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 - 71 SMACC Dublin Day 3 Round Up
Ep - 70 SMACC Dublin Day 2 Round Up.
Ep 69 - SMACC Dublin Day 1 Round Up
Ep 68 - An Englishman in South Africa with Robert Lloyd
Ep 67 - Intro to EM: Sepsis
Ep 66 - When Professional and Personal Worlds Collide with Liz Crowe
Ep 65 - The management of Paediatric trauma in the UK with Ross Fisher
Ep 64 - International Meeting for Simulation in Healthcarewith Sandra Viggers and Vic Brazil
Ep 63 - The Role of UK Trauma Units with Tim Coates (LTC)
Ep 62 - The role of paediatric surgeons in trauma with Ross Fisher (LTC)
Ep 61 - Grief at Christmas with Liz Crowe
Ep 61 - Londoon Trauma Conference 2015 Day 2 Summary
Ep 60 - Londoon Trauma Conference 2015 Day 1 Summary
Ep 59 - Lessons learned from the November Paris attacks with Youri Yordanov
Ep 58 - Clinical Judgement for the Emergency Physician
Ep 57 - When things go wrong - the difficult conversation
Ep 56 - Intro to EM: How to refer a patient
Ep 55 - Communicating (not Breaking) Bad News with Liz Crowe
Ep 54 - Intro to EM: Analgesia in the ED.
Ep 54 - A tribute to John Hinds
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