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Acute DyspneaHypoxia
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on the phone, ask the nurse for the vitals (including pulse oximetry) ... Examine the patient focusing on the cardiac and pulmonary exams: ... – PowerPoint PPT presentation
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Title: Acute DyspneaHypoxia
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Acute Dyspnea/Hypoxia
- Intern cross cover emergencies lecture series
- Beth Marlow, PGY-2
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Youre called to see a patient with shortness of
breath
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Acute dyspnea
- What to do first
- on the phone, ask the nurse for the vitals
(including pulse oximetry) - ask the nurse how the patient looks
- on your way to see the patient, review the
sign-out
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Acute dyspnea
- What do you want to do when you arrive??
- Review the vital signs
- Visually assess the patient
- Examine the patient focusing on the cardiac and
pulmonary exams - wheezing, crackles, peripheral edema,
asymmetric peripheral edema? - cardiac rhythm
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Acute dyspnea
- Dyspnea
- pulmonary non-pulmonary (cardiac)
- pulm edema arrhythmias
- asthma/COPD acute MI
- PE
myocardial ishemia - pneumonia
- pneumothorax
Dx of exclusion anxiety
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Acute dyspnea
- Your physical exam may help you narrow the
differential. - Tests to obtain in the acute setting
- ABG
- portable CXR
- EKG
- cardiac enzymes
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Hypoxia
- Differential is very similar to dyspnea
- This could be what youre called to assess.
- Same clinical assessment of the patient
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Pathophysiology of hypoxia
- Hypoventilation
- sleep apnea
- respiratory depression (narcotics?)
- V/Q mismatch
- Shunting
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Management
- If not on oxygen, place on nasal cannula
- If already on oxygen, increase liters per minute
or place on face mask - Noninvasive ventilation with BiPap is the next
step (consider MICU if using NIPPV)
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Management
- IV diuretics
- Bronchodilators
- Antibiotics
- Anticoagulation
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