Flashcards in RESP - dyspnoea Deck (8)
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1
(5) clinical causes of dyspnoea
•Respiratory
•Cardiac
•Chest wall restriction/muscle weakness
•Metabolic/anaemia
•Psychogenic
–This is a diagnosis of exclusion
–Dyspnoea may be a physical manifestation of stress
–Don’t forget, sick people are often anxious as well
2
What Ix would you do to diagnose a pt with dypsnoea?
–CXR, ECG, ABG’s, basic bloods
–Lung function, CT, VQ, exercise test, echo
3
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.
DDx?
•Pneumothorax
•Arrhythmia
•Pulmonary Embolism
•Pneumonia, Asthma (less likely), anxiety
4
•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
DDx?
Tension pneumothorax
Pneumothorax
5
23yo male, progressive SOB over 48 hours, now present at rest. Wheeze, dry cough, recent URTI, childhood asthma, hay fever.
O/E:
•RR 24, HR 110 SR, BP 110/70
•Sat 97% RA
•Widespread wheeze (what causes this sound?)
Ix:
•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
6
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
O/E:
•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
Ix:
•CXR normal
•ABG pH 7.5/CO2 30mmHg/p02 62mmHg on RA
•CTPA pending
DDx?
Rx of most likely diagnosis?
•PE
•Pneumonia
•Pneumothorax
•Arrythmia
•AMI
•Anxiety
Mx: Anticoagulation
7
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.
O/E:
•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
Ix:
•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
DDx:
•CCF with acute exacerbation
•Anxiety
•Muscle weakness
•Anaemia
Mx: Bronchodilators, controlled oxygen, corticosteroids, antibiotics, Non Invasive Ventilation (NIV)
8
