Dyspnea

Dyspnea

History

Onset

slow, insidious

anemia

pulmonary HTN (vascular)

pulmonary fibrosis (interstitium)

COPD (airway)

Pleural effusion (pleura)

Infection (parynchyma)

sudden

Acute blood loss

Vascular trauma (pulmonary embolus)

Pleural trauma (pneumothorax)

Duration

chronic (mos/yrs)

Anemia

Cardiac

Musculoskeletal disease

COPD

long (hrs/days) -- subacute

infections

short (min/hrs) -- acute

Metabolic causes

Reversible obstruction

Anxiety

Physical Exam

Percussion

Tactile Fremitus

↑ in consolidation

↓ in effusion

Dull

Hyperresonant

Emphysema

Resonance

normal!

all normal lungs are resonant.

it's only bad when you have hyperresonance

Chest excursion

how the chest moves (usually decreased movement)

Auscultation

Breath sound maneuvers

E-->A

Vocal fremitus ("99")

Whispered pectorliloquy

Consolidation

End-expiratory wheezes

Asthma

Ronchi/coarse breath sounds

Small/Mid-airway dz

Rales/crackles

Wet

"rice crispies"

Alveolar/interstitial dz

Pulmonary edema

Dry

"velcro"

Pulmonary fibrosis

Stridor

Trachea/Upper airway obstruction

No breath sounds

Effusion

Pneumothorax

Precipitating Factors

Environmental

allergens

Situational

anxiety

Position

trepopnea

SOB when laying on one side

(FINE when laying on back or standing up)

unilateral lung/pleural dz

platypnea

SOB when standing up

(FINE when laying down)

hepatopulmonary syndrome

lymphadenopathy obstructing the airways

lung base dz

orthopnea

SOB when laying down

(FINE when standing up)

diaphragm collapse

fluid in lung

Exercise

respiratory muscle d/f

hypoxia