Pulmonology Book

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Acute DyspneaAka: Dyspnea, Shortness of Breath, SOB, Orthopnea

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  1. See Also
    1. Chronic Dyspnea
    2. Dyspnea Causes
    3. Dyspnea History
    4. Dyspnea in Cancer
    5. Acute Respiratory Failure
  2. Definition: Acute Dyspnea
    1. Subjective difficult or distressed breathing <1 month
  3. Causes
    1. See Dyspnea Causes
  4. Symptoms
    1. Shortness of breath
    2. Chest tightness
  5. Signs
    1. Patient breaks up sentence to pause for breath
    2. Tachypnea
    3. Increased respiratory excursions
    4. Nasal flaring
    5. Cyanosis
    6. Accessory muscle use
      1. Chest and abdominal muscle use
      2. Neck muscle use (Scalene, Sternocleidomastoid)
  6. History
    1. See Dyspnea History
  7. Exam
    1. Nose and sinus exam
    2. Fluid status exam
      1. Jugular Venous Distention
      2. Hepatojugular Reflex
      3. Peripheral Edema
    3. Peripheral Vascular Exam
      1. Decreased pulses or bruits
    4. Respiratory Exam
      1. Increased AP Chest diameter
      2. Wheezing
      3. Rales
      4. Cyanosis
      5. Clubbing
      6. Accessory muscle use (Neck, chest, abdomen)
      7. Speaking in phrases to catch breath
    5. Cardiac Auscultation
      1. Tachycardia
      2. S3 Gallup Rhythm
      3. Cardiac Murmur
    6. Psychomotor exam
      1. Anxiety
  8. Phone Triage: Indications for Emergency Room Evaluation
    1. Adults
      1. Severe dyspnea
      2. New onset of dyspnea at rest
      3. Sudden Chest Pain onset associated with dyspnea
    2. Children
      1. Dyspnea in a child under age 3 months
      2. Sudden onset dyspnea
      3. Temperature over 102 F
      4. Lethargy
      5. Pharyngitis with Dyspnea
      6. Croup-type cough with Dyspnea
    3. References
      1. Zoorob (2003) Am Fam Physician 68(9):1803
  9. Evaluation: Acute Dyspnea
    1. Immediate ABC Management
      1. Emergency Airway Management
      2. Emergency Breathing Management
      3. Emergency Circulation Management
    2. Obtain initial vital signs
      1. Temperature, Blood Pressure, and Pulse
      2. Respiratory Rate and Oxygen Saturation
    3. Immediately triage unstable patients
      1. Hypotension
      2. Altered Level of Consciousness
      3. Hypoxia (decreased Oxygen Saturation)
      4. Arrhythmia
      5. Stridor or other signs of upper airway obstruction
      6. Unilateral breath sounds or other Pneumothorax signs
      7. Respiratory Rate >40 breaths per minute
      8. Accessory muscle use with retractions
      9. Cyanosis
    4. Initial management of acute distress
      1. Obtain Intravenous Access
      2. Administer High Flow Oxygen
      3. Evaluate and treat Hypoxia if present
        1. Consider Pulmonary Embolism Diagnosis
    5. Initiate disease specific management
      1. See Emergency Management of Asthma Exacerbation
      2. See COPD Exacerbation Management
      3. See Acute Pulmonary Edema Management
      4. See Tension Pneumothorax and Needle Thoracentesis
  10. Imaging
    1. Chest XRay
      1. Indicated in all cases
      2. Identifies primary pulmonary causes of dyspnea
    2. Spiral CT or Ventilation-Perfusion Scan
      1. Indicated for Hypoxia with normal CXR, Spirometry
    3. Echocardiogram
      1. Indicated for suspected cardiogenic cause
  11. Labs
    1. Initial (as directed by clinical findings)
      1. Hemoglobin or Hematocrit
      2. Thyroid Stimulating Hormone (TSH)
      3. Electrocardiogram (EKG)
      4. Arterial Blood Gas
      5. B-Type Natriuretic Peptide (BNP)
        1. BNP use expedites ER evaluation and lowers cost
          1. CHF most likely dyspnea cause when BNP >500 pg/ml
          2. CHF unlikely dyspnea cause when BNP <100 pg/ml
          3. Mueller (2004) N Engl J Med 350:647
        2. BNP with Chest XRay identifies CHF as dyspnea cause
          1. Knudson (2004) Am J Med 116:363
    2. Second line tests (when stable)
      1. Pulmonary Function Tests (Spirometry)
      2. Exercise treadmill testing with Oxygen Saturation
  12. References
    1. Braithwaite in Marx (2002) Rosen's Emergency, p. 155-62
    2. Degowin (1987) Diagnostic Exam, p. 281-2
    3. Fangman in Noble (2001) Primary Care, p. 175-8
    4. Marini (1987) Respiratory Medicine, p. 40-41
    5. Stulbarg in Murray (2000) Respiratory Med, p. 541-52
    6. Zoorob (2003) Am Fam Physician 68(9):1803

Crying (C0010399)

Definition (MSH)To utter an inarticulate, characteristic sound in order to communicate or express a feeling, or desire for attention.
Definition (CSP)to utter an inarticulate, characteristic sound in order to communicate or express a feeling, or desire for attention.
ConceptsIndividual Behavior (T055)
EnglishCrying, Cryings, Sobbing
Spanishllanto, llorar, sollozo
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Dyspnea (C0013404)

Definition (MSH)Difficult or labored breathing.
Definition (CSP)labored or difficult breathing associated with a variety of disorders, indicating inadequate ventilation or low blood oxygen or a subjective experience of breathing discomfort.
Definition (NCI)Difficult, painful breathing or shortness of breath.
ConceptsSign or Symptom (T184)
DanishAndenod/dyspno
DutchDyspnoe/benauwdheid
EnglishBREATHING DIFFICULT, Breathing Difficulties, Breathless, Breathlessness, Breathlessness symptom, Difficulty breathing, Dyspnea, Dyspneas, DYSPNOEA, Respiration difficult, Respiratory difficulties, Shortness of breath dyspnea, Winded
FinnishHENGENAHDISTUS/DYSPNEA
FrenchSouffle court/dyspnee
GermanKurzatmigkeit/Dyspnoe
Hebrewkotzer neshima
Hungariannehezlegzes/dyspnoe
ItalianRespiro affannoso dispnea
NorwegianTUNGPUSTET/KORTPUSTET/DYSPNE
PortugueseDispneia/fadiga respiratoria
Spanishdificultad para respirar, dificultad respiratoria, disnea, falta de aire, respiración difícil, respiración dificultosa, respiracion dificil, respiracion dificultosa, sin aliento
SwedishANDNOD/DYSPNE
CreditsDerived from the NIH UMLS (Unified Medical Language System)


[D]Orthopnea (C0085619)

ConceptsSign or Symptom (T184)
ICD9786.02
EnglishBreathlessness lying flat, Must sit up to breath, Orthopnea, Orthopnea symptom, Orthopnoea, Orthopnoea symptom
Spanishortopnea
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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