approach to shortness of breath

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

F

  • renal failure

G: ABDOMINAL

  • A: ascites
  • N: bowel obstruction

H: HEME

  • Hgb: ANEMIA

I: INTOX

  • tox

 

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

dyspnea

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