You are called to the ward at night because of an acute onset of dyspnea. Outline your initial steps.
Initial steps in management include:
- History – onset, provoking/relieving factors, history of similar symptoms, associated symptoms (cough, sputum, hemoptysis, diaphoresis, nausea, vomiting, chest pain). Get PMHx and current inpatient care from patient chart
- Physical exam – vitals (HR, BP, RR, O2 sat, Temp), precordial exam, respiratory exam
- Investigations:
- CBC, Lytes, Cr
- ECG
- Troponin, CK
- Lactate (suspect sepsis or acute metabolic lactic acidosis)
- Venous or arterial blood gas (if suspect metabolic acidosis)
- CXR
- CT PE (if suspect PE)
- Supplemental O2
- Call for help:
- If ECG changes suggestive of Unstable Angina /NSTEMI/STEMI
- If Pulmonary embolism
- If unsure
