approach to shortness of breath |

In the rapid pace of the ER it’s easy to reduce the complaint of shortness of breath to the respiratory system, which cuts off a large swath of the differential diagnosis. While the cardio-respiratory system accounts for most diagnoses, you can should consider the expanded ABCs to keep your differential broad:

A: ABCDEFGHIJKLMNOP

Anaphylaxis, Angioedemia, Angina Ludwig, Abscess
Bacterial tracheitis
Croup
Diphtheria
Epiglottitis
Foreign body
Growth, goiter
Hematoma
Inhalation
Johnson Steven
Kawasaki
Laryngitis
Mono
Node
O antisstrep
Pharyngitis

B: CHEST

Collapse: pneumothoax
Hyperinflate: asthma/COPD
Effusion
Sick: pneumonia
Tumour

C: CARDIOVASCULAR

Cardiac arrhythmia
Around heart: pericardial effusion
RV strain from PE
Dysfunctional LV
Incompetent valve
Outflow dissection

D: NEUROLOGIC

Origin nerve: GBS
Intersection neuromuscular: myasthenia, botulism

E: ENDO

Electrolyte: DKA
Determine acid-base: acidosis

renal failure

G: ABDOMINAL

A: ascites
N: bowel obstruction

H: HEME

Hgb: ANEMIA

I: INTOX

You can easily incorporate this into a rapid history and physical, and pursue it further if necessary

A: history of tongue/throat swelling/voice changes/difficulty swallowing/ingestion/inhalation –> look at lips, oropharynx, neck –> soft tissue neck Xray or CT
B: history of cough/wheeze/fever –> listen and EDE look for lung sliding/B lines/effusion/consolidation –> CXR
C: history of palpitations/exertional or pleuritic CP/cardiac and PE risk/valve problem/severe pain –> murmur/rub, ECG, EDE pericardium, RV, LV –> CXR, trop, Dimer, CT chest
D: muscle weakness –> bulbar muscles, reflexes
E: history of diabetes, ingestions –> lutes, anion gap
F: history of renal failure –> Cr
G: history of abdominal distention –> EDE ascites, Xray abdo series
H: history of bleeding, pale –> CBC
I: history of ingestions