Shortness of Breath | almostadoctor

Fields Pnuemothorax Pneumonia Pericarditis Pulmonary Pulmonary Diabetic

Emobilsm Oedema / Ketoacidosis
Heartfailure
Age Most common Extremities of age Increases Increases with Increases with More common
in 20-40y, also with Age age age <65 years
seen often in
older patients
Gender M>F M=F M>F <55 F > M, >55 M>F F>M
M>F

Typical A 30 year old A 75 year old woman A 40 year old A 35 year old A 69 year old man A 26 year old
Presentation male smoker receiving man who is woman who has with a family woman is take
with cystic radiotherapy for known to recently history of heart to A&E after
fibrosis oesophageal have had a undergone disease and becoming
presents to A&E carcinoma becomes recent orthopaedic hypertension increasingly
with shortness increasingly infection surgery develops drowsy and
of breath and confused and with presents to A&E shortness of confused at
sharp chest develops shortness coxsackie with acute breath and work, with
pain. On of breath, pleuritic virus onset shortness increasing diffuse
examination, chest pain and a dry develops of breath and intolerance to abdominal pain
there is cough. O/E she has a shortness of haemoptysis. exercise. He has and vomiting.
asymmetric temperature of 39’C breath and O/E she is found that he is She has been
lung expansion, and she is sharp, hypotensive being increasingly thirsty with
hyperresonance tachypnoeaic and pleuritic with a raised woken in the night polyuria. She
on percussion tachycardic. Chest chest pain JVP. She takes due to difficulty has been unde
and decreased auscultation which is no regular breathing. O/E he the weather th
tactile vocal suggests a pleural relieved by medications has crackles in past few days
fremitus. His rub leaning other than the both lung bases with a cold.
breath sounds forwards. He COCP. and an S3 heart
were reduced had sound.
on one side. rheumatic
Also classically fever as a
seen in child.
otherwise fit,
young, tall men.

Other Sharp chest SOB Cough SOB SOB SOB Fatigue Abdominal
Symptoms pain SOB (usually productive in Haemoptysis Lethargy pain Vomiting
Chest tightness young; dry in eldery) Dizziness Exercise Polyuria Thirs
Cough Vomiting Syncope intolerance Weight loss
Fatigue Headache Loss of Weight loss Weakness
Reduced AE on appetite Pleuritic Wheeze N&V Leg
affected side chest pain Nocturnal cough cramps
Haemoptysis (rarely) Blurred vision

Pain Acute, worse in Sub acute onset. Acute Pleuritic, acute Usually painless Gradual
inspiration Pleuritic. Sharp, onset, ften felt drowsiness,
('pleuritic') pleuritic in the back, less vomiting and
 Fields Pnuemothorax Pneumonia Pericarditis Pulmonary Pulmonary Diabetic
Emobilsm Oedema / Ketoacidosis
Heartfailure
chest pain often in the dehydration
aggravated chest with diffuse
by abdominal pain
movement,
exercise and
swallowing
and relieved
by leaning
forwards
Signs Tachycardia Fever Rigors Fever Pyrexia Orthopnea SOB
Tachypnoea Upper abdominal Pericardial Cyanosis Paroxysmal Kussmaul
Cyanosis (skin tenderness if lower friction rub Tachypnoea nocturnal breathing
blue etc.) lobe pneumonia Tachycardia dyspnea Ascites Clinical
Absent breath Signs of Hypotension Raised JVP evidence of
sounds over consolidation Raised JVP Pulsus alternans dehydration,
affected lung Dyspnoea Pleural rub Hypotension e.g. reduced
Asymmetric Tachypnoea Pleural effusion Tachycardia skin turgor
lung expansion Tachycardia Heaves Hypotension
– mediastinal Increased secretions Displaced apex Cold
and tracheal in ventilated patients beat Gallop (S3) extremities/
shift to Pleural rub/ rapid Bilateral peripheral
contralateral shallow breathing (if crepitations cyanosis
side in tension strep pnuemoniae) Cachexia and Tachycardia
pneumothorax Confusion in elderly muscle atrophy Hypothermia
Hyperresonance Hypotension and AF Hepatic Increased RR
on percussion are complications tenderness Smellof
Decreased acetone on
tactile fremitus breath
Adventitious Confusion/
lung sounds: drowsiness/
ipsilateral coma
crackles,
wheezes
Tracheal
deviation
(tension
pneumothorax -
decompress
immediately!)
Past Medical Tall and thin HX MI FH thrombosis Peripheral New onset
History Smoker FH Immunosuppression/ Autoimmune Recent stasis/ oedema UTI/ flu-like
Underlying lung HIV Hospital disease immobility (in Crackles in lungs illness/
disease (COPD, admission Recent Trauma hospital/ long Hypertension pneumonia H
cystic fibrosis, HX viral infection/ Neoplasm flight) Coronary artery recent surgery
pneumonia) ‘the flu’ Smoker Recent viral Dehydration disease Smoker Hyperglycaem
Mechanical Alcohol excess or bacterial pregnancy Arrhythmia Diabetes
ventilation HX Bronchiectesis (e.g. infection combined oral Valvular disease Mellitus –
previous in CF) Bronchial HX TB/ contraceptive Hx of MI/ predominantly
pneumothorax obstruction (e.g. rheumatic pill Obesity myocardial T1 Hx poor
HX trauma carcinoma) IVDU fever HIV Varicose veins ischaemia control of
Dysphagia positive Recent surgery Obesity hyperglycaemi
previous DVT/ Excessive alcohol Pregnancy
embolism consumption Stroke
Trauma Cocaine use Cocaine use
Infection Chemotherapeutic
Malignancy drugs (beta
Congestive blockers)
heart failure Thyrotoxicosis/
Recent MI myxedema
Thrombophilia Cardiomyopathy
 Fields Pnuemothorax Pneumonia Pericarditis Pulmonary Pulmonary Diabetic
Emobilsm Oedema / Ketoacidosis
Heartfailure
Anaemia
Pulmonary
hypertension
Pericardial
disease Family
history

