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Dyspnea
Shortness of Breath
What questions will you ask as a medical emergency physician on duty in this situation?
What must a medical emergency physician know about this situation?
Dyspnea: What is it?
What is another name or term for this?
How many causes are there? At least 45
What are various examples?
Alphabetical listing of causes of dyspnea: What are various examples?
Dyspnea: What are the categories of causes?
What causes it?
What are the most common causes of dyspnea?
What are the causes of shortness of breath that comes suddenly (called acute)?
What are the causes of shortness of breath that has lasted for weeks or longer (called chronic)?
What further questions need to be answered?
How will you further assess this situation?
What is the diagnosis?
What is the treatment?


Emergency health assessment on the spot.

What questions will you ask as a medical emergency physician on duty in this situation?

Questions that need to be answered.

In certain situations at least 35 questions have to be answered to reach a correct diagnosis and appropriate treatment.
https://www.qureshiuniversity.com/assessment.html
Answer all of these questions completely.
Is this a new or recurrent medical emergency issue for this patient?
Do you have any other symptoms?
Do any particular activities cause you to experience a shortness of breath?
How long have you experienced a shortness of breath?
What medications are you taking?
What further questions need to be answered?
Take a look at these questions: https://www.qureshiuniversity.com/assessment.html.

Dyspnea: What is it?
Difficult or labored respiration.
Dyspnea is a medical emergency.

What is another name or term for dyspnea?
Shortness of breath
Breathing difficulties

Alphabetical listing of causes of dyspnea: What are various examples?
Cardiac: Arrhythmia: Atrial fibrillation, inappropriate sinus tachycardia, sick sinus syndrome/bradycardia
Cardiac: Myocardial: Cardiomyopathies, coronary ischemia
Cardiac: Restrictive: Constrictive pericarditis, pericardial effusion/tamponade
Cardiac: Valvular: Aortic insufficiency/stenosis, congenital heart disease, mitral valve insufficiency/stenosis
Gastrointestinal: Dysmotility: Gastroesophageal reflux disease/aspiration, neoplasia
Pulmonary: Alveolar: Bronchoalveolar carcinoma, chronic pneumonia
Pulmonary: Interstitial: Drugs (e.g., methotrexate, amiodarone) or radiation therapy, lymphangitic spread of malignancy, passive congestion
Pulmonary: Obstructive: Asthma/bronchitis/bronchiectasis, bronchiolitis obliterans, chronic obstructive pulmonary disease, intrabronchial neoplasm, tracheomalacia
Pulmonary: Restrictive (extrinsic): Kyphoscoliosis, obesity, pleural disease/effusion, pneumothorax
Pulmonary: Vascular: Chronic pulmonary embolism/blood clot, idiopathic pulmonary hypertension
Pulmonary hypertension: High blood pressure in your lungs (pulmonary hypertension)
Partial or complete collapsed lung (pneumothorax or atelectasis)

Other

Sarcoidosis
Tuberculosis
Choking
Metabolic: Acidosis
Neurogenic/amyotrophic lateral sclerosis
Neurogenic/muscular dystrophic
Neurogenic/phrenic nerve palsy
Neurogenic/poliomyelitis
Anemia/iron deficiency
Anemia/hemolysis
Deconditioning/obesity/sedentary lifestyle
Pain/splinting/pleural-based malignancy
Psychological/functional/anxiety/hyperventilation
Psychological/functional/depression
Traumatic
Allergic
Other

Dyspnea: What are the categories of causes?
Cardiac
Respiratory/Pulmonary
Metabolic
Neurogenic
Traumatic
Allergic
Other

What are the most common causes of dyspnea?
Acute decompensated heart failure (ADHF)
Pneumonia
Chronic obstructive respiratory disease (COPD)
Bronchial asthma
Pulmonary embolism
Elderly chronic obstructive respiratory disease (COPD) and bronchial asthma are the most common causes of dyspnea.

What are the causes of shortness of breath that comes suddenly (called acute)?
1. Anaphylaxis
2. Asthma
3. Carbon monoxide poisoning
4. Cardiac tamponade (excess fluid around the heart)
5. COPD (chronic obstructive pulmonary disease) — a blanket term for a group of diseases that block airflow from the lungs, including emphysema
6. Infective pneumonia or similar condition
7. Heart attack
8. Heart arrhythmia (heart rhythm problems)
9. Heart failure
10. Pneumonia (and other pulmonary infections)
11. Pneumothorax (collapsed lung)
12. Pulmonary embolism (a blood clot in an artery in the lung)
13. Sudden blood loss
14. Upper airway obstruction (blockage in the breathing passage)


What are the causes of shortness of breath that has lasted for weeks or longer (called chronic)?
15. Asthma (lasting for weeks) — a long-term condition that affects airways in the lungs
16. COPD (chronic obstructive pulmonary disease) — a blanket term for a group of diseases that block airflow from the lungs, including emphysema
17. Deconditioning/lack of exercise (muscle deconditioning/see further details)
18. Heart dysfunction
19. Interstitial lung disease — a blanket term for a large group of conditions that scar the lungs
20. Obesity/body mass index (BMI) over 30
21. Pleural effusion (accumulation of fluid around the lungs)


What other health conditions can make it hard to get enough air?

