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Shortness of Breath
Initial assessment and resuscitation
- Airways, Breathing, Circulation: may require supplemental oxygen.
- Supplemental oxygen therapy:
- Titrate according to PaO2 or pulse oximeter (aim for sat.O2 >92% if pre-existing normal lungs).
- To maximize oxygen delivery use high flow O2, with a reservoir bag.
- Use regulated FiO2 (24-28%) via Venturi mask if COPD with CO2 retention. Aim for sat.O2 of 90% in long standing COPD.
Complete assessment
History
- The patient with chronic or recurrent shortness of breath can often provide a very valuable assessment of their severity.
- The patient's past history of severity may provide a warning to observe the patient closely. Obtain previous records urgently.
- Symptoms of infection should be sought - fever, rigors, productive cough.
- Shortness of breath may be a symptom of disease in another system, e.g., ischaemic heart disease, metabolic acidosis (diabetic ketoacidosis), anxiety, pulmonary embolism, anaemia.
Examination
- Severity is best assessed by observation
- Respiratory rate, pulse rate, peak expiratory flow rate or preferably FEV1, ability to speak, and use of accessory muscles are useful objective signs.
- Auscultation and percussion of the chest may be helpful in identifying pneumonia, LVF or pneumothorax.
Investigations
- Pulse oximetry is a useful guide to oxygenation (real time, non-invasive, accurate but needs an educated interpretation). Refer to Pulse Oximetry.
- Peak Expiratory Flow rate to assess asthma severity - tables of normal values can be found on the internet.
- Arterial blood gas to assess pH, PaO2 and PaCO2.
- CXR - particularly for pneumothorax (is difficult to exclude clinically), pneumonia and cardiac failure.
- Other investigations as indicated.
Definitive management
Definitive management according to the cause. Possible causes:
- Lung disease.
- Heart disease.
- Airway disease.
- Chest wall problem.
- Neurological disease (abnormal patterns of breathing).
- Other disease.
Topic Code: 1275