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Topic Info
TopicName
Acute dyspnea (SOB)
ClinicalTests
CBC with dif, ferritin (Anemia, Pneumonia); Blood culture; TSH (Hypothyroid); D-dimer (PE); BNP (CHF);
ImagingStudies
Echocardiography (Aortas Stenosis); ECG (MI); Peak expiratory flow, PEF (Asthma, COPD); Chest x-ray (bronchiectasis, pneumonia); CT scan (cancer, metastasis); Endoscopy with biopsy (GERD); x-Ray (Pneumonia);
PhysicalExams
Vitals + puls ox. – tachycardia, tachypnea, hyper/hypotensive, fever; General appearance – signs of distress, LOC, sense of doom, restlessness; HEENT - Exam of nasal mucosa, oropharynx – erythema, lymphadenopathy, examine pharynx; Heart – JVP distention, murmurs, carotid bruits; Respiratory – symmetric chest expansion, orthopnea, dullness/ consolidation, hyper resonance, wheeze, stridor, rales, rhonchi, intercostal retraction/ use of secondary respiratory muscles, dry or productive cough; Peripheral vascular – cyanosis, clubbing, edema;
Comment
Always RO: COPD, Asthma, PE, CHF, Pneumonia Location, quality, severity, radiation, duration, context (exertional, postprandial, positional, cocaine use, trauma); associated symptoms (sweating, nausea, dyspnea, palpitations, sense of doom, fever); exacerbating and alleviating factors (especially medications); history of similar symptoms; known heart or lung disease or history of diagnostic testing; cardiac risk factors (hypertension, hyperlipidemia, smoking, family history of early MI); pulmonary embolism risk factors (history of DVT, coagulopathy, malignancy, recent immobilization); R/O: thoracic aortic aneurism;
WebLink
https://www.aafp.org/afp/2003/1101/p1803.html
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