SOB diagnosis

1. Week3: shortness of breath Abdulrhman Aljoher …..(62/8)

2. How to diagnose a patient with dyspnea associated with chest pain?

3. Steps to reach the diagnosis

4. History of present illness

5. Review of systems In this step , you should look for symptoms of possible causes.

6. Past medical history Past medical history should cover disorders known to cause dyspnea , including asthma , COPD , and heart disease . You should look for risk factors for the different etiologies (next slide). Occupational exposures ( eg , gases, smoke, asbestos) should be investigated

7. Risk factors for the different etiologies

8. Physical examination Vital signs: fever, tachycardia, and tachypnea .

9. Lung examination

10. Physical examination

11. Red flags signs in PE

12. Interpretation of findings The history and physical examination often suggest a cause and guide further testing

13. Testing

14. Extra Testing If no clear diagnosis obtained from chest x-ray and ECG and patient is at moderate or high risk of having PE, he should undergo CT angiography ventilation/perfusion scanning. Patients who are at low risk may have d- dimer testing (a normal d- dimer level effectively rules out PE in a low-risk patient).

15. Now you can give your final diagnosis!

16. How to evaluate a patient with Dyspnea at the Emergency room?

17. Components of Emergency evaluation of Dyspenic patient History Physical examination Ancillary studies

18. History at ER

19. History at ER Ask for the following whenever possible!

20. Physical Examination at ER Physical examination at the beginning should look for clinical danger signs (e.g. signs of significant respiratory distress in all patients with acute dyspnea .) Respiratory arrest can be portended by: Depressed mental status Inability to maintain respiratory effort Cyanosis

21. Physical Examination Respiratory rate Pulse oximetry (normal SpO2 ≥ 95%) Abnormal breath sounds: s tridor , w heezing, crackles, diminished breath sounds. Cardiovascular signs: An abnormal heart rhythm Heart murmurs S3 or S4 heart sound Muffled or distant heart sounds Elevated JVP Pulsus paradoxus

22. ANCILLARY STUDIES

23. Ancillary studies list

24. Differential diagnosis in this patient after the clinical assessment

25. The probable Differential diagnosis of dyspnea with acute onset

26. The probable Differential diagnosis of dyspnea with acute onset

27. Case suggestive findings for the diagnosis Patient chief complaints

28. Suggestive findings from the patient's history

29. Additional information from the patient’s history

30. Suggestive findings from imaging

31. References http://www.uptodate.com/contents/evaluation-of-the-adult-with-dyspnea-in-the-emergency-department#H12 http://www.merckmanuals.com/professional/pulmonary_disorders/symptoms_of_pulmonary_disorders/dyspnea.html http://www.uptodate.com/contents/evaluation-of-the-adult-with-dyspnea-in-the-emergency-department#H12

32. Thank you