Dyspnoea

Question 1

What is dyspnoea?

Answer 1

Dyspnoea is a subjective feeling, described as ‘shortness of breath’ but also implies a sense of discomfort, with breathing having become a conscious effort.

Question 2

What are the 5 main causes of dyspnoea?

Answer 2

1. Neurological:
   - Head injury
   - Spinal injury
   - CVA/TIA
   - Seizure
   - Pain
   - Hyperventilation
   - Metabolic acidosis
2. Airway obstruction:
   - Foreign body
   - Tissue oedema
3. Respiratory compromise:
   - Asthma
   - Anaphylaxis / allergies
   - COPD
   - Inhalation injury
4. Cardiovascular compromise:
   - ACS
   - APO
   - PE
   - Shock & sepsis
   - Dysrhythmias
5. Thoracic musculoskeletal compromise:
   - Toxidromes
   - Burns

OTHER

• Toxidromes
• Burns

Question 3

What are the clinical features of dyspnoea?

Answer 3

General:

• Abnormal respiratory rate/pattern
• Difficulty speaking or change in tone
• Diminished air entry or abnormal respiratory sounds
• Flaring nostrils, accessory muscle use, tracheal tug, intercostal or supraclavicular retractions, tripoding

Obstruction:

• Inspiratory stridor (foreign body or tissue oedema)
• Snoring due to soft tissue collapse
• Gurgling due to fluids in upper airway
• Drooling or a difficulty/inability to swallow due to soft tissues oedema

Signs:

• Expiratory (or inspiratory) wheeze, crackles
• Pursing of lips
• Hyperinflated chest
• Silent chest