Shortness Of Breath

1. SHORTNESS OF BREATH JOHNEY SAPIT ASSISTANT MEDICAL OFFICER EMERGENCY DEPARTMENT QUEEN ELIZABETH HOSPITAL

2. DEFINITION  Unpleasant sensation of difficulty in breathing.  An increase in breathing occurs normally during exercise and a high altitudes.  Breathing is also increased at rest people with many illness,whether of the lungs or of the other parts of the body.

3. Shortness of breath may be due to;  Cardiac – eg.mitral stenosis or left ventricular failure of any causes.  Lung – both airway and interstitial disease.  Anatomical – diseases of the chest wall, muscles or pluera .  Trauma – pneumothorax , haemothorax  Others – thyrotoxicosis , ketoacidosis , aspirin poisoning, anaemia , psychogenic.

4. Emergency presentation Wheezing?  Asthma  COPD  Heart failure  Anaphylaxis

5. Stridor ? ( Upper airway obstruction )  Foreign body or tumour  Acute epiglottis  Anaphylaxis  Trauma, eg . Laryngeal fracture Creapitations ?  Heart failure  Pneumonia  Bronchiectasis  Fibrosis

6. Chest clear?  Pulmonary embolism  Hyperventilation  Metabolic acidosis eg . DKA  Shock ( may cause air hunger )  Central causes Others  Pneumothorax – pain, increased resonance  Plueral effusion – ‘ stony dullness ‘

7. Speed of onset helps diagnosis; Acute  Foreign body  Pneumothorax  Acute asthma  Pulmonary embolus  Acute pulmonary oedema

8. Subacute  Asthma  Parenchymal disease - eg . alveolitis , effusions, pneumonia Chronic  COPD and chronic parenchymal diseases  Non-respiratory causes – eg . Cardiac failure, anaemia

9. How to decide patient at triage counter Green Zone Yellow Zone Red Zone Acute exacerbation Bronchial asthma ( mild to moderate ) Hyperventiletion able to walk Dyspnoea < 25 per min Dyspnoea with saturation of >95% and respiration rate of 20 –25 per min Hyperventilation & unable to walk Dyspnoea of saturation < 95% and respiration of 25 per min Patient with airway compromise eg . gasping severe maxillofacial injuries & comatosed patient Severe asthma & COAD

10. MX Assess severity and examine the chest * auscultation, percussion General measures * oxygen support may help if saturation is < 90% * chest x – ray

11. THANK YOU………

12. REFERRENCE