Dyspnea

size 8-millimeter tube in adults unless it is clear this will not work because the lower airway resistance will reduce the work of breathing.

DYSPNEA

Patients will present to the emergency department with the complaint of dyspnea, which involves uncomfortable or unpleasant breathing situations. It isn’t exactly clear how the phenomenon of dyspnea occurs. There may be areas of the midbrain that perceive this but it isn’t yet well-established. The most common cause of dyspnea are pneumonia, asthma, COPD, physical conditioning, and myocardial ischemia. Many with chronic lung diseases have dyspnea when their disease is worsened for some reason.

In evaluating dyspnea, get an idea of its onset and exacerbating factors. Find out if they have dyspnea as a baseline symptom. Look for other supporting symptoms, such as fever, cough, chest pain, hemorrhaging, orthopnea, paroxysmal nocturnal dyspnea in heart failure, weight loss, night sweats, or sputum production. Important aspects of the past medical history include smoking history, risk factors for coronary artery disease, recent immobilization, or occupational exposures.

The examination will focus primarily on the heart and lungs. Vital signs will look for things like tachypnea, tachycardia, hypoxia, and fever. A complete lung exam will look for abnormal lung sounds and airflow. Adenopathy should be looked for as well as neck veins for distention. Evaluate the conjunctiva for pallor and listen for extra heart sounds, heart murmurs, or muffled heart sounds.

Concerning findings include agitation, confusion, or decreased level of consciousness, dyspnea at rest, use of accessory muscles, crackles in the lungs, palpitations, night sweats, weight loss, or chest pain. Wheezing mainly suggests COPD or asthma, while stridor represents upper airway obstruction. Crackles can be seen with lung disease or left heart failure. Leg swelling, when unilateral, indicates the possibility of a pulmonary embolism. Hyperventilation is a diagnosis of exclusion.

In testing the patient with dyspnea, pulse oximetry should always be done. A chest x-ray should be done unless the diagnosis is clear, such as an asthma or COPD exacerbation. An ECG plus cardiac markers are done if a cardiac cause is possible. Deteriorating