Dyspnea and Loss of consciousness or Agitation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]


Abbreviations: ABG (arterial blood gas); ACE (angiotensin converting enzyme); BMI (body mass index); CBC (complete blood count); CSF (cerebrospinal fluid); CXR (chest X-ray); ECG (electrocardiogram); FEF (forced expiratory flow rate); FEV1 (forced expiratory volume); FVC (forced vital capacity); JVD (jugular vein distention); MCV (mean corpuscular volume); Plt (platelet); RV (residual volume); SIADH (syndrome of inappropriate antidiuretic hormone); TSH (thyroid stimulating hormone); Vt (tidal volume); WBC (white blood cell);

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Acute Dyspnea Respiratory system Head and Neck,

Upper airway

Anaphylaxis[1] +/- + - +/- - - +/- - - - Scattered wheezing Normal Normal Normal N/A Vital sign Type 1 hypersensitivity
Aspiration[2] - + - - +/- + + - - - Diminished breath sounds Normal Normal Atelectasis Vt, ↑RV Bronchoscopy Choking
Croup[3] - + - +/- - + + - - - Stridor WBC Normal Steeple sign Normal Physical exam Barking cough
Epiglottitis[4] - + - + - + - - - - Stridor WBC Normal Thumb sign Normal Laryngoscopy Drooling
Chest and Pleura,

Lower airway

Asthma attack[5] - + - - +/- + + - - - Wheeze Eosinophil Respiratory alkalosis Normal FEV1, PEF Physical exam and

Spirometry

Chest pain
Bronchospasm[6] +/- + - - + +/- + - - - Wheeze Normal O2, ↑CO2 Normal Vt, ↑RV Physical exam Allergic reaction
COPD exacerbation[7] - + - + + + + +/- +/- +/- Wheeze, Rhonchi, and Crackles WBC, ↑RBC Respiratory alkalosis Hyperexpansion FEV1/FVC Clinical assessment Acute exacerbations of chronic bronchitis (AECB)
Rib fractures (flail chest)[8] - + - - + - - - - - Normal Normal Respiratory acidosis Fracture marks Normal Chest X-ray Pneumothorax
Cardiovascular system Acute myocardial ischemia[9] +/- + - +/- + - - - - - Normal Normal Normal Normal Normal Cardiac troponin I Nausea and vomiting, Positive pertinent risk factors, such as hypertension, diabetes, and smoking
Acute heart failure[10] +/- + - - +/- + + - + + S3 Normal Respiratory alkalosis Cardiothoracic ratio Vt B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) Excessive sweating, high blood pressure
Pericardial tamponade[11] +/- - - - + - - - + - Muffled heart sounds Normal Normal Water bottle appearance enlarged heart Normal Echocardiography Fluid accumulation in pericardium
Tachyarrhythmia[9] +/- + - - +/- - - - - - High pulse rate Normal Normal Normal Normal ECG Palpitation
Pulmonary edema[12] +/- + - + + + + + + + Basal crackle Normal Respiratory alkalosis Bat wing pattern, air bronchograms Vt, ↑RV Cardiac Catheterization Tachypnea
Central nervous system Stroke + - - +/- - - - - - - Normal Normal Normal Intracranial infarct or hemorrhage Normal Brain MRI Paralysis or paresthesia
Encephalitis[13] + + - + - - - - - - Normal WBC, neutrophilia Normal Normal Normal CSF PCR Confusion
Traumatic brain injury[14] + +/- - - - - - - - - Normal Normal Respiratory acidosis Intracerebral hemorrhage Normal Brain CT scan Lucid interval
Toxic/Metabolic Organophosphate poisoning[15] + - - + - - - - - - Wheeze Normal O2, ↑CO2 Normal Normal Blood test Salivation, Lacrimation, Emesis, Miosis
Salicylate poisoning[16] + - - - - - + - - - Normal Normal Metabolic acidosis, Respiratory alkalosis Normal Normal Blood test Vomiting, Tinnitus, Confusion, Hyperthermia
Carbon monoxide poisoning[17] + - - - + + + - - - Wheeze Carboxyhemoglobin O2, ↑CO2 Normal N/A Carboxyhemoglobin (HbCO) level Headache, Dizziness, Weakness, Vomiting, Confusion
Diabetic ketoacidosis[18] + +/- - - - - - - - - Scattered wheeze, Kussmaul's respiration WBC Metabolic acidosis Normal Normal Blood test (acidosis, hyperglycemia, ketonemia) Vomiting, Abdominal pain, Weakness, Confusion
Systemic Panic attack[19] +/- + - - - - - - - - Normal Normal Normal Normal Normal Clinical assessment Severe anxiety
Sepsis[20] +/- - - + - - - - - - Normal WBC, neutrophilia O2, ↑CO2 Normal Normal SIRS criteria Chills, Confusion
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Loss of consciousness Agitation Weight loss Fever Chest pain Cough Cyanosis Clubbing JVD Peripheral edema Auscultation CBC ABG Imaging Spirometry Gold standard
Chronic Dyspnea Respiratory system Chest and Pleura,

Lower airway

Bronchial asthma[5] - + +/- - +/- + + + - - Wheeze Eosinophil Respiratory alkalosis, Metabolic acidosis Pulmonary hyperinflation,

Bronchial wall thickening

FEV1/FVC Spirometry before and after bronchodilator Paroxysmal respiratory distress
Pleural effusion[21] - +/- + - + - - - +/- +/- Egophony ("E-to-A" change) Normal Normal Blunting of the costophrenic and cardiophrenic angle Vt, ↑RV Light's criteria Tactile fremitus, Asymmetrical chest expansion
Cardiovascular system Coronary heart disease[9] - +/- - - + - - - - - Normal Normal O2 Normal Normal Cardiac troponin I Nausea, Lightheadedness, Sweating
Neuromuscular disease Amyotrophic lateral sclerosis[22] +/- - +/- - - - - - - - Normal WBC Normal Normal Vt, ↑RV Revised El Escorial criteria (clinical) Muscle weakness, Dysphagia
Glycolytic enzyme defects (e.g., McArdle)[23] +/- - - - - - - - - +/- Normal Normal Normal Normal Vt, ↑RV Muscle biopsy (ragged red fibers) Myoglobinuria,

Muscle weakness

Systemic Anxiety[24] + + + - +/- +/- - - - - Normal Normal Normal Normal Normal Psychological interview Sweating, Palpitation
Depression[25] - + + - - - - - - - Normal Normal Normal Normal Normal Psychological interview Depressed mood, Fatigue

References

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