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
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
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 |