breathlessness
Breathlessness
ASSESSMENT
- ABCDE
- Visual inspection (colour, mobility, work of breathing)
- Observations (must include HR, BP, respiration rate, SPO2, use of accessory muscles and describe breathing)
- Respiratory assessment, including:
- Chest auscultation in all 4 quadrants & percussion if reduced sounds
- JVP
- Heart sounds
- Breath sounds
- Oedema (legs, thighs, sacral and chest
- Compare to baseline – significant change? NEWS 2 score and triggers?
- Obtain comprehensive Hx with onset, aggravating/relieving factors
Possible causes:
| Anaphylaxis | Wheeze and possible stridor , reduced SPO2 |
|---|---|
| Anxiety | Panting, SOB with maintained SPO2 |
| Asthma exacerbation | Wheeze +/- SPO2 changes |
| COPD exacerbation | Wheeze, crackles, reduced SPO2 (typically 88% to 92%) |
| Fibrosis | Chronic crackles |
| TB | Fever, sweats and weight loss, coarse crackles typically upper/midzone |
| Chest infection/pneumonia) | Crackles, temperatures, possible reduced SPO2 and possible wheeze |
| Heart failure/pulmonary | oedema Crackles to base(s), oedema to legs/thighs, +/- sacral oedema |
| Trauma | (haemo/pneumothorax) Reduced or absent breath sounds, unilateral chest expansion |
| Aspiration | Crackles to base(s), immediate or delayed cough with food, fluids or tablets, recurrent chest infection |
| Coronavirus (COVID-19) | Fever, cough, anosmia, ageusia, reduced SPO2 |
| PE/VTE | SOB, chest pain, collapse |
Red Flag
- Absent breath sound (unilaterally or bilaterally)
- Significant change from baseline
- Saturations below 94% in non COPD cases
- Saturations below 88% in COPD cases
- Sepsis