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20 yo F comes to A&E complain of progressively worsening…
20 yo F comes to A&E complain of progressively worsening breathlessness over the past 6 hours.
Hypovolumia / Heart issues
Decompensated heart failure/
cardiogenic pulmonary edema
right upper quadrant discomfort due to acute hepatic congestion resting sinus tachycardia, narrow pulse pressure, diaphoresis, and peripheral vasoconstriction, orthopnea , hx of MI, extra heart sounds, hepatomegaly
Ischemic heart disease: unstable
angina and myocardial infarction
weakness, nausea and vomiting, palpitations, and syncope, Ischemic chest pain (gradual onset, provoked by exercise, discomfort rather than pain, diffuse, hard to localise, resolve in 2 - 5 min
Blood loss
hypotension; tachycardia; impaired cognition; cool, clammy, pale, ashen skin
Cardiac tamponade
chest pain, tachypnea, and dyspnea, jugular venous pressure is markedly elevated, low arterial blood pressure, dilated neck veins, and muffled heart sounds, Pulsus paradoxus: defined as an abnormally large decrease in systolic blood pressure (>10 mmHg) on inspiration
Hypoxia/Hypoxemia / lung issues
COPD
wheezing and tachypnea and may include features of respiratory compromise such as difficulty speaking due to respiratory effort, use of accessory respiratory muscles, and paradoxical chest wall/abdominal movements
Upper airway obstruction: foreign body,
angioedema, hemorrhage
Anaphylaxis
Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
Reduced blood pressure (BP) or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse] syncope, incontinence)
Tension pneumothorax
complication of blunt trauma, often sustained from a fractured rib tachypnea, chest pain, hypoxia, unilateral diminished or absent breath sounds, or unilateral hyperresonance to percussion
Acute pulmonary embolism
dyspnea followed by chest pain (classically pleuritic in nature), cough, and symptoms of deep venous thrombosis (Calf or thigh pain and/or swelling)
Asthma
intermittent cough, wheeze, and shortness of breath brought on by characteristic triggers
pleural effusion
Chest pain, painful breathing, cough (dry/productive), orhtopnea
symptoms
Wheezing
Upper airway
(more likely to be stridor, may be hard to separate from wheezing)
Angioedema: allergic, angiotensin-converting enzyme inhibitor, Idiopathic
Foreign body
Infection: croup, epiglottis, tracheitis
Lower airway
Asthma
Transient airway hyperreactivity (usually caused by infection or irritation)
Bronchiolitis
Chronic obstructive pulmonary disease
Foreign body
Cardiovascular
Cardiogenic pulmonary edema (“cardiac asthma”)
Noncardiogenic pulmonary edema (acute respiratory distress syndrome)
Pulmonary embolus (rare)
Psychogenic
Cough (Acute)
Upper respiratory infection: rhinitis, sinusitis, pertussis
Lower respiratory tract infection: bronchitis, pneumonia
Allergic reaction
Asthma
Environmental irritants
Transient airway
hyperresponsiveness
Foreign body