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Breathlessness (Classification (Subacute Develops over hours/days,…
Breathlessness
Classification
Subacute
Develops over hours/days
Chronic
Develops over weeks/months
Acute
Develops over minutes
Diagnosis
Examination
Cardio
Pallor/cyanosis, HR, JVP, apex, heart sounds, murmurs, peripheral oedema, pulmonary oedema
Resp
Pallor/cyanosis, RR, JVP, chest expansion, percussion, breath sounds and additional sounds, peripheral oedema
Investigation
Bloods
FBC (anaemia, infection), CRP (infection),
U+Es (hypovolemia), LFTs, D-dimer (PE)
TFTs (hypothyroidism), toxicology (e.g. salicylate)
Imaging
CXR (infection, effusions, oedema, fibrosis, masses)
CT chest (staging for cancers)
CTPA (PE)
Bronchoscopy + biopsy (masses)
Bedside
Obs (sats, RR, HR, BP, temp)
ECG (arrhythmias, ACS)
Peak flow (asthma)
History
DH
Current meds
allergies (?anaphylaxis)
FH
Cardio/resp disease
PMH
Cardio/resp disease
anaemia
SH
Occupation, stress,
alcohol, smoking, illicit drugs
PC/HPC
SOB onset, character, associated symptoms, timing, exacerbating/reliving factors, severity,
red flags (weight loss, night sweats, fever)
Aetiology
Acute/subacute
Lungs
Vascular: PE
Infection/inflammation: pneumonia, acute asthma,
acute COPD, acute bronchiectasis
Trauma: lobar collapse, upper airway obstruction
Systemic
Infection/inflammation: sepsis, anaphylaxis
Metabolic: anaemia, DKA, renal failure
Drugs: OD e.g. aspirin
Trauma: hypovolemia
Functional: anxiety
Heart
Vascular: MI, angina, valve disease, arrhythmia, acute HF
Infection/inflammation: pericarditis, cardiac tamponade
Chronic
Heart
Vascular: HTN, IHD, cardiomyopathy, valve disease, arrhythmia, congenital heart disease
Lungs
Vascular: recurrent PE
Trauma: pleural effusion
Neoplastic: mesothelioma, lung Ca
Degeneration: COPD, ILD
Systemic
Metabolic: anaemia
Endocrine: hypothyroidism
Developmental: pec carniatum/excavatum
Degenerative: AS, diaphragmatic splinting, neuromuscular disorders e.g. MND
Management
Initial ABCDE
Oxygen, fluids, bloods,
CXR, ECG etc.
Nebulisers if warranted
Definitive
Per cause
Definition
A subjective, distressing sensation or
awareness of difficulty with breathing