Lung problems

22. Croup (especially in young children)
23. Pleurisy (inflammation of the membrane surrounding the lungs)
24. Pulmonary edema (excess fluid in the lungs)
25. Pulmonary fibrosis (a disease that happens when lung tissue becomes damaged and scarred)
26. Pulmonary hypertension
27. Sarcoidosis
28. Tuberculosis
29. Lung cancer


Heart problems

30. Cardiomyopathy (problem with the heart muscle)
31. Heart failure
32. Pericarditis (inflammation of the tissue around the heart)

Other problems

33. Anemia (a condition in which the body does not get oxygen due to a lack of healthy red blood cells) 34. Anxiety disorders
35. Broken ribs or injuries that make breathing difficult
36. Choking
37. Epiglottitis (swelling of the "lid" of the windpipe)
38. Foreign object inhaled
39. Guillain-Barre syndrome
40. Kyphoscoliosis (a chest wall deformity)
41. Myasthenia gravis (a condition causing muscle weakness)
42. Medications such as statins (cholesterol-lowering drugs) and beta-blockers (used to treat high blood pressure)
43. Extreme temperatures (being very hot or very cold).
44. Sleep apnea, which can cause paroxysmal nocturnal dyspnea (PND)
45. Research can reveal many more problems.


What is the treatment?
Fix the underlying cause.
Here are further guidelines.

What are the potential complications of shortness of breath?

It is vital to seek prompt treatment if you experience shortness of breath as it can be a sign of a serious disease and, left untreated, may put you at risk of serious complications and even permanent damage. Once your doctor has diagnosed the underlying cause, you should make every effort to follow the recommended treatment plan precisely in order to minimize risk of potential complications including:

* Brain damage
* Heart failure
* Respiratory failure
* Spread of cancer
* Spread of infection

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Asthma
Management and Treatment
Not everyone with asthma takes the same medicine. Some medicines can be inhaled, or breathed in, and some can be taken as a pill. Asthma medicines come in two types—quick relief and long-term control. Emergency treatment Effect on daily activities / None / Well controlled Mild
Moderate
Severe: Pulse/minute:> 120  Respiratory rate: Often > 30/minute
Subset: Respiratory Arrest Imminent / Drowsy or confused / Paradoxical thoracoabdominal movement / Absence of wheeze /  Pulse/minute: Bradycardia

What is the treatment?
Quick-relief medicines include:
Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others).
Levalbuterol (Xopenex, Xopenex HFA).

If you go to the emergency room for an asthma attack in progress, you'll likely get a number of treatments to restore regular breathing. Treatments may include:

Oxygen. Oxygen may be given through a tube attached to the nose if there are signs of too little oxygen in the blood.

Quick-relief medicines. Inhaled quick-relief medicines, such as albuterol and levalbuterol, are given either with an inhaler or a nebulizer to open airways.

Ipratropium (Atrovent HFA). Ipratropium is a drug also used to open airways that is inhaled with an inhaler or a nebulizer.

Corticosteroids. Corticosteroids are given as a pill or shot to treat inflammation.

Mechanical ventilation. If an asthma attack is life-threatening, a machine may be used to help you breathe and get extra oxygen. This may be done with a breathing mask. But in some cases, a tube is placed down the throat and into the windpipe. This procedure is called intubation.

Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack. Types of long-term control medications include:

Inhaled corticosteroids. These medications include fluticasone propionate (Flovent HFA, Flovent Diskus, Xhance), budesonide (Pulmicort Flexhaler, Pulmicort Respules, Rhinocort), ciclesonide (Alvesco), beclomethasone (Qvar Redihaler), mometasone (Asmanex HFA, Asmanex Twisthaler) and fluticasone furoate (Arnuity Ellipta).

You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, inhaled corticosteroids have a relatively low risk of serious side effects.

Leukotriene modifiers. These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms.

Montelukast has been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away if you experience any of these reactions.

Combination inhalers. These medications — such as fluticasone-salmeterol (Advair HFA, Airduo Digihaler, others), budesonide-formoterol (Symbicort), formoterol-mometasone (Dulera) and fluticasone furoate-vilanterol (Breo Ellipta) — contain a long-acting beta agonist along with a corticosteroid. Theophylline. Theophylline (Theo-24, Elixophyllin, Theochron) is a daily pill that helps keep the airways open by relaxing the muscles around the airways. It's not used as often as other asthma medications and requires regular blood tests.


A medical emergency physician should always ask these questions.
What medicines are available in the medical emergency room?
What medicines are available on the crash cart?
What medicines are available for this medical condition?
What medical emergency equipment is available on the crash cart?
Who must provide further funding to enhance this research?

Last Updated: December 8, 2023