History and exam - breathlessness

Question 1

A patient has a sudden onset chest pain, dysponea and pleuritic pain. What could the differentials be?

Answer 1

Vascular - arrythmia, ACS, pericarditis, pleural effusion, pulomary oedema, asthma exacerbation, anaphylaxis

Infection - pneumonia, COVID,

Trauma - PE or pneumothorax

Autoimmune - SLE, sarcoidosis

Metabolic - liver disease, kidney disease, DKA, metabolic acidosis

Iatrogenic - NSAIDs, propanolol, overdose

Neoplasm - lung cancer, neoplasm

Congenital - atrial or septal defects

Degenerative - Myaesthesia gravis and Gullian Barre

Question 2

What is pneumothorax and how is it treated?

Answer 2

Pneumothorax. Primary is usually without prior respiratory disease and correlates with those that are young, tall and male or have Marfans who were playing sport. It is spontaneous. If smaller than 2cm not a worry. Tension pneumothorax is a worry.

Measure using a CXR. Measure at level of hilum from chest wall to lung border.

If no SOB and less than 2cm you can discharge and not treat.

SOB/ >2cm aspiration

If happens again chest train.

Tension pneumothorax is damage to the wall of the pleura/ chest wall. Pneumothorax gets larger with each breath therefore needs a large bore cannula in 2^nd ICS MCL. Then chest drain.

Triangle of safety = 5^th intercostal space, midaxillary line, anterior axillary line. X ray for chest drain.

Question 3

What scoring system can be used for breathlessness?

Answer 3

NYHA