Acute dyspnea

This page is for adult patients. For pediatric patients, see: acute dyspnea (peds).

Clinical Features

Emergent Pattern Recognition

Diagnosis Lungs CXR ECG Treatment Contraindicated
Pulmonary EdemaBilateral ralesInterstitial fluidNormal/abnormalR/O AMI, lasix, nitrates, ACEi, BiPAPIVF; ?albuterol; ?Beta-blockers
BronchoconstrictionWheezesClear/hyperinflatedNormal/pulmonary strainAlbuterol, atrovent, steroids, consider anaphylaxis (epi)Beta-blockers; ?aspirin
PneumoniaFocal ronchi/decreased breath soundsInfiltrate/effusionNormalIVF, antibioticsRate control; diuresis
Pulmonary embolismClearClear (most) or Westrmark/Hampton humpNormal/S1Q3T3Anticoagulate/thrombolyticsRate control
Pneumothorax/HemothoraxUnequalPneumo/hemoNormalNeedle thoracentesis/chest tubeRate control
DysrythmiaClear/pulmonary edemaClear/pulmonary edemaAbnormalType dependentAlbuterol; ?IVF
ACSClear/pulmonary edemaClear/pulmonary edemaNormal/abnormalAspirin; nitrates, anticoagulation, ?beta-blockers, +/- thrombolyticsAlbuterol; ?IVF

Differential Diagnosis

Acute dyspnea

Emergent

Non-Emergent

Evaluation

Bedside Lung Ultrasound in Emergency (BLUE) Protocol[1]

  • Predominant A lines + lung sliding = Asthma/COPD
  • Multiple predominant B lines anteriorly with lung sliding = Pulmonary Edema
  • Normal anterior profile + DVT= PE
  • Anterior absent lung sliding + A lines + lung point = Pneumothorax (PTX)
  • Anterior alveolar consolidations, anterior diffuse B lines with abolished lung sliding, anterior asymmetric interstitial patterns, posterior consolidations or effusions with out anterior diffuse B lines = Pneumonia

Management

  • Oxygen
  • Treat underlying cause

See Also

Video

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References

  1. http://ccm.anest.ufl.edu/files/2012/08/BLUELung.pdf Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure - The BLUE Protocol
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