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Related Subjects: Asthma |Acute Severe Asthma |Exacerbation of COPD |Pulmonary Embolism |Acute Heart Failure and Cardiogenic Pulmonary Oedema |Pneumothorax |Tension Pneumothorax |Respiratory (Chest) infections Pneumonia |Fat embolism |Hyperventilation Syndrome |ARDS |Respiratory Failure |Diabetic Ketoacidosis
In difficult cases It is reasonable to treat more than one - suspected pathology e.g. PE, pneumonia and pulmonary oedema at one time while you await test and radiology results.
Cause | Notes |
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Acute Cardiogenic Pulmonary Oedema | Breathless, Basal crackles, tachycardia, S3 Fluid accumulates in the interstitium of the lungs. An older patient with cardiac disease. Breathless, Sitting up helps, distressed, tachycardia, raised JVP, S3, can be wheezy, the context of cardiac disease e.g. chest pain/fluid overload. Needs CXR (Batwing oedema) ,ECG,Troponin, Echo |
Acute severe Asthma | Younger patient, known asthma. Bronchospasm and mucus plugging. PEFR, Breathless and Wheeze, Young. |
Anaphylaxis | Patient urticaria, wheeze, stridor, hypotension. Look for trigger - food, sting, drug, blood transfusion. |
Exacerbation of COPD | Known COPD, Progressive SOB + exacerbations. Chronic cough, Typical CXR, Smoker, Wheeze, Pursed lips, cachexia |
Pneumothorax | Air in the pleural space. Acute breathlessness. Determine if preexisting lung disease and primary or secondary PTX. CXR diagnostic. If hypotensive worsening consider tension ptx |
Pulmonary embolism | Occluded pulmonary artery and branches. Risk factors. Calf pain. Wells score. D-Dimers, CT Pulmonary Angiogram |
Pleural effusion | Stony dull, reduced chest wall movement, malignancy. Depends on rate and size of fluid collection and whether fluid is infective, inflammatory or neoplastic |
Lung segment collapse | Malignancy, foreign body, TB. CXR/CT changes. May need bronchoscopy |
Pneumonia | CXR changes, cough, sputum, Fever, Systemically unwell. Consolidation, coarse crackles, dull. |
Pneumocystis Pneumonia | CXR changes, cough, sputum, Fever, Systemically unwell. chest may be clear. |
Upper airways obstruction | Causes stridor - Anaphylaxis, new drug, inhaled foreign body |
Non-Cardiogenic pulmonary oedema (ARDS) | Hypoxia, Stiff boggy lungs, CXR changes, Another illness - Sepsis, Trauma, coexisting illness |
Hyperventilation | Situational anxiety, panic attack |
Metabolic acidosis | Diabetic ketoacidosis or other causes of metabolic acidosis |
Fat embolism | Recent fracture, sickle cell, agitated, skin rash |
Inhaled Foreign Body | Usually children, Sudden and acute stridor or cyanosis and distress if into bronchus |
Aspiration pneumonia | Neurological disease or obstructive oesophageal lesion, Unsafe swallow, comatose, sudden breathlessness, a chemical rather than infectious pneumonitis |
Sarcoidosis or Occupational lung disease | Progressive dyspnoea over months, cough |
Fibrosing Alveolitis | Progressive dyspnoea over months, cough and velcro crackles and Clubbing |
Presentation | Differentials |
Wheezy breathlessness | Asthma, COPD, Heart Failure, Acute Pulmonary oedema, Anaphylaxis |
Breathless and stridor |
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Breathless and normal CXR |
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