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Approach to Dyspneu

Stephanie Wirjomartani

40138166

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Description

• Dyspnea derives from Greek forhard !reathin"#$ %t is often a&sodescri!ed as shortness of!reathin"#$

•  'his is su!jective sensation of!reathin"( from mi&d discomfort to

fee&in"s of su)ocation$

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*ana"ement

1$ Air+ays ,reathin" -ircu&ation .A,-/

$ -reate a sta!i&ity of these aspects ofthe patients vita&s

3$ 2roceed to history and physica& partof the assessment

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Durin" assessment( one can initiate mana"ement!ased on initia& assessment

1$ 2&ace a&& patients on supp&ementa& oy"en( pu&seoimetry( and cardiac monitor

$ %nitiate therapy for suspected cause of dyspneasuch as

 – Asthma5-2D  ne!u&i7ed !ronchodi&ators and %$$streoids

 – -on"estive heart fai&ure diuresis( morphine( nitrates(sit upri"ht

9%ntu!ate patiens if impendin" respiratory fai&ure

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:tio&o"y

• :tio&o"y for dyspnea arisin" from ;main cate"ories  –

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>istory

Onset – ery sudden onset minutes( usua&&y &ife

threatenin" conditions .such as those +ith an 9 inthe a!ove ta!&e/

 – Acute hours .pneumonia( ->? +ith pu&monaryedema( A-S( pericardia& disease( va&vu&ar heartdisease( A

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Ask a!out the fo&&o+in" associatedsymptoms 

• Stridor

• -ou"h .sputumproduction and

co&or/• ?ever and chi&&s

• S+eats

• @ethar"y

• -hest pain

• Whee7e

• -hest ti"htness

• >emoptysis

• >oarseness

• :dema

• Wei"ht &oss5"ain

• rthopnea

• 2=D

• Aniety• -onfusion

• @i"htheadedness

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Positionally – rthopnoea .->?( asthma( -2D( inammatory

and de"enerative neuro&o"ica& diseases( "astroB

oesopha"ea& reu( pericardia&( and !i&atera&diaphra"matic para&ysis

 – 2&atypnoea +orsenin" dyspnea on an upri"htposition( +ith a&&eviation on supine .patentforamen ova&e( a!domina& musc&e deCciency( orstatus postBpenumonectomy/

 – 'repopnoea present on&y in &atera& decu!itusposition .->?/

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2hysica& :amination

•  'achycardia( tachypnea( fever and hypertension

• Wei"ht increase may si"na& +orsenin" ->?

• -ontractions of the accessory musc&es of respirationsu""est severe dicu&ty

•

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• -rack&es su""est uid in the air+ay( as occurs +ith!ronchitis( pneumonitis and ->?

• =orma& Cndin"s on &un" eamination do not ru&e outpu&monary patho&o"y !ut do &essen its pro!a!i&ity and

the &ike&ihood that it is severe•  'he cardiac eamination shou&d focus on si"ns of &eftB

sided heart fai&ure( detection of &eftBsided murmurs( andsi"ns of pu&monary hypertension and its conseEuences.accentuated and de&ayed 2(

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Workup

Standard +orkup for dyspnea

• -<

• :-G  assess A-S

• A,G  ca&cu&ate ABa "radient and assessacidosis

• -,-  assess anemia and W,- for

infectious processes• :&ectro&ytes( ,H=( -reatinine( ,&ood

G&ucose  assess meta!o&ic deran"ements

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