Dyspnea and Hypoxia
On Call: Shortness of Breath (Dyspnea) and Hypoxia
Table of Contents
Differential Diagnosis
Upper Airway Obstruction
- Angioedema
- Anaphylaxis
- Epiglottitis
- Foreign Body in Trachea
Cardiac Etiology
- Myocardial Infarction (MI)
- Pericardial Tamponade
- Heart Failure
- Arrhythmia
Pulmonary Etiology
- Pulmonary Embolism (PE)
- COPD/Asthma Exacerbation
- Tension Pneumothorax
- Pneumonia
- Pulmonary Edema
- Pleural Effusion
- Acute Chest Syndrome
Other Etiology
- Anxiety and Hyperventilation
- Diabetic Ketoacidosis (DKA)
- Sepsis
- Stroke
- Salicylate Poisoning
- Trauma/Rib Fracture
- Postoperative Pain
Particular Concerns for History & Physical
Vitals
- ABC’s – Airway, Breathing, and Circulation
- Vital Signs
- Oxygenation Monitoring – Pulse Oximetry
Subjective
- Severity
- Timing (Sudden or Gradual)
- Associated Chest Pain
- Fevers
- Cough/Sputum
- Tobacco or Drug Use
History
- History of Cardiac Disease
- History of Pulmonary Disease
- History of Psychiatric Disease
- Surgical History
- Prior Intubations
Physical Exam
- Mental Status Changes
- Cyanosis
- Retractions and Use of Accessory Muscles
- Diaphoresis
- Unable to Lie Supine
- Heart/Lung Auscultation
- Jugular Venous Distention
Work Up & Management
Always Start with ABC’s – Airway, Breathing, and Circulation
Initial Orders
- EKG
- Chest X-Ray
- Troponin
Other Potential Orders
- Arterial Blood Gas (ABG)
- Other Labs (CBC, CMP, BNP)
- Echocardiogram
- CT Chest
- CTA Chest
- CT Pulmonary Angiogram
Supplemental Oxygenation
- Generally Start by Either Adding or Advancing Supplemental Oxygenation
- *See Supplemental Oxygenation – The Trauma ICU
- *See Non-Invasive Ventilation (CPAP/BiPAP) – The Trauma ICU
- *See Mechanical Ventilation – The Trauma ICU
Further Management
- Dictated by Findings and Diagnosis