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Dyspnea, Emergency Medicine

Matthew M. Hall Reviewed 06/2017
 


Basics

Description

Inability to breathe comfortably 
  • Describes a symptom of many possible underlying diseases

  • Is different from signs of increased work of breathing

  • Usually an unconscious activity, dyspne...

Diagnosis

Signs and Symptoms

  • Difficult, labored, or uncomfortable breathing

  • Upper airway:

    • Stridor

    • Upper-airway obstruction

  • Pulmonary:

    • Tachypnea

    • Accessory muscle use

    • Wheezing

    • Rales

    • Asymmetric breath sounds

    • Poor a...

Treatment

Pre-Hospital

  • Place all patients on supplemental oxygen, pulse oximetry, end tidal CO2, and cardiac monitor.

  • Initiate therapy for suspected cause of dyspnea when indicated:

    • Asthma

    • COPD

    • CHF

  • Utilize ...

Follow-Up

Disposition

Admission Criteria

  • Assisted ventilation

  • Hypoxia

  • A–a gradient >40

  • Medical condition requiring hospital therapy

Discharge Criteria

  • Adequate oxygenation

  • Stable medical illness that can b...

Pearls and Pitfalls

  • Altered mental status is an indication for immediate airway management in a patient with severe dyspnea.

  • Dyspnea can and should be quantified.

  • Dyspnea and tachypnea may occur without...

Additional Reading

  • Camargo  CA Jr, Rachelefsky  G, Schatz  M. Managing asthma exacerbations in the emergency department: Summary of the National Asthma Education and Prevention Expert Panel Report 3 g...

Codes

ICD9

  • 786.05 Shortness of breath

  • 786.07 Wheezing

  • 786.09 Other respiratory abnormalities

  • 786.02 Orthopnea

  • 786.06 Tachypnea

  • 786.7 Abnormal chest sounds

ICD10

  • R06.00 Dyspnea, unspecified

  • R06.02 Shortness of ...

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