''Building differential diagnosis is essential, but immediate action is also important for dyspnea patient.''1. DDx by organ system
- tips: using organ system to organize DDx can help doctor to link appropriate test, I will show you on next section soon...
A. Blood: anemia
B. Kidney: metabolic acidosis
C. Heart: arrhythmia, heart failure with acute exacerbation, acute coronary syndrome
D. Lung: pneumonia, pneumothorax, lung cancer, interstitial lung disease, COPD AE, asthma AE, pulmonary embolism
- Red flag: NEED to rule out IMMEDIATELY
A. pulmonary embolism, acute coronary syndrome, pneumothorax, airway obstruction
2. Test
- tips 1: REMEMBER that we should find more evidence to rule in/out the disease we care about.
- tips 2: Build your own check list for quick action in the hospital. TIME FLY!!!
A. CBC with different count ...
B. Artery blood gas ...
C. EKG, Cardiac echo ...
D. CXR, A-a gradient, Lung CT ...
3. Manegement
- Tip 1: Keep vital sign first. (Follow ACLS guideline)
- Tip 2: Deal with underlying disease
4. Clinical pearl
- Applying 100% O2 for 2-3 hours might cause lung injury, so 60% O2 was recommended (non-breathing mask 6L/min O2)
- During endotracheal tube insertion, ventilation was important. Keeping SpO2 100% for 3 minutes can get more time to intubation.
5. Ref:
1. 內科住院醫師鐵則
