2. Definition
▶It is feeling of an uncomfortable need
to breathe.
▶It is most common complaint of
patients with cardiopulmonary
diseases.
3. Pathophysiology
▶Dyspnea results when there is
imbalance between perceived need to
breathe and perceived ability to
breathe.
▶CO2 build-up and oxygen deprivation
are the critical factors that result in
dyspnea.
4. Causes of Acute Dyspnea
▶Pulmonary : Pneumothorax,
Pulmonary edema, Massive pulmonary
embolus, Acute severe Asthma, Acute
exacerbation of COPD, Pneumonia,
Foreign body, toxic inhalation.
6. Diagnostic Evaluation of Acute
Dyspnea
▶ History and Clinical examination:
▶ Recent trauma, silent resonant
hemithorax…..Pneumothorax.
▶ Risk factors, severe breathlessness, chest
pain, pleurisy, syncope*, dizziness*……Massive
Pulmonary embolus (with signs of central
cyanosis, raised JVP*, absence of signs in the
lung*, shock)
7. ▶History of Asthma, asthma
medications, wheeze……Acute severe
Asthma (signs: tachycardia, pulsus
paradoxus, JVP normal*, wheeze*)
▶ Previous episodes*, smoker, prolonged
expiration, may be drowsy…..Acute
exacerbation of COPD (signs: cyanosis,
hyperinflation*, signs of CO2 retention—
flapping tremor, bounding pulses)
9. ▶Evidence of Diabetes mellitus, or renal
disease, aspirin or ethylene glycol
overdose…..Metabolic acidosis (signs:
Ketones, hyperventilation without
heart and lung signs*, dehydration*, Air
hunger)
▶Previous episodes, digital or perioral
dysaesthesia…..Psychogenic (signs: no
cyanosis, no heart or lung signs,
carpopedal spasm)
10. ▶In children, the possibility of
inhalation of a foreign body or acute
epiglottitis should always be
considered.
15. Management:
▶Treatment is directed at the cause.
▶Non-drug Treatment
-Positioning… sitting up
-Relaxation
-Humidified Air
-Non invasive positive pressure mask
▶Quit smoking
16. ▶Opioids(drug of choice)...5mg IV every
5-10 mins until relief
▶Oxygen..5-6L/min (not always helpful)
▶Specific treatment:
Pneumothorax----Aspiration, Chest tube,
pleurodesis, thoracoscopy
Massive pulmonary embolism----High dose
unfractionated heparin, Dopamine or
dobutamine with norepinephrine for PE related
shock, open surgical embolectomy, catheter
thrombectomy.
17. Acute Asthma exacerbation---- inhaled
anticholinergic drugs with beta2
agonists in children, systemic
corticosteroids
Acute exacerbation of COPD---- Beta2
agonists, corticosteroids, antibiotics,
oxygen, ventilator support
Pneumonia---- IV antibiotics, oxygen
therapy, IV fluids.
18. Pulmonary edema----keep oxygen
saturation greater than 90%, intubation,
preload reducers (nitroglycerine,
diuretics) afterload reducers
(nitroprusside), ultrafiltration
Metabolic Acidosis----severe cases(pH
<7.2)- bicarbonate therapy, treat
underline cause
Psychogenic Dyspnea---- anxiolytics,
paper bag technique (increases needed
CO2 and reduces symptoms, but may
worsen the condition sometimes)
19. Foreign body---- Heimlich maneuver,
supportive measures(oxygen, pulse
oximetry), racemic epinephrine as
temporary measure until bronchoscopy
can be done, bronchoscopy
Acute epiglottitis---- intubation
(difficult if laryngeal edema present) ,
antibiotics.