Dyspnea DSA Flashcards
How do we determine whether a patient has a symptom of dyspnea and distinguish it from respiratory distress?
Rely on patients self-description.
Sensation of dyspnea originates at the _________.
cerebral CTX
What are the 2 main mechanisms that causes dyspnea?
- Impaired ventilatory mechanisms
- Increase in respiratory drive
In cardiopulm cases, both of these will exist.
What can cause impaired ventillation => dyspnea?
- - Airflow obstruction (asthma and COPD)
- - Muscle weakness
- - Decrease chest wall compliance (kyphoscoliosis and obesity)
What can cause increase in respriatory drive => dyspnea?
- Parenchymal or pulmonary vascular lung disease
- CHF
- Chemoreceptor simulation (hypoxemia, hypercapnia, acidemia)
- Impraired gas exhcange
- PG
- Behavioral factors like hypervent, panic attacks
How do we diagnose dyspnea?
Hx and PE
When should we transfer a patient with dyspnea to acute care setting?
- BAD tachypnea
- Use of accessory muscles
- Conversational dyspnea
Describe the MRC Dyspnea Scale
- 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.
How quickly does acute dyspnea develop?
rapidly over minutes to a day
What are cardiovascular causes of acute dyspnea?
- -Acute decrease in function of LV
- -Anything that causes increase in pulmonary capillary pressure
- Acute coronary sundrome
- Tachycardia
- Cardiac tamponade
-
What are respiratory causes of acute dyspnea?
- Airway dysfunction (bronchoaspsm, aspiration, obstruction)
- Pneumonia/ ARDS causing a disruption in gas exchange
- PE
- Distrub ventillary pump (pleural effusion, pneumothorax, respiratory muscle weakness)
How should a patient with acute dyspnea be treated on arrival?
STABILIZE
1. Take vital signs
2. Respiratory support if needed
- supplimental O2
- Invasive or noninvasive O2
Once we stabilize a patient with acute dypnea, what are the next steps?
- PE can provide clues of differentials
- CXR (primary diagnostic tool) can indicate cause or further exam
What findings on CXR would indicate:
pneumonia
pneumothorax
pleural effusion
HF
- pneumonia: focal infiltrates
- pneumothorax: air in pleural space
- pleural effusion: basal opacity w meniscus
- HF: cardiomegaly and vascular congestion
How can we exclude heart failure when a patient presents with acute dyspnea?
Check to see if serum BNP level is less than 100 pg/mL
Chronic dyspnea is defined as dyspnea persisting beyond
1 month
2/3 of patients with chronic dyspnea is due to what?
1. COPD
2. Asthma
3. Intersitial lung disease
4. HF
What is the key to w/u in a patient with chronic dyspnea?
Detailed history in a systematic way:
- Quality
- Precipitating events (degree of exertion and positional changes)
- Assx features
- 4. Risk factors for cardiac and pulmonary disease
Chronic dyspnea due to HF is described as
air hunger, suffociating
Chronic dyspnea due to asthma is described as
tight chest
In patients whose history, exam, and initial workup are unrevealing, which test can be helpful in providing additional diagnostic information?
Six-minute walk test
*
Pt presents w no known chronic conditions that could cause dyspnea, what should be tested?
Cardiac-related symptoms (orthopnea, edema, exertional sx)
if +; check for volume overload or PE
In pts with chronic dyspnea and no potential cardiac causes, how should pulmonary sx be assessed?
- Exposure to pulmonary toxins
-
Lung exam: focus on
- wheezing
- distant breath sounds
- prolonged expiratory phase
- increase AP diameter
