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 110 - March 2018 Round Up
Ep 109 - The Physican Response Unit (PRU) with Rich Carden and Tony Joy
Ep 108 - February 2018 Round Up
Ep 107 - January 2018 Round Up
Ep 106 - Debriefing in Critical Care with Liz Crowe
Ep 105 - Critical Apprasal Nugget 8: Diagnostics and PICTR questions.
Ep 104 - Managing Perceived Devastating Brain Injured patients with Dan Harvey and Mark Wilson
Ep 103 - December 2017 Round Up
Ep 102 - HEMS, reflections and St.Emlyn's e-books.
Ep 101 - November 2017 Round Up
Ep 100 - How to use WhatsApp and other group messaging systems in a Major Incident.
Ep 99 - October 2017 Round Up
Ep 98 - Life as an EM trainee in South Africa. A panel discussion
Ep 97 - Foreskins: A PED primer with Ross Fisher
Ep 96 - Everybody's free - Top Tips for the Class of 2017
Ep 95 - Non accidental injury in the ED.
Ep 95 - Burnout in Critical Care with Liz Crowe
Ep 94 - The Teaching Course Copenhagen Day 3
Ep 93 - The Teaching Course Copenhagen Day 2
Ep 92 - The Teaching Course Copenhagen Day 1
Create your
podcast in
minutes
It is Free
The Relaxback UK Show
Good Nurse Bad Nurse
On Call With Dr. Anselm Anyoha
The Doctor’s Farmacy with Mark Hyman, M.D.
The Peter Attia Drive