Dyspnea

Precipitating Factors

Exercise

hypoxia

respiratory muscle d/f

Position

orthopnea

SOB when laying down(FINE when standing up)

fluid in lung

diaphragm collapse

platypnea

SOB when standing up(FINE when laying down)

lung base dz

lymphadenopathy obstructing the airways

hepatopulmonary syndrome

trepopnea

SOB when laying on one side(FINE when laying on back or standing up)

unilateral lung/pleural dz

Situational

anxiety

Environmental

allergens

Physical Exam

Auscultation

No breath sounds

Pneumothorax

Effusion

Stridor

Trachea/Upper airway obstruction

Rales/crackles

Dry

"velcro"

Pulmonary fibrosis

Wet

"rice crispies"

Pulmonary edema

Alveolar/interstitial dz

Ronchi/coarse breath sounds

Small/Mid-airway dz

End-expiratory wheezes

Asthma

Breath sound maneuvers

E-->AVocal fremitus ("99")Whispered pectorliloquy

Consolidation

Percussion

Chest excursion

how the chest moves (usually decreased movement)

Consolidation

Effusion

Pneumothorax

Resonance

normal!

all normal lungs are resonant.it's only bad when you have hyperresonance

Hyperresonant

Pneumothorax

Emphysema

Dull

Consolidation

Effusion

Tactile Fremitus

↓ in effusion

↑ in consolidation

History

Duration

short (min/hrs) -- acute

Anxiety

Reversible obstruction

Metabolic causes

Exercise

long (hrs/days) -- subacute

infections

allergens

chronic (mos/yrs)

COPD

Pulmonary fibrosis

Musculoskeletal disease

Cardiac

Anemia

Onset

sudden

Pleural trauma (pneumothorax)

Vascular trauma (pulmonary embolus)

Anxiety

Acute blood loss

slow, insidious

Infection (parynchyma)

Pleural effusion (pleura)

COPD (airway)

pulmonary fibrosis (interstitium)

pulmonary HTN (vascular)

anemia