Dyspnea
What is the definition of dyspnea? What kind of complaint is it?
abnormally increased awareness of breathing or sensation of difficulty breathing subjective complaint
What classifies acute vs. chronic dyspnea?
acute <1 month (usually shorter) chronic >1 month
What causes a productive cough?
acute pneumonia flash pulmonary edema COPD (chronic bronchitis)
What increases the work of breathing?
airway obstruction changes in lung compliance respiratory muscle weakness
Why is lip swelling, hives and wheezing and alarm symptoms?
anaphylaxis angioedema
Many patients who have organic causes for their dyspnea will appear to be...?
anxious hypoxia can manifest as anxiety!!
What causes a nonproductive cough?
asthma PE GERD
What are the physical signs of acute dyspnea?
can say 2-3 words then taking breath nasal flaring cyanosis accessory muscle use **basically a really out of shape person running
Why is fever with worsening sore throat and hoarse voice an alarm symptom?
epiglottitis
What are the constitutional associated symptoms?
fever weight loss fatigue night sweats
Why is pink frothy sputum an alarm symptom?
flash pulmonary edema
Why is fever with sputum production an alarm symptom?
pneumonia vs. bronchitis pneumonia = bacterial = antibiotics bronchitis = viral = none
What are DVT risk factors?
prolonged immobilization OCP/estrogen use Hx cancer Recent travel
Dyspnea is the __ most common reason for ER visits in the US.
second
Why is pleuritic chest pain an alarm symptoms?
sharp unilateral chest pain that increases with respiration - PE, PTX, pneumonia
Slow progression of dyspnea is likely to lead to what etiology? rapid progression?
slow -> chronic rapid -> acute/alarm symptoms
What is the first question you should ask a patient complaining of dyspnea?
How long has this been going on?
Why is substernal chest pain an alarm symptoms?
AMI
What are the 4 major physiological reasons that dyspnea occur?
1. Increased the work of breathing - can't get air in 2. Poor oxygen uptake 3. Increased respiratory drive -> hypoxia, metabolic acidosis 4. Primary psychologic conditions -> anxiety
What are causes of poor oxygen uptake?
1. Lung circulation problem -PE -L sided HF -Pulm HTN 2. Hemoglobin disorder -Anemia -CO poisoning
What percentage of people with pneumonia have a fever? PE?
80% of pneumonia patients 20% of PE patients
A history of what conditions are risk factors for dyspnea?
CAD CHF MI smoking - COPD, CAD, lung cancer
The people with chronic dyspnea will end up having one of the following conditions...?
COPD Asthma Interstitial lung dz Myocardial dysfunction Obesity/deconditioning
What causes pulmonary edema in acute dyspnea?
Cardiogenic - CHF Pulmonary - high altitude, gas inhalation (less common)
What are accessory muscles used for breathing?
Chest wall Abdominal muscles Neck - sternocleidomastoid and scalene
What are other risk factors for dyspnea?
Medications Occupation
What causes acute dyspnea?
PPOPPA-M Pulmonary embolism Pulmonary edema Obstructed airway Pnemumothorax Pneumonia/bronchitis Ashtma/COPD MI/tamponade
What should you consider if the dyspnea is worse when laying down? Better when laying on one side?
laying down: orthopnea -> CHF one side: trepopnea -> unilateral effusion