Dyspnea Lecture Powerpoint Flashcards
Dyspnea definition
Shortness of breath, breathlessness, troubled or labored breathing, either acute over a few hours or days or chronic over 4-8 weeks, can be related to almost any system in the body as a symptom
3 Categories of dyspnea
- Oxygen ingress problem (uptake of air into airways)
- Oxygen uptake problem (cannot absorb the O2 into the bloodstream)
- Neuromuscular or miscellaneous
Common pulmonary causes of dyspnea (4)
- Pneumothorax
- PE
- COPD
- Restrictive lung disease (obesity or sarcoidosis for example)
Common cardiac causes of dyspnea (5)
- CAD MI/angina
- Congestive heart failure
- Aortic aneurysm
- valvular dysfunction
- arrhythmias (early sign)
Other system causes of dyspnea (immunology, endocrinology, neurology, musculoskeletal, infectious, psychiatric, and airway)
Immunology: angioedema Endocrine: metabolic acidosis Neurologic: myasthenia gravis Musculoskeletal: kyphoscoliosis Infectious: epiglottitis Psych: anxiety Airway causes: foreign body aspiration, epiglottitis, retropharyngeal abscess
PPOPPA acronym for acute dyspnea causes in adult
- Pulmonary embolism
- Pulmonary edema
- Obstructed airway
- Pneumothorax
- Pneumonia
- Asthma or COPD
Common causes of acute dyspnea in children (4)
- asthma
- pneumonia
- croup
- foreign body aspiration
How to differentiate between foreign body in trachea and esophagus
Look for the pattern of airway (esophagus only widens around the object and is flat otherwise, airway is clear and wide
3 important HPI questions to ask patient
- What were you doing?
- When does it happen?
- What makes it worse?
Dyspnea at rest with pleuritic chest pain strongly indicates…
….PE
Important to distinguish between dyspnea at ____ and dyspnea ____ when documenting
rest, upon exertion
Postprandial dyspnea
Dyspnea after ingesting food, can be caused due to food allergy, aspiration, GERD, or due to filling preventing diaphragm contracting (perhaps a sign of restrictive lung disease being further exacerbated by full stomach and noncompliant diahpragm)
Contributing factors of dyspnea (3)
- Tobacco use
- medications
- occupational exposure
Immunization status in dyspnea (3)
- Influenza
- Pneumonia
- Tdap (diphtheria and pertussis are causes of dyspnea)
Concerns with travel history and dyspnea (3)
- Altitude changes (High altitude pulmonary edema)
- PE
- exposure to SARS, MERS, etc.
Signs of imminent respiratory distress (5)
- depressed mental status
- inability to maintain respiratory effort
- brief, fragmented speech
- cyanosis
- inability to lie supine
Acute dyspnea diagnostic studies (7)
- CXR (AP lateral)
- CBC
- BNP
- D-Dimer
- ABG
- Peak flows
- echocardiogram
Peak flows can be useful in tracking progress…
…of a stable patient with dyspnea
Obliterative bronchiolitis
“Popcorn lung”, obstruction of bronchioles due to inflammation, commonly due to vaping
Angioedema is often caused by what drug class?
ACEI such as lisinopril
Pleuritic chest pain
Sharp chest pain with inspiration caused by inflammation of the pleura
ABC approach to diagnosis of dyspnea
Correct anything immediately correctable, (airway, breathing, circulation), then determine acute, chronic, or acute on chronic
Epiglottis (thumb print sign)
A neck x ray radiologic sign that suggests epiglottitis from a thickened free edge of the epiglottis looking like a thumb
Croup (steeple sign)
A neeck x ray radiologic sign that presents with subglottic tracheal narrowing creating the shape of a church steeple, indicative of croup caused by paramyxovirus
