whether a patient has a symptom of dyspnea and distinguish it from respiratory distress?

A

Rely on patients self-description.

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2
Q

Sensation of dyspnea originates at the _________.

A

cerebral CTX

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3
Q

What are the 2 main mechanisms that causes dyspnea?

A
  1. Impaired ventilatory mechanisms
  2. Increase in respiratory drive

In cardiopulm cases, both of these will exist.

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4
Q

What can cause impaired ventillation => dyspnea?

A
  • - Airflow obstruction (asthma and COPD)
  • - Muscle weakness
  • - Decrease chest wall compliance (kyphoscoliosis and obesity)
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5
Q

What can cause increase in respriatory drive => dyspnea?

A
  1. Parenchymal or pulmonary vascular lung disease
  2. CHF
  3. Chemoreceptor simulation (hypoxemia, hypercapnia, acidemia)
  4. Impraired gas exhcange
  5. PG
  6. Behavioral factors like hypervent, panic attacks
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6
Q

How do we diagnose dyspnea?

A

Hx and PE

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7
Q

When should we transfer a patient with dyspnea to acute care setting?

A
    1. BAD tachypnea
    1. Use of accessory muscles
    1. Conversational dyspnea
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8
Q

Describe the MRC Dyspnea Scale

A
  • Grade 1: breathlessnes ONLY when working out
  • Grade 2: SOB when walking up a straight hill
  • Grade 3: walks slower than NL on the level, stops after 1 mile or after 15 min walking at own pace
  • Grade 4: stops to breath after walking 100 yards or after a few min on ground level
  • Grade 5: too OOB to leave house/OOB when undressing.
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9
Q

How quickly does acute dyspnea develop?

A

rapidly over minutes to a day

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10
Q

What are cardiovascular causes of acute dyspnea?

A
  • -Acute decrease in function of LV
  • -Anything that causes increase in pulmonary capillary pressure
    • Acute coronary sundrome
    • Tachycardia
    • Cardiac tamponade

-

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11
Q

What are respiratory causes of acute dyspnea?

A
  • Airway dysfunction (bronchoaspsm, aspiration, obstruction)
  • Pneumonia/ ARDS causing a disruption in gas exchange
  • PE
  • Distrub ventillary pump (pleural effusion, pneumothorax, respiratory muscle weakness)
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12
Q

How should a patient with acute dyspnea be treated on arrival?

A

STABILIZE

1. Take vital signs

2. Respiratory support if needed

  • supplimental O2
  • Invasive or noninvasive O2
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13
Q

Once we stabilize a patient with acute dypnea, what are the next steps?

A
  1. PE can provide clues of differentials
  2. CXR (primary diagnostic tool) can indicate cause or further exam
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14
Q

What findings on CXR would indicate:

pneumonia

pneumothorax

pleural effusion

HF

A
  • pneumonia: focal infiltrates
  • pneumothorax: air in pleural space
  • pleural effusion: basal opacity w meniscus
  • HF: cardiomegaly and vascular congestion
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15
Q

How can we exclude heart failure when a patient presents with acute dyspnea?

A

Check to see if serum BNP level is less than 100 pg/mL

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16
Q

Chronic dyspnea is defined as dyspnea persisting beyond

A

1 month

17
Q

2/3 of patients with chronic dyspnea is due to what?

A

1. COPD

2. Asthma

3. Intersitial lung disease

4. HF

18
Q

What is the key to w/u in a patient with chronic dyspnea?

A

Detailed history in a systematic way:

    1. Quality
    1. Precipitating events (degree of exertion and positional changes)
    1. Assx features
  • 4. Risk factors for cardiac and pulmonary disease
19
Q

Chronic dyspnea due to HF is described as

A

air hunger, suffociating

20
Q

Chronic dyspnea due to asthma is described as

A

tight chest

21
Q

In patients whose history, exam, and initial workup are unrevealing, which test can be helpful in providing additional diagnostic information?

A

Six-minute walk test

*

22
Q

Pt presents w no known chronic conditions that could cause dyspnea, what should be tested?

A

Cardiac-related symptoms (orthopnea, edema, exertional sx)

if +; check for volume overload or PE

23
Q

In pts with chronic dyspnea and no potential cardiac causes, how should pulmonary sx be assessed?

A
  • Exposure to pulmonary toxins
  • Lung exam: focus on
    • wheezing
    • distant breath sounds
    • prolonged expiratory phase
    • increase AP diameter

CPR Exam 2 (29 decks)

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