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