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