Shortness of breath resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Steven Bellm, M.D. [2]

Shortness of breath resident survival guide Microchapters
Overview
Classification
Causes
FIRE
Diagnosis
Treatment
Do's
Dont's

Overview

Dyspnea is a common and often debilitating symptom that affects up to 50% of patients admitted to acute, tertiary care hospitals and a quarter of patients seeking care in ambulatory settings. The presence of dyspnea is a potent predictor of mortality, often surpassing common physiological measurements in predicting the clinical course of a patient. Respiratory discomfort may arise from a wide range of clinical conditions, but also may be a manifestation of poor cardiovascular fitness in our increasingly sedentary population. Diagnosis and treatment of the underlying cause of dyspnea is the preferred and most direct approach to ameliorating this symptom, but there are many patients for whom the cause is unclear or for whom dyspnea persists despite optimal treatment. We define dyspnea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Because dyspnea is a symptom (i.e., perception of an abnormal or distressing internal state), it must generally be distinguished from signs that clinicians typically invoke as evidence of respiratory distress, such as tachypnea, use of accessory muscles, and intercostal retractions.

Classification

Causes

Life Threatening Causes

Common Causes

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

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Complete Diagnostic Approach

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Treatment

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References