SOB Flashcards
first thing to do when evaluating dyspnea
Look for evidence of a respiratory distress/failure
What are markers of respiratory distress/failure
- marked tachypnea and tachycardia
- stridor
- accessory respiratory muscles (during inhalation)
- inability to speak normally as a consequence of breathlessness
- agitation or lethargy as a consequence of hypoxemia
- depressed consciousness due to hypercapnia
- paradoxical abdominal wall movement
- the abdominal wall retracts inward with inspiration, indicating diaphragmatic fatigue (pushes out)
How MUST you check accessory respiratory muscle
clothes off
what are the accessory muscles that may be used with respiratory distress?
sternocleidomastoid, intercostals, sternoclavicular
SIS
What should you ask history-wise if someone has respiratory distress?
Need for mechanical ventilation
What medication can cause dyspnea
steroids
When is a patient NOT in respiratory distress
If they can talk to you
What must you look at for EENT for dyspnea?
Oral for angioedema (allergy)
FB
What do you do for cardio exam for dyspnea?
JVD
good cardio
look for acrocyanosis
what is the first sign of respiratory distress
acrocyanosis
because blood is diverted to vital organs
life-threatening causes of dyspnea
upper airway obstruction with object/ hemmorage
tension pneumo
PE
Neuromuscular weakness
Fat embolism
MCC of dyspnea
Obstructive airway disease (asthma)
decompensated HF
Ischemic heart disease
PNA
Psychogenic
HF history, symptoms, PE, and CXR, EKG with dyspnea
PND
Orthopnea
edema
dyspnea on exertion
S3
JVD
S4
wheezing
pulm venous congestion
cardiomegaly
EKG abnormalities
what do you order for diganostic evaluation of dyspnea?
CBC
CMP
Peak expiratory flow rate
will help differentiate asthma/COPD from other disorders
decreased in obstructive disease
pt noncompliance due to acute dyspnea will affect the results
ABG
EKG
Troponin
BNP or N-terminal pro BNP
D-Dimer
CXR
Bedside Point of Care Ultrasound
helps differentiate acute cardiac from noncardiac causes
pleural effusion, pneumothorax, pulmonary consolidation, intravascular volume status, cardiac tamponade, cardiac function
CT scan, CTA, V-Q scan
what is the INITIAL goal of dyspnea
admit to maintain O2 if hypoxemia
THEN see underlying cause
Goal O2 for hypoxia in general and for COPD
not black and white
O2 > 90 is MC (chronic COPD may have a lower O2 - so do not treat them too much or they will lose their drive
How do you supply O2
depends on how bad their O2 stat
Simple mask is most (6-10 L)
NC (0.25 - 4)
What is the high flow O2
High flow NC can be used up to 40 L/min
what is the non-rebreather bpm?
O2 builds up in bag and goes through a one-way valve so that they are not breathing in their expired air
need to make sure that there is not an obstruction
If there is help of O2, what is next?
a little more invasive
CPAP or BiPAP
CPAP = same during inhilation and exhalation (sometimes have trouble exhaling)
BiPAP higher pressure while breathing in
MC sign of an upper airway obstruction
stridor
explain stridor
high-pitched inspiratory stridor
What is the MCC of stridor in neonates
Laryngotracheomalacia
What are the infectious etiologies of upper airway
Croup (laryngotracheobronchitis)
Bacterial tracheitis
Retropharyngeal abscess
Peritonsillar abscess
Epiglottitis
not on exam?
MC age and object for airway obstruction in a child
1-3 years
food and toys
MC foods that lead to FB obstruction in child
peanuts, sunflower seeds, RAW carrots, raisins, grapes, and hot dogs
they cannot be chewed up enough
Presentation of airway FB obstruction
sudden coughing/choking associated with gagging, stridor or cyanosis
presentation of laryngotracheal FB
STRIDOR, hoarseness or complete apnea
PA and lateral soft tissue neck
presentation of Bronchial FB and what you order
unilateral wheezing and decreased breath sounds
PA and lateral CXR
inspiratory and expiratory
confirms or rules out diagnosis
therapeutic to remove FB
Bronchoscopy
what does inspiratory and expiratory FB
inspiratory normal
expiration = lung will not collapse, get larger, and eventually pneumothroax
what is atelectasis
alveoli do not open and do not enter sacs, so tissue looks lighter gray or white (because air is black)
if a FB is stuck for a long time
