On Call: Shortness of Breath (Dyspnea)/Hypoxia

Differential Diagnosis

Upper Airway Obstruction

  • Angioedema
  • Anaphylaxis
  • Epiglottitis
  • Foreign Body in Trachea

Cardiac Etiology

  • Myocardial Infarction (MI)
  • Pericardial Tamponade
  • Heart Failure
  • Arrhythmia

Pulmonary Etiology

  • Pulmonary Embolism (PE)
  • COPD/Asthma Exacerbation
  • Tension Pneumothorax
  • Pneumonia
  • Pulmonary Edema
  • Pleural Effusion
  • Acute Chest Syndrome

Other Etiology

  • Anxiety & Hyperventilation
  • Diabetic Ketoacidosis (DKA)
  • Sepsis
  • Stroke
  • Salicylate Poisoning
  • Trauma/Rib Fracture
  • Postoperative Pain

Particular Concerns for History & Physical

Vitals

Subjective

  • Severity
  • Timing (Sudden or Gradual)
  • Associated Chest Pain
  • Fevers
  • Cough/Sputum
  • Tobacco or Drug Use

History

  • History of Cardiac Disease
  • History of Pulmonary Disease
  • History of Psychiatric Disease
  • Surgical History
  • Prior Intubations

Physical Exam

  • Mental Status Changes
  • Cyanosis
  • Retractions & Use of Accessory Muscles
  • Diaphoresis
  • Unable to Lie Supine
  • Heart/Lung Auscultation
  • Jugular Venous Distention

Work Up & Management

Initial Orders

  • EKG
  • Chest X-Ray
  • Troponin

Other Potential Orders

  • Arterial Blood Gas (ABG)
  • Other Labs (CBC, CMP, BNP)
  • Echocardiogram
  • CT Chest
  • CTA Chest
  • CT Pulmonary Angiogram

Further Management

  • Dictated by Findings & Diagnosis

Supplemental Oxygenation