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Sudden onset shortness of breath
| Clinical Discipline(s)/Organ System(s) Respiratory Medicine, Respiratory System, Immunology | Progress Test Topic(s) Respiratory |
Description
A 17 year old Tokelauan woman, with a background of asthma, is brought into the Emergency Department after becoming suddenly short of breath with associated wheezy breathing. She is distressed but speaking in long sentences.
Progress Test-Type Questions: Question 1 | Question 2 | Question 3 | Question 4 | Question 5Applied Science for Medicine
- Anatomy and function of the respiratory tract including larynx/upper airway; microanatomy of airways
- Pulmonary mechanics, gas exchange, control of breathing
- Anatomy and physiology of pulmonary vasculature
- Coagulation; risk factors for and mechanisms of thromboembolism
- Pathophysiology of asthma; mechanism and pathophysiology of exercise-induced asthma
- Physiology of acute airway obstruction; intra- vs extra-thoracic, focal vs diffuse airflow obstruction
- Mechanism and diagnosis of stridor
- Pathophysiology of pneumothorax, pulmonary embolism
- Type I hypersensitivity, immunoglobulin E (IgE) , mast cells, eosinophils
- Pharmacology of beta-2 adrenoceptor agonists, inhaled anti-inflammatory corticosteroids, ipratropium, leukotriene receptor antagonists, sodium cromoglycate
- Anatomy and function of the respiratory tract including larynx/upper airway; microanatomy of airways
- Pulmonary mechanics, gas exchange, control of breathing
- Anatomy and physiology of pulmonary vasculature
- Coagulation; risk factors for and mechanisms of thromboembolism
- Pathophysiology of asthma; mechanism and pathophysiology of exercise-induced asthma
- Physiology of acute airway obstruction; intra- vs extra-thoracic, focal vs diffuse airflow obstruction
- Mechanism and diagnosis of stridor
- Pathophysiology of pneumothorax, pulmonary embolism
- Type I hypersensitivity, immunoglobulin E (IgE) , mast cells, eosinophils
- Pharmacology of beta-2 adrenoceptor agonists, inhaled anti-inflammatory corticosteroids, ipratropium, leukotriene receptor antagonists, sodium cromoglycate
Clinical and Communication Skills
- History from a patient with acute shortness of breath; relevant history for a patient with asthma including circumstances of acute attack and background control;relevant history for a patient with anaphylaxis/laryngeal odema; relevant history for a patient with pneumothorax; relevant history for a patient with pulmonary embolism
- Perform a rapid and targeted examination of a patient with sudden onset shortness of breath; recognise respiratory distress and a pneumothorax
- Differential diagnosis of sudden onset shortness of breath
- Diagnosis of hyperventilation syndrome
- Co-morbidities of patients with airways disease
- Perform Peak Expiratory Flow (PEF), spirometry and arterial blood gas
- Perform and interpret relevant investigations: PEF, arterial blood gas, bloods and chest X-ray
- Indications for detailed pulmonary function tests, CT pulmonary angiogram, V/Q scan
- Classify acute asthma into mild, moderate, severe and life-threatening
- Management of acute asthma including respiratory arrest
- Management of chronic asthma; pharmacological, non-pharmacological; patient education
- Classify pulmonary embolism: massive, sub-massive
- Management of pulmonary embolus (acute and longer term) and pneumothorax
- Management of anaphylaxis/laryngeal odema
- Prognosis of asthma, pulmonary embolus and pneumothorax
- History from a patient with acute shortness of breath; relevant history for a patient with asthma including circumstances of acute attack and background control;relevant history for a patient with anaphylaxis/laryngeal odema; relevant history for a patient with pneumothorax; relevant history for a patient with pulmonary embolism
- Perform a rapid and targeted examination of a patient with sudden onset shortness of breath; recognise respiratory distress and a pneumothorax
- Differential diagnosis of sudden onset shortness of breath
- Diagnosis of hyperventilation syndrome
- Co-morbidities of patients with airways disease
- Perform Peak Expiratory Flow (PEF), spirometry and arterial blood gas
- Perform and interpret relevant investigations: PEF, arterial blood gas, bloods and chest X-ray
- Indications for detailed pulmonary function tests, CT pulmonary angiogram, V/Q scan
- Classify acute asthma into mild, moderate, severe and life-threatening
- Management of acute asthma including respiratory arrest
- Management of chronic asthma; pharmacological, non-pharmacological; patient education
- Classify pulmonary embolism: massive, sub-massive
- Management of pulmonary embolus (acute and longer term) and pneumothorax
- Management of anaphylaxis/laryngeal odema
- Prognosis of asthma, pulmonary embolus and pneumothorax
Personal and Professional Skills
- Understanding barriers to accessing healthcare for adolescents
- Interprofessional management of chronic disease
- Discussion of treatment options
- Understanding barriers to accessing healthcare for adolescents
- Interprofessional management of chronic disease
- Discussion of treatment options
Hauora Māori
- Appropriate engagement and consultation with whānau
- Importance of whānau for adolescent wellbeing
- Ability to cater for differential health literacy needs of Māori patients and whānau
- Appropriate engagement and consultation with whānau
- Importance of whānau for adolescent wellbeing
- Ability to cater for differential health literacy needs of Māori patients and whānau
Population Health
- Socio-economic determinants of health
- Preventative health and health promotion needs for adolescents
- Epidemiology of asthma and atopy/anaphylaxis
- Pharmaco-epidemiology relevant to asthma
- Socio-economic determinants of health
- Preventative health and health promotion needs for adolescents
- Epidemiology of asthma and atopy/anaphylaxis
- Pharmaco-epidemiology relevant to asthma
Conditions to be considered relating to this scenario
Common
asthma, anaphylaxis/laryngeal oedema, pulmonary embolism, simple/tension pneumothorax, anxiety/hyperventilation
asthma, anaphylaxis/laryngeal oedema, pulmonary embolism, simple/tension pneumothorax, anxiety/hyperventilation
Less common but 'important not to miss'
heart failure ('flash' pulmonary odema, consider rheumatic heart disease as an underlying cause), substance abuse, cardiac tamponade
heart failure ('flash' pulmonary odema, consider rheumatic heart disease as an underlying cause), substance abuse, cardiac tamponade
