EMERGENCY MEDICINE GUIDELINES for ACE the ACEM
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APPROACH TO ACUTE DYSPNOEA

It's 3 AM and a 65 YO male is bought in by ambulance with acute respiratory distress. His has markedly increased work of breathing with a RR of 40, sats 0f 88% on 15 L 02, a BP of 160/90 HR of 120 and a T 0f 37.9.  Sound familiar? Acute respiratory distress is a common (and potentially quite dramatic) ED presentation. Having a robust and efficient approach to assessment and management is important. Timely appropriate intervention can really save a life.

DDX

- APO + precipitants (especially Ischemia and  arrythmia)
-COPD / Asthma
-PE
-Pneumonia
-PTX
- (Effusion)

Resus Cares


-Patients are often initially undifferentiated and you may begin management for APO / COPD + /- pneumonia cncurrently currently

Options for respiratory support
  • 1: 02
  • 2: NIV (particular benefit in COPD and APO but may be trialled in severe respiratory distress of any sort - (with some caveats ,know the indications and contraindications for NIV.) In the session we will walk through setting up the ventilator for NIV and ventilate each other. You should be able to set up the ventilator from scratch)
  • 3: Invasive ventilation

Asessment:

Attempt to identify the cause of dyspneoa and quantify the severity.

Hx:

- Timecourse!  Acute vs Subacute (APO vs COPD)
Associated Sx - Infective, Chest pain,
Risk profile - For APO, Obstructive airaways, PE, etc.


Ex-
To quantify severity

Features of APO
Features of COPD
Focal chest signs
++Not always clear cut acutely ++


Ix
- ABG vs VBG
-ECG
-CXR (Signs of APO)
(Role of bedside USS / ECHO)
(Role and contraindications to CTPA / D-Dimer / Echo
Role of TNI
Resources
non-invasive_ventilation_version_2_march_2013.doc
File Size: 192 kb
File Type: doc
Download File

Copyright © 2015
  • Home
  • Guidelines
    • AAA Rupture
    • Acute Coronary Syndrome
    • Anaphylaxis
    • Aortic Dissection
    • Appendicitis
    • Asthma
    • Backpain
    • Bowel Obstruction
    • Bronchiectasis
    • Burns
    • Chest Pain >
      • ADP Chest Pain Pathway
    • Cholecystitis
    • Confusion
    • COPD
    • Diverticulitis
    • DKA
    • DVT
    • Eating Disorders
    • Febrile Neutropaenia
    • Fractures >
      • Bier's block procedure form
      • Fractured neck of Femur
    • Funnel Web Spider Bite
    • Headache
    • Influenza Like illness
    • Meningitis
    • Obstetrics >
      • Hypertensive disorders in pregnancy
      • Normal Birth
      • PPH
      • Preterm labour
      • Still birth
      • Trauma in pregnancy
    • Pancreatitis
    • Paracetamol OD
    • Pathology Ordering
    • Peri-anal abscess
    • Pertussis
    • Pneumonia
    • Pneumothorax
    • Podiatry
    • Procedural Sedation >
      • Procedural Sedation
    • Pulmonary Embolus
    • PV Bleeding in Early pregnancy >
      • EPAU - Early Pregnancy Assessment Unit
    • Redback Spider Bite
    • Ring cutter use
    • Seizure
    • Septic Arthritis
    • Use of Restraints
    • Stroke / TIA
    • Sepsis
    • Smoking cessation
    • Snake Bite
    • Syncope >
      • Telemetry guideline
    • TIA
    • Tonometer use
    • Antidotes
    • Dagibatran reversal guidelines
    • Funnel Web Spider Bite
    • Redback Spider Bite
    • Paracetamol OD
    • Snake Bite
    • Warfarin Reversal Guidelines
    • Trauma >
      • C-spine injury
      • Head Injury
      • Imaging Guidelines
      • Trauma in pregnancy
      • Sutures
    • Abdominal Pain
    • Allergy / Anaphylaxis
    • Antimicrobial Guidelines
    • Asthma & Wheeze
    • Behavioural Disturbance
    • Boils - Staph decolonisation treatment
    • Bronchiolitis
    • Buckle fractures
    • Burns
    • Cervical Spine Guideline
    • Chest Pain (Paediatric)
    • Child Protection
    • Constipation
    • Croup
    • DKA
    • Drowning
    • Eating Disorders
    • Fever
    • Fluids in Kids
    • Foreign Bodies
    • Gastroenteritis
    • Headache
    • Head Injury
    • High Flow Nasal Cannula Oxygen
    • Hypoglycaemia
    • Jaundiced Neonate
    • Limping in children
    • Malaria
    • Meningitis
    • Oncology Emergencies
    • Otitis Externa
    • Otitis Media
    • Paediatric Fracture Clinic Referral
    • Paracetamol Poisoning
    • Petechial Rash
    • Pneumonia (CAP)
    • Seizures / Status Epilepticus
    • Sepsis Guideline
    • Tetanus Prophylaxis
    • Torticollis
    • UTI NICE Guideline
    • Trauma in children >
      • LCCH Paeds Trauma Guidelines
      • C Spine Injury LCCH Guideline
      • LCCH Massive Transfusion
    • RCH Melbourne Guidelines
  • Parent Handouts
    • Accidental Poisoning
    • Abdominal Pain
    • Ankle Sprain
    • Arrhythmia
    • Asthma
    • Bronchiolitis
    • Chest Infections
    • Cast Care
    • Cellulitis
    • Constipation
    • Croup
    • DKA
    • Epistaxis
    • Eye Foreign Body
    • Febrile Convulsion
    • Fever
    • Fracture- Buckle
    • Fracture- Clavicle
    • Fracture- Elbow
    • Fracture- Finger/Toe
    • Fracture- Foot
    • Gatroenteritis
    • Glue- Lacerations
    • Head Injury
    • Jaundice
    • Otitis Externa
    • Parechovirus
    • Periorbital and Orbital cellulitis
    • Pulled Elbow
    • Seizures
    • Tonsillitis
    • Urticaria
    • Viral Illness
    • Wound Care
  • ACE the ACEM
  • Blog