Flashcards in RESP - dyspnoea Deck (8)
(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.
•Pneumonia, Asthma (less likely), anxiety
•Looks unwell, quite distressed with WOB
•RR 26, HR 125 SR, BP 80/60, afeb
•Saturation 93% RA
•reduced chest expansion on the left
•Hyperesonant percussion note on the left
•reduced air entry left lung
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?)
•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?
–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
•ABG pH 7.5/CO2 30mmHg/p02 62mmHg on RA
Rx of most likely diagnosis?
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
Dx: Chronic obstructive pulmonary disease (COPD) with acute infective exacerbation
•CCF with acute exacerbation
Mx: Bronchodilators, controlled oxygen, corticosteroids, antibiotics, Non Invasive Ventilation (NIV)