Dypnoea can often present in dramatic and frightening fashion - Look for cyanosis, speaking words only, marked accessory muscle use and diaphragmatic excursions, intercostal/subcostal/suprasternal recessions, SaO2 < 90%
Do not waste time getting an ABG initially - the best initial investigation is a CXR
If the patient is hypoxic - a calm, methodical approach will help you keep the patient alive and arrive at a correct diagnosis and management plan
Oxygen will keep your patient alive while you assess the patient, CPAP is another option
Avoid the temptation to give a definitive treatment before a diagnosis
If hypoxia is severe, the patient may require early intubation and mechanical ventilation
Causes for severe dyspnea are:
Severe pneumonia
Large pneumothorax
Massive Pulmonary embolism
| COAD | Acute pulmonary oedema | |
| Onset/course | Respiratory prodromal symptoms | Explosive |
| General appearance | Barrel chest | Old CABG scar |
| Sweating | No | Yes |
| Fever | Yes | No (unless precipitating infection) |
| Raised JVP | No (if no cor pulmonale) | Yes |
| Hypertension | Common (but not in cardiogenic shock) | |
| Heart sounds | Faint | Gallop rhythm |
| Chest | Expiratory +/- inspiratory wheeze (+/ creps) | Inspiratory creps or wheeze |
| COAD | Acute pulmonary oedema |
| Hyperinflated Decreased lung markings +/- focal consolidation |
Cardiomegaly Kerley B lines Upper lobe diversion Hilar opacities |