Breathless patients are a challenge in the ED. Shortness of breath can be a frightening presenting complaint for both patients and doctors. As always, think about the possible life threatening causes and actively rule them out. For breathless patients think especially about:

  • Pneumonia
  • Asthma/COPD
  • Pulmonary Embolism
  • Acute left ventricular failure
  • Pneumothorax

Any patient with significant dyspnoea will require a rapid assessment of their vital signs followed by appropriate resuscitation (airway support, supplemental oxygen, ventilatory support, etc.).

Patients who do not require immediate resuscitation will have their management guided by a thorough clinical assessment commencing with a focussed history and examination. Certain examination findings upon respiratory system examination are diagnostic in the context of presentation with dyspnoea. Pulse oximetry provides a simple, accurate, non-invasive and continuous means of monitoring arterial oxygen saturation. A number of factors can affect the accuracy of pulse oximetry and it is important to be aware of its limitations.

Remember: A high RR can also be caused by non-respiratory pathology, for example compensation for a metabolic acidosis.

tasks

1. Listen to the following podcasts which discuss

  • an approach to the breathless patient
  • management of a patient in type 2 respiratory failure
  • an update on the Asthma 2016 BTS Guideline

2. Spend some time reviewing normal and abnormal CXR appearances on the Radiology Masterclass website - link below.

3. On your next shop floor shift try to see a patient presenting with acute breathlessness and complete a case based discussion with a senior. 

 

A blog and podcast by the St. Emlyn's team discussing an approach to the breathless patient.

A short podcast from The Resus Room running over the summary of recommendations published by the British Thoracic Society and the Intensive Care society on the Ventilatory Management of Acute Hypercapnia Respiratory Failure in Adults

In this podcast from The Resus Room, the 2016 BTS Asthma Guidelines are discussed -  briefly running through some of the aspects covered in the acute management section.

Make sure you have a look at the full document that can be found here.

This tutorial from the excellent website, Radiology Masterclass, demonstrates some of the important anatomical structures visible on a chest X-ray. These structures are discussed in a specific order to help you develop your own systematic approach to viewing chest X-rays.

This tutorial takes you through some abnormalities of the structures you learned about in the chest X-ray anatomy tutorial.

Although specific diseases are mentioned, the aim of the tutorial is to introduce you to some key principles relating to a range of abnormalities, and to help you learn how to describe them.