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Flashcards in RESP - dyspnoea Deck (8)
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(5) clinical causes of dyspnoea

•Chest wall restriction/muscle weakness
–This is a diagnosis of exclusion
–Dyspnoea may be a physical manifestation of stress
–Don’t forget, sick people are often anxious as well


What Ix would you do to diagnose a pt with dypsnoea?

–CXR, ECG, ABG’s, basic bloods
–Lung function, CT, VQ, exercise test, echo


23 yo male, sudden onset SOB, present for a few hours & now very severe. Previously well, 10 cigarettes/day. L chest pain pleuritic & started with SOB.


•Pulmonary Embolism

•Pneumonia, Asthma (less likely), anxiety


•Looks unwell, quite distressed with ­ WOB
•RR 26, HR 125 SR, BP 80/60, afeb
•Saturation 93% RA
•Trachea midline
•reduced chest expansion on the left
•Hyperesonant percussion note on the left
•reduced air entry left lung


Tension pneumothorax



23yo male, progressive SOB over 48 hours, now present at rest. Wheeze, dry cough, recent URTI, childhood asthma, hay fever.

•RR 24, HR 110 SR, BP 110/70
•Sat 97% RA
•Widespread wheeze (what causes this sound?)

•CXR normal
•Peak Flow 300/min (how does this help us?)
•ABG ph 7.5/CO2 30/O2 70/HCO3 23

What do the blood gases show? Dx? Mx?

Resp alkalosis
–Widened Aa gradient
–Gas exchange is NOT normal despite normal saturation on the monitor.

Dx: exacerbation of asthma

Mx: Bronchodilators, corticosteroids, oxygen


68yo female, sudden onset SOB (for 1 hour quite severe). R pleuritic chest pain, mild fever, R TKR 3 days ago, persistent leg swelling. non smoker, no previous CV/resp disease, no injury

•Not too unwell but clear evidence of tachypnoea and some ­ WOB
•RR 24, T 37.6, HR 110, BP 110/70
•Sats 93% RA
•Chest clear with normal percussion and normal breath sounds

•CXR normal
•ABG pH 7.5/CO2 30mmHg/p02 62mmHg on RA
•CTPA pending

Rx of most likely diagnosis?



Mx: Anticoagulation


68 yo female, progressive SOB over 6/12 worse over 24 hours. Chronic cough, usually with white sputum, now worse with change in sputum amount & colour. Fever. Some orthopnoea, heavy smoker of 35pack years.

•Unwell, RR 26, T 37.8, HR 90 SR, BP 140/80
•Sat’s 88% RA
•Evidence of ­increased work of breathing and use of accessory muscles (which are these?)
•Signs of hyperinflation
–Barrel chest, reduced chest expansion, hyper-resonant percussion
•Prolonged expiration with wheeze

•ABG pH 7.28/pCO2 60/pO2 55/HCO3 26
•What do these show?
•Acute Type II respiratory failure

DDx? Mx?

Dx: Chronic obstructive pulmonary disease (COPD) with acute infective exacerbation

•CCF with acute exacerbation
•Muscle weakness

Mx: Bronchodilators, controlled oxygen, corticosteroids, antibiotics, Non Invasive Ventilation (NIV)


68yo male, progressive SOB over 6/12, worse over 24hours. Orthopnoea, PND, SOA present to a minor degree over 6 months but worse for 24 hours. Palpitations (last 24hours), previous AMI 4 years ago, pace maker. Ex-smoker, HTN, DM.

•Unwell looking with increased work of breathing
•RR 26, afeb, HR Irreg 130, BP 100/70
•Sat 90% RA
•JVP 5cm
•SOA ++
•Displaced apex beat, no cardiac murmurs, 3rd heart sound present
•Normal chest expansion but stony dull percussion in the bases (R>L), bilateral inspiratory crepitations just above the dull areas

•ECG Rapid AF
•ABG ph 7.43/pCO2 36/PO2 60/HCO3 20

DDx? Mx?

Dx: Long standing heart failure with an acute exacerbation due to new onset rapid AF

•Acute myocardial infarct/angina

Mx: Digoxin, Beta blocker, diuretic, ACE inhibitor, warfarin, oxygen

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