approach to dyspnea课件.pptVIP

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2018-06-02 发布于河南
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approach to dyspnea课件.ppt

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Pneumonia 1.Fever with chills 2.Pleuratic chest pain 3. purulent sputum 4. History of upper respiratory symptoms 5.signs of consolidation 6.x-ray chest 7. CBC 8. Blood culture 9. ABG acute bronchial asthma age startedat childhood 2. Acute Bronchial Asthma 1.Age start in young age 2. Family History 3. H/O Allergic Rhinitis 4.Physical exam 5.barrel shape chest 6.X-ray chest 7. ABG Pneumothorax 1.Suden chest pain 2. dyspnea,caugh 3. H/O asthma 4.COPD 5.Examination, trachea, shifted to opposite side absent breath sound 6 x-ray chest 3. Acute Pulmonary edema Previous H/O Heart Disease Hyperthyroidism Rheumatic Heart disease (ms) Sign of LVF Tachycardia Pulses alternan Basal criptation ECG change X-ray Chest ( cardiomegaly) Echo Pulmonary Embolism History of prolonged remobilization pelvic surgery contraceptive pills cyanosis ECG x-ray chest ABG ECHO PIQ study Case 1History Symptoms started 2 days ago Onset gradual and progressive Exertion makes it worse New onset (+) chest pain, cough, DOE, PND No past medical Hx No medications or smoking Hx Case 1Physical Examination Moderate respiratory distress, talks in partial sentences, prefers to sit in ED cart BP = 190/110 mmHg; HR = 118 /min; RR = 36 bpm; afebrile; SpO2 = 85% HEENT: no angioedema Lungs: rales wheezing bilaterally Cardiac: (+) JVD; (+) S3 Skin: no rashes Extremities: no edema Case 1 What are likely etiologies for this patient’s dyspnea? Heart failure ? ACS DyspneaDiagnostic Adjuncts What study will most patient’s with dyspnea get? CXR Indicated in most cases of dyspnea, especially new-onset Case 1 DyspneaDiagnostic Adjuncts What other non-laboratory study would you like? ECG Indicated if cardiac etiology suspected or cardiac history Case 1 DyspneaDiagnostic Adjuncts What lab tests might be useful in dyspnea workup? ABG If any question about ventilatory or acid-base status Beware of interpretation of (A–a)O2 Troponin How would it be helpful in our patient? B-type n