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1. Acute Dyspnea
Dr. Varun bansal
FEM-Mumbai
Master in Emergency Medicine-GW(USA)
2nd Year

2. Definition
▶It is feeling of an uncomfortable need
to breathe.
▶It is most common complaint of
patients with cardiopulmonary
diseases.

3. Pathophysiology
▶Dyspnea results when there is
imbalance between perceived need to
breathe and perceived ability to
breathe.
▶CO2 build-up and oxygen deprivation
are the critical factors that result in
dyspnea.

4. Causes of Acute Dyspnea
▶Pulmonary : Pneumothorax,
Pulmonary edema, Massive pulmonary
embolus, Acute severe Asthma, Acute
exacerbation of COPD, Pneumonia,
Foreign body, toxic inhalation.

5. ▶Cardiac: Acute pulmonary edema
▶Metabolic acidosis: Diabetic
ketoacidosis, lactic acidosis,uremia,
overdose of salicylates, ethylene
glycol poisoning.
▶Psychogenic: Anxiety, panic attack

6. Diagnostic Evaluation of Acute
Dyspnea
▶ History and Clinical examination:
▶ Recent trauma, silent resonant
hemithorax…..Pneumothorax.
▶ Risk factors, severe breathlessness, chest
pain, pleurisy, syncope*, dizziness*……Massive
Pulmonary embolus (with signs of central
cyanosis, raised JVP*, absence of signs in the
lung*, shock)

7. ▶History of Asthma, asthma
medications, wheeze……Acute severe
Asthma (signs: tachycardia, pulsus
paradoxus, JVP normal*, wheeze*)
▶ Previous episodes*, smoker, prolonged
expiration, may be drowsy…..Acute
exacerbation of COPD (signs: cyanosis,
hyperinflation*, signs of CO2 retention—
flapping tremor, bounding pulses)

8. ▶Prodromal illness*, fever*, rigors*,
pleurisy*….Pneumonia (signs: fever,
confusion, pleural rub*, consolidation*,
cyanosis-if severe.)
▶ Chest pain, orthopnea, palpitations,
cardiac history*…… Acute Pulmonary
edema. ( signs: of central cyanosis,
raised JVP, sweating, cool extremities,
basal crackles*)

9. ▶Evidence of Diabetes mellitus, or renal
disease, aspirin or ethylene glycol
overdose…..Metabolic acidosis (signs:
Ketones, hyperventilation without
heart and lung signs*, dehydration*, Air
hunger)
▶Previous episodes, digital or perioral
dysaesthesia…..Psychogenic (signs: no
cyanosis, no heart or lung signs,
carpopedal spasm)

10. ▶In children, the possibility of
inhalation of a foreign body or acute
epiglottitis should always be
considered.

13. Investigations:

15. Management:
▶Treatment is directed at the cause.
▶Non-drug Treatment
-Positioning… sitting up
-Relaxation
-Humidified Air
-Non invasive positive pressure mask
▶Quit smoking

16. ▶Opioids(drug of choice)...5mg IV every
5-10 mins until relief
▶Oxygen..5-6L/min (not always helpful)
▶Specific treatment:
 Pneumothorax----Aspiration, Chest tube,
pleurodesis, thoracoscopy
 Massive pulmonary embolism----High dose
unfractionated heparin, Dopamine or
dobutamine with norepinephrine for PE related
shock, open surgical embolectomy, catheter
thrombectomy.

17.  Acute Asthma exacerbation---- inhaled
anticholinergic drugs with beta2
agonists in children, systemic
corticosteroids
 Acute exacerbation of COPD---- Beta2
agonists, corticosteroids, antibiotics,
oxygen, ventilator support
 Pneumonia---- IV antibiotics, oxygen
therapy, IV fluids.

18.  Pulmonary edema----keep oxygen
saturation greater than 90%, intubation,
preload reducers (nitroglycerine,
diuretics) afterload reducers
(nitroprusside), ultrafiltration
 Metabolic Acidosis----severe cases(pH
<7.2)- bicarbonate therapy, treat
underline cause
 Psychogenic Dyspnea---- anxiolytics,
paper bag technique (increases needed
CO2 and reduces symptoms, but may
worsen the condition sometimes)

19.  Foreign body---- Heimlich maneuver,
supportive measures(oxygen, pulse
oximetry), racemic epinephrine as
temporary measure until bronchoscopy
can be done, bronchoscopy
 Acute epiglottitis---- intubation
(difficult if laryngeal edema present) ,
antibiotics.

20. ThankYou