So when someone comes in with respiratory distress
we wanna think about the most important questions you have to ask
and sometimes you have to ask and think about these things pretty rapidly.
This is something where you’re not gonna wanna take your time.
Your patient is having respiratory distress; they’re having a hard time breathing.
You don’t wanna just kind of wait around
so the important questions that you wanna be thinking about,
that you want to be asking right when you see this patient.
So you wanna know when did it start?
Did it start just before they came in?
Did it start 5 days ago?
Did it start months ago?
Is this a chronic problem for the patient?
Did the symptoms begin suddenly or were they more of gradual onset?
So sudden onset of shortness of breath makes you think about certain things.
More gradual onset of shortness of breath
makes you think about other potential etiologies.
Has this ever happened before?
There are a lot of things that cause respiratory distress
that have happened before for patients.
So for example, COPD, asthma,
those are generally recurring problems where patients get intermittent exacerbations
or something like a pulmonary embolus
might be something that just happens one time for patient.
Are there any other associated symptoms?
For example, is your patient having chest pain?
Have they had leg swelling?
And any other kind of associated symptom they can have.
Are they having a fever?
Are they having a cough?
There’s lots of other things that you wanna make sure that you’re asking about.
And then past medical history.
What are the medical problems does the patient have?
Do they have obstructive lung disease?
Are they a smoker?
Have they had heart attacks before?
Do they have heart failure?
Are they on diuretic medication?
So all of that stuff you want to try and formulate as quickly as you possibly can.
Now, the history can provide you with lots of clues
as to the etiology of a patient’s shortness of breath
so it’s important to try and gather as much information as possible.
And not just gathering as much information as possible
but to try and gather this information as quickly as you possibly can.
Now, the main issue here when we’re dealing with respiratory distress
especially for those patients that are severely dyspneic…
so for patients who are really struggling to breathe and talk,
so for example that patient that can only speak a couple of words at a time,
they’re not gonna be able to tell you
all of their medical history or when it started necessarily.
So for those patients,
what you’re gonna need to do is you’re gonna need to utilize other resources.
You’re gonna need to reach out to the EMTs
who brought the patient into the emergency department
so the family potentially or friends
who’s been with the person over the last little bit,
to the medical record can sometimes be very helpful
to help obtain historical information.
So you may be in a situation
where you’re not necessarily able to ask your patient all of these questions.
You know this may be different than other clinical experiences
that you’ve had in the past.
Often times, in the pre-clinical years of medical school,
if you have some patient contact usually that’s gonna be with a stable patient.
Here, these patients are gonna be very sick potentially
and you’re gonna wanna try and gather
as much information as quickly as you can
and potentially utilize these additional resources.