Shortness of breath

Chapter 4 Shortness of breath






Primary survey positive patients



Recognition


Patients with a life threatening respiratory emergency will present in either respiratory failure or respiratory distress. Patients with respiratory distress are still able to compensate for the effects of their illness, and urgent treatment may prevent their further deterioration. They present with signs and symptoms indicating increased work of breathing but findings suggesting systemic effects of hypoxia or hypercapnia will be limited or absent. Conversely, patients with respiratory failure may have limited evidence of increased work of breathing as they become too exhausted to compensate. The systemic effects of hypoxia and hypercapnia will be particularly evident in this group and immediate treatment will be required to prevent cardiac arrest. The key findings of primary survey positive patients with shortness of breath are presented in Box 4.3.







Treatment


If it is not possible to obtain an airway, if the patient’s condition is deteriorating rapidly, or they show signs of significant respiratory failure (in particular failure to maintain SpO2 of 95% on high concentration oxygen) consider immediate transportation to a hospital with appropriate facilities. Important treatment points for primary survey positive patients are listed in Box 4.4.





Secondary survey


The SOAPC system should be used to undertake a secondary survey (see Chapter 2). In primary survey positive patients, a secondary survey may not be completed in the pre-hospital phase of treatment as the focus must be on treatment of life threatening problems. For primary survey negative patients requiring hospital care the secondary survey may be undertaken during transportation. For the remaining patient population a secondary survey may be undertaken at the point of contact and will contribute to the decision to admit, treat and refer, or treat and leave.




Objective examination





General examination


Look for signs of the ‘unwell’ patient (see Chapter 2). A detailed examination of the respiratory system is mandatory for patients with shortness of breath. Remember, however, that myocardial infarction, acute coronary syndromes and congestive cardiac failure can also result in respiratory distress, as may endocrine and neurological problems (for example Kussmaul’s and Cheyne–Stokes respiration in hyperglycaemia and raised intra-cranial pressure respectively). If a respiratory problem cannot be readily identified as the cause of the patient’s symptoms, undertake an examination of the other systems.




For details of the respiratory examination, refer to Boxes 4.3, 4.5, 4.6 and 4.7 and to Chapter 2. Note if the patient has excessive production of sputum. What colour is this? Yellow, green or brown sputum indicates a chest infection. White frothy sputum, which may also be tinged with pink, suggests pulmonary oedema.

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Jun 14, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Shortness of breath

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