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Breathlessness - Coggle Diagram
Breathlessness
INVESTIGATIONS
Chest X-Ray
Abdominal Ultrasound
BNP - PRO
ECG
CRP
FBC
U&E
LFTs
TFTs
Pulse Oximetry
Peak Flow
PULMONARY CAUSES
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Pneumonia
Pulmonary Embolism
Lung Cancer/Pleural Cancer
Pleural Effusion
COVID 19
Bronchieetasis
Pneumothorax
MANAGEMENT
Arrange emergency admission for patients with: Rapid onset/worsening symptoms. Suspected Symptoms of worsening heart failure, Suspected Sepsis, Anaphylaxis, ECG suggestive of cardiac arrhythmia or MI. Cardiac Tamponade, PE, Pneumothorax, Pulmonary Oedema, Super vena cava syndrome, Life threatening asthma or COPD, Patients with a CURB65 score of 3 or more
Management waiting on admission: Sit patient upright, If persons SP02 is 94% or less consider if COPD and risk of hypercapnia.
Identify clinical features of COPD exacerbation and administer Bronchodilator therapy via a metered dose inhaler or nebulizer. Give oral prednisolone 30mgs if available.
Asthma acute severe: Give a bronchodilator by nebulizer with 02 - Repeat in 15-30 min intervals if initial response. Give 40-50mgs of oral prednisolone,
Pulmonary Oedema: Give IV Diuretic
Silent MI: Give 300mgs Aspirin
If emergency admission is not indicated: Refer urgently using a suspected cancer pathway for lung CA if they have a chest X-RAY findings suggestive of lung CA.
Cardiac Causes
Silent Myocardial Infarction
Cardiac Arrhythmia
Acute Pulmonary Oedema
Chronic Heart Failure
Cardiac Tamponade
Super vena cava syndrome
OTHER CAUSES
Anaemia
Diaphragmatic Splinting
Psychogenic Breathlessness
Anxiety
Anaphylaxis
Assessment
Carry out A-E Assessment
Assess if emergency admission required if not take a robust history
In the assessment ask about: Duration, Onset, Severity, relieving and exacerbating factors, pattern of dyspnoea, affects on daily activities, associated symptoms, comorbidities, surgeries, drug Hx, smoking, alcohol intake, Physical and travel Hx.
Examine the patient: Respiratory, Cardiac, Neurological for any under lying conditions
Arrange appropriate investigations with examination findings in mind
DEFINITION: Also known as Dyspnoea is a highly subjective, uncomfortable or distressing sensation that occurs when actual ventilation is perceived not to satisfy demand: Breathlessness is characterised by speed on onset, acute, subacute and chronic. It can be caused by pulmonary, cardiac or other causes.