So what's on your differential of consequence.
Now, if you all remember,
our differential of consequence is thinking about the things
that are most life threatening to our patient.
In the ED, we wanna rule out what's the most likely thing
to cause harm or to potentially kill our patient
in the next few hours, days.
So what's on our differential of consequence here?
There's a handful of organ systems
which can cause respiratory distress.
The lungs are the main one that we think about, right?
So you think about all the things
that could be going on in the lungs.
But the heart can also cause respiratory distress,
as can kidney failure,
promus with the kidneys,
liver failure as well,
and then a handful of systemic stuff
such as anemia or a low blood cell count.
So thinking about the lungs.
What in the lungs can cause shortness of breath?
is one that we always are thinking about
in the Emergency Department
and we'll be talking about that
all of these in more detail in other lectures.
COPD, asthma, pneumonia, and pneumothorax,
all things in the lungs that can cause a patient
to present with shortness of breath.
Thinking about the heart,
we think about congestive heart failure
which leads to pulmonary edema,
fluid on the lungs.
We think about acute coronary syndromes
and we always have to make sure we're considering these.
So these are your stemis,
We think about cardiac tamponade.
This is another key area that an echocardiogram
can potentially really help you.
Cardiac tamponade often times presents following trauma,
but also can be related to
you can get larger fusions related to different malignancies,
as well as related to pericardial effusions.
So definitely, you wanna make sure
you're thinking about cardiac tamponade.
And then acute valvular insufficiency.
Does the patient have sever aortic regurgitation,
severe aortic stenosis,
all of those things can lead to shortness of breath.
And then last but not least,
we have a big list of other things.
Now, this is by no means all-inclusive.
There are a lot of things out there
that can make someone feel short of breath.
Symptomatic anemia is one.
Every so often,
I have a patient in the Emergency Department
who comes in with this gradual onset of shortness of breath
and every so often,
I get the labs back,
and I’m surprised that a patient is found
to have been severely anemic.
So that they have very low blood cell counts
and I say to them that we found the answer for your problem
and often times,
those patients will need a blood transfusion.
Symptomatic anemia can be due to lot of different things,
due to bleeding in the GI tract
or you know, a variety of things.
But we wanna make sure that we're thinking about this.
This is one of those reasons
why those basic blood test that we send off
can really help us out.
In the appropriate situation,
you wanna think about carbon monoxide poisoning.
Definitely, it’s a good idea when these people present
shorter breath especially in the winter months
when people are running indoor heaters and various generators,
to think about carbon monoxide poisoning,
definitely after a fire kind of a situation,
you wanna think about that.
Pregnancy can by in it of itself
cause people to be short of breath
and that’s due to various physiologic changes
in the body during pregnancy.
promus with the kidneys.
Patients who are maintained on hemodialysis
can often times get a backup of fluid
mainly into their lungs so can cause pulmonary edema.
And we know that patients from time to time
are non-compliant with their dialysis treatments
that they don’t go like they’re supposed to.
Especially people are vulnerable in times
when they're kind of peri dialysis,
when they’re about to be started on dialysis treatments.
So asking about kidney failure can be key.
And for patients who come in with severe respiratory distress
and you’re not sure if they have kidney failure.
One key thing that you can do for those patients
is you can go ahead and again, examine your patient.
You can look for points of dialysis access,
you can look for an AV fistula.
You can look to see if they have a lining,
or if they have had a prior lines
that indicate that they have had kidney failure before.
And then last but not the least,
thinking about liver failure with ascites.
So in the situation of liver failure,
your body can develop a lot of ascites or fluid in the abdomen.
If you get significant fluid in the abdomen,
then that can in turn push up on the lung fields
and potentially cause shortness of breath.
So thinking about liver failure as well.
Again, your examination can help you here.
Does the patient have any stigmata of liver failure?
Do they have scleral icterus
or yellowing of the eyes?
Does their skin appear to be yellow?
So before you even get your labs back,
you can start thinking about this as a possible ideology
just by utilizing your physical exam.
Very important here to consider
a broad differential of consequence.
This is one of the areas in emergency medicine
where potentially early closure can really hurt us.
So we see a patient who has a known history of COPD,
who comes in short of breath,
we sometimes automatically assume
that this is an exacerbation of their COPD.
But in reality,
you wanna also make sure they don’t have a pneumonia
that they're not having a heart attack
and it's not a blood clot in their lungs.
So you really wanna keep that differential of consequence broad
to prevent missing a critical diagnosis.
You wanna really try to avoid
early closure on these patients.