DR.MUHAMMAD ALJOHANI ER CONSULTANT SBEM-ABEM

 Dyspnea: unpleasant, subjective sensation of abnormal respiration.  Labored breathing - physical presentation of respiratory distress/ dyspnea

Dyspnea of exertion (DOE)  Exertion-induced SOB Orthopnea  Recumbent-induced SOB Paroxysmal nocturnal dyspnea (PND)  Sudden SOB after recumbent

 Eupnea - normal breathing  Bradypnea - decreased breathing rate  Tachypnea – breathing very fast. Pt not always aware of it.  Apnea – not breathing at all  Hyperpnea - faster and/or deeper breathing  Hyperventilation - rapid breathing with hypocarbia

Organ SystemCritical DiagnosesEmergent DiagnosesNonemergent Diagnoses PulmonaryAirway obstructionSpontaneous pneumothoraxPleural effusion Pulmonary embolusAsthmaNeoplasm Noncardiogenic edemaCor pulmonaleCOPD AnaphylaxisAspiration Tension pneumothoraxPneumonia CardiacPulmonary edemapericarditisCongenital heart disease AMI Valvular heart disease Tamponade cardiomyopathy Associated with normal or increased respiratory effort Abdominal Mechanical interferencePregnancy intraabdominal sepsisAscites Bowel obstructionPickwikian Inflammatory/infectious process Hypotension viscerothorax Psych Hyperventilation syndrome Panic attack Met/EndocrineDKARenal failurefever Electrolyte abnormalityThyroid disease Metabolic acidosis InfectiousEpiglottitispneumonia TraumaTension pneumothoraxSimple pneumothoraxRib fracture Cardiac tamponadehemothorax Flail chestDiaphragm rupture Hematologic anemia Associated with decreased respiratory effort NeuromuscularCVAMSALS Guillan BarrePolymyositis Tick paralysisporphyria Toxicologicorganophosphate poisoning CO poisoning Toxic ingestion

TOOLS TO EVALUATE DYSPNEA  Suspicion / Clinical knowledge. “If you don’t think of it, you will never find it.”  History  PE including  Vital Signs, pulse ox, PEF  Formal Studies

 Ability to speak  Patient position  Cyanosis  Central vs. peripheral (acrocyanosis)  Mental status  Altered MS - hypoxemia/hypercapnia

 Pulmonary  Use of accessory muscles  Intercostal retractions  Abdominal-thoracic discoordination  Presence of stridor  Cardiac  Check neck for presence of JVD

 Inspection  Use of accessory muscles  Splinting  Intercostal retractions  Percussion  Hyper-resonance vs. dullness  Unilateral vs. bilateral

 Auscultation  Air entry  Stridor = upper airway obstruction  Breath sounds  Normal  Abnormal  Wheezing, rales, rhonchi, etc.  Unilateral vs. bilateral

 ABG  Vidas d-Dimer  BNP  Basic Metabolic Panel  Cardiac Enzymes  What else, and why?

 Asthma  Pneumonia  Acute Pulmonary Edema  Pulmonary Embolism  Emphysema  Pneumo / hemothorax  Carbon Monoxide (CO)  Cyanide poisoning  ANAPHYLAXIS

1.Age start in young age 2. Family History 3. H/O Allergic Rhinitis 4.Physical exam 5.barrel shape chest 6.X-ray chest 7. ABG

 Symptoms:  Sudden onset; respiratory distress,  Rales, ronchi. Foamy sputum. Sometimes blood tinged.  Blood pressure high (vasoconstriction) usually 240/120. a) Previous H/O Heart Disease b) Hyperthyroidism c) Rheumatic Heart disease (ms) Sign of LVF a) Tachycardia b) Pulses alternan c) Basal criptation d) ECG change e) X-ray Chest ( cardiomegaly) f) Echo

1.Fever with chills 2.Pleuratic chest pain 3. purulent sputum 4. History of upper respiratory symptoms 5.signs of consolidation 6.x-ray chest 7. CBC 8. Blood culture

1.Suden chest pain 2. dyspnea,caugh 3. H/O asthma 4.COPD 5.Examination, trachea, shifted to opposite side absent breath sound 6 x-ray chest

a) Previous H/O Heart Disease b) Hyperthyroidism c) Rheumatic Heart disease (ms) Sign of LVF a) Tachycardia b) Pulses alternan c) Basal criptation d) ECG change e) X-ray Chest ( cardiomegaly) f) Echo

a) History of prolonged remobilization b) pelvic surgery c) contraceptive pills d) cyanosis e) ECG f) x-ray chest g) ABG h) ECHO i) PIQ study