APPROACH TO SHORTNESS

OF BREATH

DR MOHD FAQHROLL MUSTAQIM BIN MOHD

FUDZI
MBBS (IIUM) M.MED(EMERGENCY
MEDICINE)USM
 DEFINITION

Lelah?
Susah nafas?
Tok puas nyawo?
Dyspnea
Hard to breath
 INITIAL ASSESSMENT

Always manage using A-B-C

Main priority is AIRWAY and BREATHING
Look for:
 Unable to talk
 Sitting position
 Respiratory rate
 Usage accessory muscle
 Stridor / Wheezing
 Subcostal recession / intercostal recession / nasal flaring
 Cyanosis
 INTIAL ASSESMENT

Foreign body / Secretion

Auscultate for:
 Rhonchi
 Crepitations
 Reduced air entry
SPO2
Blood Pressure
Heart Rate
 ETIOLOGY

Always look for

 Respiratory
 Cardiac
 Systemic
 Airway obstruction
 RESPIRATORY CAUSE

ASTHMA
COPD
PNEUMONIA
PNEUMOTHORAX
PULMONARY EMBOLI
PLEURA EFFUSION
LUNG CA
ASPIRATION
 CARDIAC

ACUTE CORONARY SYNDROME

PULMONARY EDEMA
HEART FAILURE
VALVULAR HEART DISEASE
ARRYTHMIA
CARDIAC TAMPONADE
 SYSTEMIC

ANEMIA
RENAL FAILURE
METABOLIC ACIDOSIS
ANAPHYLAXIS
SEPSIS
THYROXICOSIS
LIVER CIRRHOSIS
 TRAUMA

RIB FRACUTURE
FLAIL CHEST
CARDIAC TAMPONADE
 OTHERS

CROUP
BRONCHIOLITIS
FOREIGN BODY
HYPERVENTILATION
GERD
 HISTORY

ONSET
 Acute – ACS, APO, pnumothorax, foreign body, anaphylaxis
DURATION
 Slow progression (hours to days) – COPD/asthma, heart
failure, penumonia, pleural effusion
PATTERN
 Orthopnea - heart failure
 Paroxysmal Nocturnal Dyspnea – heart failure, GERD
 HISTORY

VARIATION
 Intermittent – Asthma , COPD
 Exercise induced – ACS, Asthma
 Seasonal

ASSOCIATED SYMPTOMS
 Chest Pain!! – ACS, Aortic dissection, Pulmonary Embolism
 Fever
 Cough
 Hemoptysis
 Leg edema
 Abdominal distension
 Panic attack
 INVESTIGATION

ECG!!
CXR
ABG

Glucometer
FBC
RFT/LFT