Shortness of Breath

Question 1

Definition

Answer 1

Highly subjective, uncomfortable or distressing sensation that occurs when actual ventilation is perceived not to satisfy demand.

Question 2

Presentation

Answer 2

Left sided heart failure - dyspnoea on lying flat
Woken up from sleep with dysponea - pulmonary oedema
Other symptoms may include:
chest pain
palpitations
wheezing
cough
fever

Question 3

What must we assess with dysponea

Answer 3

BP
Pulse
Resp rate
Temps
O2 sats
consciousness

Take a history focussing on onset, duration, severity, travel history, PMH (mainly resp and CVS related)

Question 4

Differentials

Answer 4

PULMONARY:
- acute asthma
- exacerbation of COPD, bronchiectasis
- Pneumothorax
- PE
- Pneumonia

CARDIAC
- heart failure
- silent MI
- arrhythmia

OTHER
- hyperventilation from anxiety
- Anaphylaxsis
- Myasthenia gravis
- diabetic ketoacidosis

Question 5

When should a pt be admitted

Answer 5

• rapid onset of suspected HF
• suspected sepsis
• anaphylaxsis
• ECG suggesting MI
• PE, pneumothorax, pulmonary oedema, or tamponade