Breathless patients are a challenge in the ED. Shortness of breath can be a frightening presenting complaint for both patients and doctors. As always, think about the possible life threatening causes and actively rule them out. For breathless patients think especially about:
Breathless Patients Podcast
In this podcast Iain and Simon discuss their approach to breathless patients in the ED which we hope will provide you with a good starting point.
For those of you who are more visual learners here is the video recorded a few years ago for SEMEP featuring our very own Iain Beardsell.
http://vimeo.com/35310564
Take Home Points
Oxygen - or no oxygen??
Oxygen administration is rarely a problem in the immediate and acute
setting - and can save lives. So yes, when you first approach a patient
who is short of breath, get that oxygen on while you make your
assessment then think about the finer points of respiratory failure
afterwards.
Where do I begin?
A focused history, including asking the patient about previous conditions and whether they know what's going on!
And then - initial assessment and examination including vital signs
(especially respiratory rate), looking for clues as to the underlying
cause of their breathlessness, remembering the five common causes.
What treatments might be useful?
A small fluid bolus might help and carries relatively little risk;
think about the need for nebulised bronchodilators for patients with
asthma or COPD, and remember that antibiotics given early to patients
with sepsis save lives.
If the patient has pain we should definitely treat that too.
Which investigations might help me find out more?
One of the key investigations in patients with shortness of breath is the humble chest radiograph. There are some phenomenal FOAM resources for interpretation of CXRs (along with other XRs) at Radiology Masterclass. Well worth bookmarking for your ED shifts (but do ask a senior if you're unsure).
Chest X-Ray Anatomy - Chest X-Ray Abnormalities - Chest X-Ray Systematic Approach
Think! Do you really need an ABG? If the answer is yes, please use local anaesthetic! Your patients will thank you...
Further Reading on Shortness of BreathThe Flipped EM Classroom - Shortness of Breath (with further links).
Natalie May
Ep 34 - Intro to EM: Problems in Early Pregnancy
Ep 33 - Impact Brain Apnoea with Gareth Davies from London HEMS (LTC 2014)
Ep 32 - The Christmas review podcast 2014
Ep 31 - London Trauma Conference: Day three round up.
Ep 30 - London Trauma Conference: Day two round up.
Ep 29 - London Trauma Conference: Day one round up.
Ep 28 - Iain and Nat preview the amazing London Trauma Conference.
Ep 27 - Intro to EM: The patient with chest pain
Ep 26 - Intro to EM: The ED approach to the child with shortness of breath
Ep 24 - Getting started in Emergency Medicine Research
Ep 23 - Smacc Chicago update
Ep 22 - Button Battery ingestion in children
Ep 21 - Code for Cash and Credibility
Ep 20 - Understanding Troponin Part 3: The NICE guidance.
Ep19 - In Situ and Guerrilla Sim in the ED
Ep 18 - Victoria Brazil on great presentations with St.Emlyn's
Ep 17 - Diffuse Axonal Injury with John Hell
Ep 16 - Intro to EM: The patient with syncope (transient loss of consiousness)
Ep 15 - Understanding Troponin Part 2
Ep 14 - Exeter CEM conference with Adam Reuben
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