SOB

DC Inst – Shortness of Breath

DC

You were evaluated in the Emergency Department today for shortness of breath. Your symptoms improved with Albuterol and steroids, and your evaluation did not show evidence of medical conditions requiring emergent intervention at this time. ***You have been given a prescription for steroids, please take them as directed.

Please follow up with your primary care physician within two days.

Return to the Emergency Department if you experience worsening shortness of breath, chest pain, headache, light headedness, or any other concerning symptoms.

Thank you for choosing us for your care.

DYSPNEA – General

MDM

This patient presents with dyspnea, most likely secondary to ***. Differential diagnosis includes ***. Presentation not consistent with acute cardiac etiologies to include ACS (HEART score ***), CHF, pericardial effusion / tamponade . Presentation not consistent with acute respiratory etiologies to include acute PE (Wells low risk ***), pneumothorax , asthma, COPD exacerbation, allergic etiologies, or infectious etiologies such as PNA. Presentation also not consistent with non-cardiopulmonary causes to include toxidromes, metabolic etiologies such as acidemia or electrolyte derangements, sepsis, neurologic causes (i.e. demyelinating diseases).

Plan: supplemental O2, NIPPV ***, CXR, labs, troponin, close hemodynamic monitoring, serial reassessment

COPD Exacerbation – Admit

MDM

This patient presents with symptoms most consistent with an acute COPD exacerbation. These constellation of symptoms are similar to prior flares without overt deviations from normal exacerbations. The likely precipitant is acute respiratory infection // weather change or air quality // recent beta-blocker or opiate use.*** Low suspicion for alternate etiologies such as pneumothorax, acute PE. Presentation not consistent with other acute cardiopulmonary causes including ACS / CHF / cardiac effusion.

Pseudomonas risk factors: recent hospitalization // frequent antibiotic treatment // severe COPD // previously isolated Pseudomonas.*** Plan to maintain SaO2 ~90-94% with supplemental O2. Based on current presentation, including work of breathing, patient will need NIPPV (CPAP/BiPAP) // will not need NIPPV at this time. Plan for trial of duonebs, steroids. Antibiotics ***indicated given purulent sputum // increased sputum production // trial of NIPPV // No indication for antibiotic treatment at this time.*** Will evaluate for other acute cardiopulmonary processes with a CXR.

Anticipate hospitalization given marked increase in symptoms // significant co-morbidities and age // new arrhythmias.***

Plan: supplemental O2 (goal SaO2 ~90-94%), NIPPV***, duonebs, steroids, antibiotics***, CXR***, serial reassessment