Acute Dyspnea
most common cause of dyspnea in the ED - ANSWER: pneumonia (20%), CHF
exacerbation (15%), COPD exacerbation (13%), asthma (13%), other (28%)
rating for assessing dyspnea - ANSWER: 0- not troubled by breathlessness, except with
strenuous activity
1- shortness of breath walking
2- walks slower than normal due to breathlessness
3- stops to rest after 100m or a few minutes
4- too breathless to leave house or ADLs
causes of central mismatch - ANSWER: brain, chemoreceptors, metabolic
causes of ventilatory effort mismatch - ANSWER: chest wall, scoliosis, neuromuscular
and parenchyma
causes of gas exchange mismatch - ANSWER: airways, parenchyma, alveoli,
pulmonary vasculature and anemia
dyspnea clinical signs - ANSWER: tachypnea
chest retraction or accessory muscle use (abdomen, neck)
gasping for air
panting
restlessness
AMS (from hypoxia or hypercarbia)
Initial tests for acute dyspnea - ANSWER: full set of vitals, EKG, lab tests
what lab tests should you order for acute dyspnea? - ANSWER: Blood gas (arterial vs.
venous)
CBC
BMP
Troponin
D-Dimer
BNP
Lactate
Procalcitonin
Toxicology Labs
CT chest non contrast used for - ANSWER: bones, simple pneumothorax or when
contrast contraindicated
, CT chest with contrast used for - ANSWER: infection, mass, pulmonary contusion,
bleeding
CTA (angiogram) chest used for - ANSWER: specific to PE and dissection
Indications for intubation - ANSWER: inability to protect airway
loss of adequate oxygenation or ventilation
high likelihood of clinical decompensation without a secured airway
capnography - ANSWER: noninvasive measurement of CO2 concentration in expired
air
dead space ventilation - ANSWER: phase 1 of capnography (A)
ascending phase - ANSWER: phase 2 of capnography (B)
alveolar plateau - ANSWER: phase 3 of capnography (C)
inspiratory limb - ANSWER: phase 4 of capnography (D)
Normal capnogram characteristics - ANSWER: four distinct phases
CO2 conc starts at 0 and returns to 0
maximum CO2 conc reached with each breath
characteristic shape
Capnography is (more/less) sensitive than clinical assessment of ventilation in detecting
apnea or other respiratory complications - ANSWER: more sensitive
peak expiratory flow meter - ANSWER: What?
handheld device as a personal monitoring tool, measures flow rates which peak at early
sages of forced expiration
Clinical Use?
Identifying risk for exacerbation, need for medication adjustment and identify risk for
distress and avoidance of certain activities
incentive spirometry - ANSWER: -inspiratory device to improve respiratory muscle
strength and pulmonary toilet
-it encourages maximal and sustained inspiratory effort by inflating lungs improving
ventilation and oxygenation, prevents splinting and improves mucous clearance
incentive spirometry clinical use and frequency - ANSWER: Uses:
rib injury, bed rest, pregnancy, asthma, pneumonia, COPD, cystic fibrosis, post surgery
Frequency:
10x/hour
most common cause of dyspnea in the ED - ANSWER: pneumonia (20%), CHF
exacerbation (15%), COPD exacerbation (13%), asthma (13%), other (28%)
rating for assessing dyspnea - ANSWER: 0- not troubled by breathlessness, except with
strenuous activity
1- shortness of breath walking
2- walks slower than normal due to breathlessness
3- stops to rest after 100m or a few minutes
4- too breathless to leave house or ADLs
causes of central mismatch - ANSWER: brain, chemoreceptors, metabolic
causes of ventilatory effort mismatch - ANSWER: chest wall, scoliosis, neuromuscular
and parenchyma
causes of gas exchange mismatch - ANSWER: airways, parenchyma, alveoli,
pulmonary vasculature and anemia
dyspnea clinical signs - ANSWER: tachypnea
chest retraction or accessory muscle use (abdomen, neck)
gasping for air
panting
restlessness
AMS (from hypoxia or hypercarbia)
Initial tests for acute dyspnea - ANSWER: full set of vitals, EKG, lab tests
what lab tests should you order for acute dyspnea? - ANSWER: Blood gas (arterial vs.
venous)
CBC
BMP
Troponin
D-Dimer
BNP
Lactate
Procalcitonin
Toxicology Labs
CT chest non contrast used for - ANSWER: bones, simple pneumothorax or when
contrast contraindicated
, CT chest with contrast used for - ANSWER: infection, mass, pulmonary contusion,
bleeding
CTA (angiogram) chest used for - ANSWER: specific to PE and dissection
Indications for intubation - ANSWER: inability to protect airway
loss of adequate oxygenation or ventilation
high likelihood of clinical decompensation without a secured airway
capnography - ANSWER: noninvasive measurement of CO2 concentration in expired
air
dead space ventilation - ANSWER: phase 1 of capnography (A)
ascending phase - ANSWER: phase 2 of capnography (B)
alveolar plateau - ANSWER: phase 3 of capnography (C)
inspiratory limb - ANSWER: phase 4 of capnography (D)
Normal capnogram characteristics - ANSWER: four distinct phases
CO2 conc starts at 0 and returns to 0
maximum CO2 conc reached with each breath
characteristic shape
Capnography is (more/less) sensitive than clinical assessment of ventilation in detecting
apnea or other respiratory complications - ANSWER: more sensitive
peak expiratory flow meter - ANSWER: What?
handheld device as a personal monitoring tool, measures flow rates which peak at early
sages of forced expiration
Clinical Use?
Identifying risk for exacerbation, need for medication adjustment and identify risk for
distress and avoidance of certain activities
incentive spirometry - ANSWER: -inspiratory device to improve respiratory muscle
strength and pulmonary toilet
-it encourages maximal and sustained inspiratory effort by inflating lungs improving
ventilation and oxygenation, prevents splinting and improves mucous clearance
incentive spirometry clinical use and frequency - ANSWER: Uses:
rib injury, bed rest, pregnancy, asthma, pneumonia, COPD, cystic fibrosis, post surgery
Frequency:
10x/hour
