Goals

• Trainee will demonstrate competence in the initial evaluation and basic management of adults with dyspnea and respiratory distress

Objectives

Trainee will be able to:

• List and describe common acute life-threatening causes of dyspnea

  • Acute coronary syndrome

  • Arrhythmia

  • Asthma

  • Cardiac tamponade

  • CHF / Pulmonary edema

  • COPD

  • Pneumonia

  • Pneumothorax

  • Pulmonary embolus

• Describe presenting features of common acute life-threatening causes of dyspnea

• List and discuss the rationale for initial diagnostic interventions for patients with dyspnea

  • Auscultation

  • Pulse oximetry

  • ECG

  • CXR

  • Peak flow

  • Ultrasound

  • Volume status assessment

• List and discuss the rationale for initial therapeutic interventions for patients with dyspnea and their indications

  • Oxygen

  • NIPPV

  • Endotracheal intubation

  • Nebulized medications

  • Steroids

  • Nitroglycerin

Acute Coronary Syndromes

• See: Acute Coronary Syndromes (EM Fundamentals)

Asthma

• General

  • Asthma (IBCC 2017)

• Ventilator Management

  • Vent Management in Asthma (EM-in-5 2013)

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Cardiac Tamponade

• Acute Myopericardial Syndromes (EM:RAP 2021)

• Cardiac Tamponade (Eur Heart J Acute Cardiovasc Care 2020)

• Pericarditis and Tamponade (EM:RAP 2011)

• Ultrasound

  • Pericardial Effusion vs. Tamponade (ALiEM 2019)​

• Pericardiocentesis

  • Pericardiocentesis (HighlandEM US 2019)

  • Pericardiocentesis (EM-in-5 2016)

  • Pericardiocentesis (Ultrasound Podcast 2013)

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CHF / Pulmonary Edema

• Sympathetic Crashing Acute Pulmonary Edema (EMCrit 2009/2017)

• Acute Heart Failure Syndromes (ACEP Clinical Policy 2007) (pdf)

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COPD

• Acute COPD Exacerbation (emDocs 2018)

• Acute Exacerbations of COPD (EB Medicine 2017)

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Pneumonia

• Diagnosis and Treatment of Community-Acquired Pneumonia (Am J Resp Crit Care Med 2019) (pdf)

Pneumothorax

• General

  • Pneumothorax (CDEM 2019)

  • Pneumothorax (Postgrad Med J 2007) (pdf)

• Ultrasound

  • US for Pneumothorax (REBEL EM 2014)

• Decompression

  • Needle Decompression for Tension Pneumothorax (EPMonthly 2014)

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Pulmonary Embolism

• Suspected Acute Venous Thromboembolic Disease (ACEP Clinical Policy 2018) (pdf)

• Acute Management of Pulmonary Embolism (ACC 2017)

• PE Treatment Options (EMCrit 2014)

• When the PERC Rule Fails (ALIEM 2014)

• D-Dimer Testing

  • Age-adjusted D-dimer (MD Calc)

• Ultrasound​

  • RV Strain (ACEP US 2018)​

• Thrombolysis

  • Thrombolysis for Submassive PE (LITFL 2016)​

Volume Status Assessment

• US Assessment of Volume Status (EMCrit 2017)

• IVC US (LITFL 2020)

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Airway Management

• See: Airway Management (EM Fundamentals)