Dyspnea

Dyspnea results from a variety of conditions, ranging from nonurgent to life-threatening. Neither the clinical severity nor the patient’s perception correlates well with the seriousness of underlying pathology.

Dyspnea is subjective and the differential diagnosis can be divided into acute, acute on chronic, and chronic causes, of which the majority are cardiopulmonary. Other causes include metabolic, infectious, neuromuscular, traumatic, psychiatric, and hematologic conditions.

Chronic or progressive dyspnea usually denotes primary cardiac or pulmonary disease. Acute dyspneic spells may result from asthma exacerbation, infection, pulmonary embolism, cardiac dysfunction, or psychogenic causes.

All patients experiencing dyspnea, regardless of etiology, should be promptly evaluated. Bedside pulse oximetry readings should be obtained, and the patient placed on a cardiac monitor.

If the pulse oximetry is less than 92% on room air, the patient should be placed on supplemental oxygen either by nasal cannula or mask, depending on the degree of desaturation.

If altered level of consciousness, or hypoxia cannot be improved with suctioning, supplemental oxygen, or airway adjuncts then breathing should be assisted with manual or mechanical ventilation, either noninvasively for the short term, or with intubation for prolonged ventilation.

Unstable patients or patients with critical diagnoses must be stabilized and may require an emergent procedure and admission to an intensive care unit. Urgent patients who improve with emergency department management may be admitted to an intermediate care unit. Patients diagnosed with urgent conditions in danger of deterioration without proper treatment or patients with severe comorbidities, such as diabetes, immunosuppression, or cancer, may also require admission for observation and treatment.