Approach to Difficult in Breathing

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Shortness of breath or breathlessness may result from a range of pulmonary, cardiac and central  nervous system causes. It is important to look for the underlying cause for immediate intervention. 

Clinical presentation 

• Increased work of breathing
• Altered mental status
• Diaphoresis
• Additional sounds - stridor, wheezes

Differential diagnosis 

• Pulmonary embolism
• Pulmonary oedema
• Myocardial infarction
• Asthma
• Anaphylaxis
• Airway obstruction
• Tension pneumothorax
• Cardiac tamponade
• Acute chest syndrome
• Pneumonia
• Pericarditis

Investigations 

Blood gases, Serum Electrolytes, Serum Creatinine and Urea, Troponins, Chest X-ray, POC ECG,  Bedside Ultrasound, Lactate, Troponin, Random blood glucose  

Non pharmacological treatment 

• Perform  both  primary  survey  (ABCs)  and  secondary  survey  and  provide  necessary interventions
• Obtain Vital signs
• Position the patient
• Give Oxygen if hypoxic or increased work of breathing

Pharmacological treatment 

Pharmacological management will depend on the underlying cause of difficulty in breathing. (Refer Asthma-respiratory chapter and Acute chest syndrome and Pulmonary embolism-hematology chapter)