Dyspnea

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of shortness of breath ‍on exertionat rest

Graded at ‍1234 / 4

orthopnea

paroxysmal nocturnal dyspnea

Worsening factors: ‍nonelying flat

Alleviating factors: ‍none, ‍effectiveineffective

Onset was ‍gradualsudden

Pattern ‍constantintermittent



Associated symptoms: *Try using right-click for negatives*

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍wheezing

‍fatigue

‍dizziness

‍palpitations

‍orthopnea

‍paroxysmal nocturnal dyspnea

‍edema

‍cyanosis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍hemoptysis

‍unexplained weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths

‍anxiety

‍use of accessory muscles

‍decreased exercise tolerance



Contributing factors:

‍smokingpast smoking

‍obesity

‍occupational exposure to irritants

‍recent travel

‍similar symptoms in close contacts

no history of: ‍asthma, ‍COPD, ‍CAD, ‍heart failure, ‍pneumonia, ‍pulmonary embolism, ‍anemia, ‍anxiety

no use of: ‍opioids, ‍sedatives, ‍new medication

no risk factors for ‍PE, ‍CAD





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Respiratory distress ‍likelysuspectedpossible

DDx: asthma exacerbation, COPD exacerbation, pneumonia, pulmonary embolism, heart failure, acute coronary syndrome, anxiety/panic attack, anemia, acute respiratory distress syndrome, interstitial lung disease, pleural effusion, pneumothorax, cardiac arrhythmia, valvular heart disease, pericarditis, myocarditis, upper airway obstruction, foreign body aspiration, pulmonary hypertension, sarcoidosis, tuberculosis, lung cancer, neuromuscular disorders





PLAN:

Investigations:

- Chest X-ray

- ECG

- Blood work: ‍CBC, ‍D-dimer, ‍troponin, ‍BNP, ‍blood gas, ‍electrolytes, ‍creatinine, ‍glucose, ‍CRP

- CT scan of the chest

- Stress test

- Echocardiogram

- Cardiac catheterization

- Pulmonary function tests

- Sleep study

Treatments:

- Oxygen therapy if SpO2 < 92%

- ‍Bronchodilators

- ‍Inhaled corticosteroids (ICS)

- ‍Diuretics

- ‍Anticoagulants

- Smoking cessation counseling

Further care:

- Referral to pulmonologist

- Referral to cardiologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if shortness of breath worsens or if new symptoms develop such as chest pain, palpitations, or syncope