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Breathlessness: A subjective awareness of difficulty breathing (Management…
Breathlessness: A subjective awareness of difficulty breathing
Diagnosis
Pulmonary
PE- pleuritic pain, cough, haemoptysis, syncope
Pneumonia
COPD- barrel chest, chronic cough, smoker
Pleural effusion -
Asthma
Pneumothorax- sudden onset, pleuritic pain, trauma
Bronchiectasis
LRTI/URTI- productive cough/purulent sputum, focal chest signs, abnormal CXRay
Fibrosis- weight loss, fatigue, cough, fever
Cardiac
Cardiac Arrythymia
IHD
Chronic Heart Failure
Valvular Dysfunction
Cardiac Tamponade
Other
Thyrotoxicosis
Acute blood loss
Metabolic disorders
Neuromuscular disease
Hyperventilation
Causes
Cardiac
IHD
Congenital heart disease
Hypertension
Cardiomyopathy
Valvular Heart disease
Cardiac Arrhythmia
Other
Hypothyroidism
Chest wall disease (AS)
Anaemia
Diaphragmatic splinting
Hypoventilation caused by NM disease
GORD
Anxiety
Pulmonary
Pleural effusion
Lung Ca- weight loss, haemoptysis, smoker
Recurrent PE
Cystic Fibrosis
LTC - asthma, COPD, Bronchiectasis, ILD,
Allergy
Anaphylaxis
Asthma
Management (Acute)
Peak flow
ECG
ABCDE assessment- BP, pulse, resp, SpO2, Temperature
NEWS and sepsis screening
Emergency hospital admission
Sepsis
Cardiac Arrhythmia/MI/ Rapid or Worsening heart failure
Pneumothorax/PE
Life threatening asthma attack
Pnuemonia CRB score >0
Management (Chronic)
Assess for hospital admission
Investigations -vital signs, PEFR, ECG, CXRay
Treat underlying cause
Review
Specialist advice- respiratory nurse etc
O2
Anticipatory Care Planning
Treatment
02 therapy
Treat Cause
Antibiotics
Steroids
RED FLAGS
Altered conscious level
Increased respiratory effort, cyanosis, PEFR <50% of expected
hypotension, tachycardia,SpO2 <92%
Stridor
At risk groups: elderly, immunosuppressed, pregnancy/postnatal, significant comorbidities, poor or deteriorating condition, children
Classification
Subacute (develops over minutes & weeks)
Chronic (develops over weeks or months)
Acute (develops over minutes)