Bloods ABG: low O2 Raised WCC ABG: O2 low, Anaemia

and high CO2 Raised ESR Leukocytosis CO2 normal/low Hyponatraemia Hyperglycaem
with respiratory >100mm/h Raised if resulting +/- metabolic Hypo/ (but not
acidosis CRP Possible from acidosis D- hyperkalaemia always!)
anaemia (if abscess) bacterial/ dimer Abnormal LFTs Ketones in
Blood cultures to viral Abnormal RFTs blood
identify organism infection TFT to rule out Urinalysis:
thyrotoxicosis/ ketones and
myxedema blood ABG:
acidosis Urea
and creatinine
may indicate
kidney
impairment du
to dehydration
High CRP
High WCC
May have high
serum amylase

Imaging CXR: air in CXR: consolidation None CXR: normal/ CXR: CXR to
pleural space, 48h after onset of specific pulmonary cardiomegaly and exclude
trachea symptoms oedema signs pleural effusions infection CT
deviated away (raised Echocardiogram to exclude
from hemidiaphragm) to confirm stroke if
pneumothorax +/- atelectasis Angiography to confusion/
if tension VQ scan or CT assess extent of recurrent
pneumothorax, depending on IHD vomiting
lung collapse patients age
may be visible. and other
(NB - if a factors
tension
pneumothorax,
you shouldn't be
doing a CXR,
you should be
decompressing
immediately
based on
clinical signs!)

Additional None specific O2 sats <94% ECG: ECG: Sinus Vital capacity
Investigations worrying, unless widespread tachycardia, T- decreased by a
COPD / smoker, then saddle wave inversion, third of maximum
88-92% acceptable shaped ST new onset AF, value ECG may
 Fields Pnuemothorax Pneumonia Pericarditis Pulmonary Pulmonary Diabetic
Emobilsm Oedema / Ketoacidosis
Heartfailure
Sputum culture elevation right bundle indicate
Urine culture for and PR branch block, underlying cause,
legionella Pleural interval right axis e.g. MI, BBB,
fluid aspiration depression. deviation ventricular
CURB-65 score for Later sign: T Severe ECG hypertrophy,
community-acquired wave changes: S pericardial
pneumonia insertion and waves in lead I, disease,
ST elevation Q waves in lead arrhythmia
in inferior III, T wave Pulmonary
and anterior inversion in lead function tests to
leads III exclude lung
disease causing
breathlessness

Full Article Pneumothorax Pneumonia  and  Pericarditis DVT and PE Heart Failure Diabetes
Pneumonia in
Children