Acute-onset dyspnea, cough, mild to severe chest pain, sense of impend¬ ing doom; hemoptysis; history of DVT, recent surgery, oral contraceptive, smoker, hypercoagulabilitystates
Pulmonary embolus
Restlessness, fever, tachycardia, tachypnea, diminished breath sounds, crackles, wheezing, pleural friction rub
Pulmonary embolus
Diagnostic Studies of Pulmonary embolus?
CTPA, ABGs, chest radiograph, ECG, ventilation/ perfusion scans, D-dimer, Wells score
Acute-onset dyspnea; history of drinking large amounts of alcohol; in children, history of putting small objects in mouth; possible cough
Foreign body aspiration
Apnea or tachypnea, restlessness, suprasternal retractions, intoxication, inspiratory stridor, localized wheeze
Foreign body aspiration
Diagnostic Studies of Foreignbody aspiration?
Lateral neck radiograph, chest radiograph, bronchoscopy
Acute-onset dyspnea; history of insect sting, ingestion of drug, or allergen
Anaphylaxis
Angioedema, tachypnea, clammy skin, hypotension, bilateral wheezes, tachycardia
Anaphylaxis
Diagnostic Studies of Anaphylaxis
None; emergency measures necessary
Acute-onset dyspnea; sharp, tearing chest pain; pain can radiate to ipsilateral shoulder
Pneumothorax
Tachycardia, diminished breath sounds, decreased tactile fremitus, hyperresonance of lung area affected; possible hypertension and tracheal shift
Pneumothorax
Diagnostic Studies of Pneumothorax?
Chest radiograph, ABGs
Historyofupper respiratory tract infection
Croup
Hoarse, seal-barkcough,fever (variable)
Croup
Diagnostic Studies of Croup?
None initially; if respiratory distress increases, pulse oximeter and referral
Positionalsittingforward; sorethroat, anxious,toxicchild
Acute epiglottitis
High fever, drooling, stridor, muffled voice
Acute epiglottitis
Diagnostic Studies of Acute epiglottitis?
None;emergency measures forairway support
Recentviralinfection
Bacterial tracheitis
Fever, stridor, purulent sputum
Bacterial tracheitis
Diagnostic Studies of Bacterial tracheitis?
Radiography of airway, WBC increased, tracheal culture
Recent URI, exposure to allergens, breathlessness
Status asthmaticus
Wheezing, coughing, tachycardia, tachypnea
Status asthmaticus
Diagnostic Studies of Status asthmaticus?
Peak flows, chest radiograph, ABGs
Honey ingestion in infant, contaminated food ingestion
Botulism
Hypoventilation, drooling, weak cry, ptosis, ophthalmoplegia, loss of head control
Botulism
Diagnostic Studies of Botulism?
Pulmonary function testing, chest radiograph, fluoroscopy, stool culture
Dyspnea, cough, sputum production (green,rust, or red), pleuritic chest pain, chills; in infants and children: irritabilityandfeeding problems
Pneumonia
Fever, tachycardia, tachypnea, inspiratorycrackles, asynchronous breathing,vocal fremitus, percussiondull or flat over area of consolidation, bronchophony, egophony
Pneumonia
Diagnostic Studies of Pneumonia?
Chest radiograph, sputum cultures, ABGs, WBC
Dyspnea, light-headedness, palpitations, paresthesias (perioral and extremities)
Hyperventilation syndrome
Restlessness, anxiety, normal CV examination
Hyperventilation syndrome
Diagnostic Studies of Hyperventilation syndrome?
Chest radiograph, TSH
Neonate, infant: history of stridor, history of URI
Bronchomalacia
Inspiratory stridor; normal cough, cry
Bronchomalacia
Diagnostic Studies of Bronchomalacia?
Refer forvisualization oflarynx
Infant: dyspnea,brassycough, difficulty swallowing
Vascularring
Inspiratorystridorwithexpiratory wheeze
Vascularring
Diagnostic Studies of Vascularring?
Barium swallow, echocardiography
Chronic progressive dyspnea, cough, frothy sputum, fatigue, lightheadedness, syncope, weight gain, ankle swelling, palpitations, PND, orthopnea, history of heart disease; in children: chronic progressive dyspnea, sweating above lip and forehead, especially while eating
Heart failure
Altered levelof consciousness, restlessness, jugular venous distention, tachypnea,use of accessory muscles to breathe, rales, rhonchi, wheezes,tachycardia, decreased peripheral pulses, cool extremities, displaced PMI, S3, S4, ascites, liverenlargement
Heart failure
Diagnostic Studies of Heart failure?
ECG, chest radiograph, ABGs, echocardiogram
Dyspnea on exertion, fatigue, palpitations, light-headedness, history of chronic disease
Anemia
Pallor, tachypnea, cool dry skin of extremities, possible orthostatic hypotension
Anemia
Diagnostic Studies of Anemia?
CBC, iron studies
Dyspnea on exertion, weight gain, palpitation on exertion, sedentary lifestyle, cigarette smoker
Poor physical conditioning
Overweight, tachycardia
Poor physical conditioning
Diagnostic Studies of Poorphysical conditioning?
Cardiac stress test
Dyspnea, paroxysmal cough, audible wheeze, history of asthma or allergies
Asthma
Restlessness, tachypnea, use of accessory muscles to breathe, intercostal retractions, decreased vocal fremitus, decreased breath sounds, inspiratory and possibly expiratory wheezes
Asthma
Diagnostic Studies of Asthma
Spirometry followed by a methacholine challenge, chest radiograph, ABGs
Chronicprogressive dyspnea, dyspneaon exertion, persistentcough,minimal sputum, easy fatigue,history of smoking
COPD
Rapid shallow respirations,reddish complexion, increased AP diameter of thorax, use of accessory muscles to breathe, pursed-lip breathing,decreasedtactile fremitus, decreased respiratory excursion bilaterally,lungs hyperresonant, distant breath sounds, prolonged expiration, occasionalwheezes,possible tachycardia,muffled heart sounds
COPD
Diagnostic Studies of COPD?
Chestradiograph, spirometry, exercisetests, ABGs
