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:
- Pulmonary Embolism
- Acute left ventricular failure
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.
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.