Shortness of Breath Differential Diagnosis PDF

Preview

Summary

Shortness of on Inhalation Aspirin Trauma Lung Left Aortic Mitral Severe Anxiety, BREATHLESSNESS (SOB) DIFFERENTIAL PULMONARY SOB heave, loud fever, cough airway Sx sore crackles of at onset FBC, CRP, tachy, RV strain hypoxia, loss of lung sharp line, air Rim of air no SOB Otherwise O2, or still SOB...

Description

Shortness of breath Chronic

Acute

Acute

• PE • Pneumothorax • Pneumonia • ARDS • MI

Others

Acute on Chronic • COPD exacerbation • Asthma exacerbation • Pulmonary oedema

Upper airway • Anaphylaxis • Inhalation of

Foreign body

• DKA • Pericarditis

Obstructive Pulmonary • COPD

• Aspirin OD

• Asthma

• Trauma to

• Bronchiectasis

• Arrythmia

larynx

Restrictive • Pulmonary fibrosis Malignancy • Lung cancer

Cardiovascular • Left ventrcular

dysfunction • Aortic stenosis • Mitral stenosis

Others • Severe anaemia • Anxiety, panic attack • Thyrotoxicosis • Obesity • Neuromuscular

MG, GBS

ACUTE BREATHLESSNESS (SOB) DIFFERENTIAL DIAGNOSIS Condition Pulmonary embolism

Symptoms •

ACUTE PULMONARY CAUSES

• • •

Pneumothorax

• •

•

Hx asthma, Marfan’s Sudden SOB + pleuritic

•

• • •

• •

Tachycardia, JVP distension RV heave, loud P2, S4 Calves – DVT SBP24hr) If massive PE – thrombolysis with UFH Vitamin K antagonist (warfarin) in 24hr

Bloods - FBC, U+E, CRP, Ddimer ECG – tachy, RV strain (T inversion), RBBB, RAD, S1Q3T3 (rare) ABG – hypoxia, hypocapnia CXR CTPA/V:Q scan

• • •

CXR – loss of lung markings outside sharp line, air in pleural space Pulse oximetry ABG, VBG

Primary pneumothorax • Rim of air 2cm or still SOB –O2, chest drain Secondary pneumothorax • 50y, air >2cm +/- SOB – chest drain Tension pneumothorax • Needle decompression – large bore through 2nd/3rd ICS, oxygen • Oxygen if hypoxia, ventilate if severe • Fluids – rehydration • Analgesics – PCM, NSAIDs, opiate • ABx • Chest physiotherapy

Tension pneumothorax: • JVP distension, hypotension • Trachea deviation Pneumonia

ACUTE ON CHRONIC CAUSES

Signs

Sudden SOB + pleuritic pain Haemoptysis Calf pain/swelling Current COCP use, malignancy, immobility

FBC, U+E (urea), CRP, culture, pulse oximetry ABG, VBG CXR – consolidation Sputum culture Urinary pneumococcal/ legionella antigen Bloods – FBC, U+E, CRP, culture Pulse oximetry Sputum culture CXR – hyperinflation, rule out other cause ECG – RVH, arrhythmia, ischaemia ABG – respiratory acidosis Spirometry - FEV1:FVC 1) • Dual ABx – amoxicillin + macrolide 7-10d Prevention • Lifestyle changes – smoking cessation • Influenza and pneumococcal vaccination General/Prevention • Education, lifestyle – smoking, exercise • Influenza and pneumococcal vaccination • Prophylactic ABx use • Physiotherapy, travel advice (bullae) Medical – Bronchodilator therapy 1. SABA or SAMA 2. FEV1>50%: + LABA or LAMA FEV150-75% best/predicted SpO2 ≥ 92% Speech normal RR PCI

General/Conservative • Diet, stop smoking, exercise Medical • GTN, aspirin, clopidogrel (first 12m) • Beta-blocker, ACE-I, statin Invasive strategy • Coronary angiography +/- PCI • CABG surgery General/Conservative • Patient education on T1DM/T2 – info on risk factors of DKA and how to monitor own BM and ketone levels • Structured educational programmes on avoid omitting insulin, increasing dose when unwell • Modifying risk factors – lifestyle, diet, exercise • Psychosocial support Medical • Insulin sub cut injections

Continuous monitoring – pulse oximetry, BP, HR, ECG Large bore IV access/ central venous catheter for fluid resuscitation Fluid replacement with crystalloid + K+ replacement (KCl) – most deplete around 5-8L o 0.9% NaCl 1L over 1st hr o NaCl 1L + KCl over next 2 hr x2 o NaCl 1L + KCl over next 4hr x2 o NaCl 1L + KCl over next 6hr o Slow infusion to prevent cerebral oedema (first 24hr- neuro signs) Insulin infusion (suppress ketogenesis, reduce BM, correct electrolytes) – fixed rate 0.1 units/kg/hr, once BM 80% Moderate 50-79% Severe 30-49% V. severe 50%: + LABA or LAMA FEV1...