Dyspnea (also known as shortness of breath, difficulty in breathing, or breathing difficulty) sucks. Let us elaborate.
According to the American Thoracic Society, dyspnea is a "subjective experience of breathing discomfort that is comprised of qualitatively distinct sensations that very in intensity." Wow, that's a mouthful. Saying that definition out loud definitely can cause dyspnea. Have an inhaler ready.
Well, the main symptom for dyspnea is dyspnea, sometimes shortness of breath, maybe even feeling a little winded too. Onset can be sudden or gradual, range from mild to severe, intermittent or nocturnal, and can be caused by anything from bad lungs (COPD exacerbation) to bad interns ("You gave the patient how much insulin?!?").
Oxygen saturation is the most helpful of the vital signs; respiratory rate, not so much, since it'll be documented as 16 breaths/min anyway. Physical exam has been replaced by radiology, but should you do a physical exam, it is helpful to see how many lungs the patient has. Stethoscopes are relics of the past, but should you find one, you can try to listen to some lung sounds. (For a helpful guide on the lung exam, see Gomerblog's Physical Exam Tips: The Lung.) Clubbing is something that can only be picked up on a Friday or Saturday night. JVD may suggest the presence of JVP. Distant heart sounds suggest that you should move in a bit closer.
Common Causes in the General Population
- Interstitial lung disease
- Cardiovascular such as congestive heart failure or acute coronary syndrome
- Obesity or deconditioning
Common Causes in Health Care Professionals
- Pulmonary embolism from the hours of immobility spent writing notes
- The threat of litigation
- Exasperation over something a new intern did
- Putting a foot in one's own mouth, particularly prevalent in the intern population
- Taking the stairs instead of waiting for the elevator
The best treatment starts in the emergency room and involves the simultaneous initiation of any treatment that can improve shortness of breath. Therefore, when a patient presents with dyspnea initiate each of the following:
- Supplemental oxygen
- Endotracheal tube
- High-dose steroids
- High-dose Lasix
- Heparin gtt
- Allergic Ryanitis
- Incentive Spirometer
- Machu Picchu in Three Words: “I Can’t Breathe”
- One-Trach Pony
- Pneumonic Device
- Pulmonary Embolism
- Trick Collar
- July Intern Really Excited to Cause His Very First Pneumothorax (Gomerblog)
- Intern Put Into Timeout Cage to Think About What She Did (Gomerblog)
- Podiatry & ENT Take July Intern to OR to Surgically Remove Foot from Mouth (Gomerblog)
- Pulmonary Team Hypoxic After Climbing Seven Flights of Stairs (Gomerblog)
- Nurse Waiting for Elevator Faces Stark Reality He Might Have to Take the Stairs (Gomerblog)