DYSPNEA ד"ר אבי עירוני מחלקה לרפואה דחופה תל השומר

Dyspnea Subjective feeling of difficult,labored, or uncomfortable breathing “shortness of breath” breathless” 2/3 of patients-cardiac or pulmonary problems

Terms Tachypnea Orthopnea Paroxysmal nocturno dyspnea Hyperpnea – minute ventilation in excess of metabolic demand

Hypoxia Insufficient delivery of oxygen to the tissues Occurs in: low CO, low Hgb, low Sao2 CNS –agitation, headache, somnolence, coma, seizures,

Pathophysiology of hypoxia Hypoventilation Right to left shunt-no improvement with O2 Ventilation perfusion mismatch- improve with O2 Diffusion impairment Low inspired oxygen

Common causes of dyspnea Airway Cardiac Lung- parenchyma Pleural and chest wall Vascular Neuromuscular Miscellaneous-metabolic

airway Mass Foreign body Angioedema stenosis

Cardiac Left ventricular failure Ischemia Pericardial tamponade Arrhythmia CMP Valvular HTN emergency

Pleural / chest wall Pneumothorax Pleural effusion Kyphoscoliosis Pregnancy Abdominal distention

Vascular PE Air, amniotic or fat embolism Pulmonary HTN Vasculitis

Parenchymal Asthma/copd Pneumonia Pulmonary edema Atelectasis ARDS ILD

Neuromuscular CVA Phrenic N. paralysis Guillain Barre’ syndrome Myopathy Botulism

Miscellaneous Anemia Acidosis Shock Hypoxia CO poisoning Fever Thyroid Psychogenic

Clinical features Identify respiratory failure Tachypnea tachycardia Stridor Accessory respiratory muscles Inability to speak Agitation or lethargy Paradoxical abdominal wall movement

Diagnosis History-chronic disorders, infectious, environmental exposure, medications, Pulse oximetry ABG and CBC Chest x ray Peak flow ECG CT, ECHO,STRESS TEST

Treatment Oxygen –Pao2>60 mmHg Benzodiazepines, opiates

The End