Assessment and Initial Management of the Patient with Acute Breathlessness - Flowchart
Assessment and Initial Management of the Patient with Acute Breathlessness - Flowchart Assessment and Initial Management of the Patient with Acute Breathlessness Assessment and Initial Management of the Patient with Acute Breathlessness
Flowchart

Assessment of the patient with acute breathlessness

Assessment of the patient with acute breathlessness

Assessment of the patient with acute breathlessness

Sit patient up
High-flow oxygen
IM adrenaline
If suspected anaphylaxis call resuscitation team and ENT surgeon

Sit patient up
High-flow oxygen
IM adrenaline
If suspected anaphylaxis call resuscitation team and ENT surgeon

Sit patient up
High-flow oxygen
IM adrenaline
If suspected anaphylaxis call resuscitation team and ENT surgeon




End

End

End

Assess using ABCDE method
Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Nebulized salbutamol if wheeze
Focused assessment (Table 10.1)
Urgent investigation (Table 10.2)

Assess using ABCDE method
Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Nebulized salbutamol if wheeze
Focused assessment (Table 10.1)
Urgent investigation (Table 10.2)

Assess using ABCDE method
Key observations (Table 1.1)
Oxygen, ECG monitor, IV access
Nebulized salbutamol if wheeze
Focused assessment (Table 10.1)
Urgent investigation (Table 10.2)


Table 1.1


Table 10.1
Table 10.2

Upper airway obstruction likely?


Abnormal voice
Stridor
Features of anaphylaxis (Chapter 38)

Upper airway obstruction likely?


Abnormal voice
Stridor
Features of anaphylaxis (Chapter 38)

Upper airway obstruction likely?


Abnormal voice
Stridor
Features of anaphylaxis (Chapter 38)


Abnormal voice
Stridor
Features of anaphylaxis (Chapter 38) Chapter 38

Yes

Yes

Yes

No

No

No

Decompress with large-bore needle, 2nd intercostal space in mid-clavicular line, then tube drainage (Chapters 64 and 122)

Decompress with large-bore needle, 2nd intercostal space in mid-clavicular line, then tube drainage (Chapters 64 and 122)

Decompress with large-bore needle, 2nd intercostal space in mid-clavicular line, then tube drainage (Chapters 64 and 122)

64 122

Tension pneumothorax likely?


Progressive breathlessness following invasive procedure or chest trauma
Pleuritic chest pain
Absent/reduced breath sounds on affected side

Tension pneumothorax likely?


Progressive breathlessness following invasive procedure or chest trauma
Pleuritic chest pain
Absent/reduced breath sounds on affected side

Tension pneumothorax likely?


Progressive breathlessness following invasive procedure or chest trauma
Pleuritic chest pain
Absent/reduced breath sounds on affected side


Progressive breathlessness following invasive procedure or chest trauma
Pleuritic chest pain
Absent/reduced breath sounds on affected side

Yes

Yes

Yes

No

No

No

Immediate echocardiography
Pericardiocentesis (Chapter 120) if tamponade confirmed (Chapter 54)

Immediate echocardiography
Pericardiocentesis (Chapter 120) if tamponade confirmed (Chapter 54)

Immediate echocardiography
Pericardiocentesis (Chapter 120) if tamponade confirmed (Chapter 54)


120 54

Cardiac tamponade likely?


Progressive breathlessness
Risk factor for pericardial effusion, especially cancer
Raised jugular venous pressure
Palpable pulsus paradoxus

Cardiac tamponade likely?


Progressive breathlessness
Risk factor for pericardial effusion, especially cancer
Raised jugular venous pressure
Palpable pulsus paradoxus

Cardiac tamponade likely?


Progressive breathlessness
Risk factor for pericardial effusion, especially cancer
Raised jugular venous pressure
Palpable pulsus paradoxus


Progressive breathlessness
Risk factor for pericardial effusion, especially cancer
Raised jugular venous pressure
Palpable pulsus paradoxus

Yes

Yes

Yes

No

No

No

Call resuscitation and/or intensive care team.
See Chapter 11

Call resuscitation and/or intensive care team.
See Chapter 11

Call resuscitation and/or intensive care team.
See Chapter 11


11

Respiratory failure likely?


Respiratory rate < 8 or >30/min
Agitation or reduced conscious level
Oxygen saturation < 90% despite high-flow oxygen

Respiratory failure likely?


Respiratory rate < 8 or >30/min
Agitation or reduced conscious level
Oxygen saturation < 90% despite high-flow oxygen

Respiratory failure likely?


Respiratory rate < 8 or >30/min
Agitation or reduced conscious level
Oxygen saturation < 90% despite high-flow oxygen


Respiratory rate < 8 or >30/min
Agitation or reduced conscious level
Oxygen saturation < 90% despite high-flow oxygen

Yes

Yes

Yes

No

No

No

Correct major arrhythmias
IV furosemide (plus nitrate if systolic BP >110 mmHg)
Urgent echocardiography
Ventilatory support with CPAP if needed

Correct major arrhythmias
IV furosemide (plus nitrate if systolic BP >110 mmHg)
Urgent echocardiography
Ventilatory support with CPAP if needed

Correct major arrhythmias
IV furosemide (plus nitrate if systolic BP >110 mmHg)
Urgent echocardiography
Ventilatory support with CPAP if needed




Review clinical features and results
Diagnosis and treatment of underlying disorder(s)

Review clinical features and results
Diagnosis and treatment of underlying disorder(s)

Review clinical features and results
Diagnosis and treatment of underlying disorder(s)


Heart failure likely?


Evidence of heart disease
CXR consistent with acute pulmonary oedema

Heart failure likely?


Evidence of heart disease
CXR consistent with acute pulmonary oedema

Heart failure likely?


Evidence of heart disease
CXR consistent with acute pulmonary oedema


Evidence of heart disease
CXR consistent with acute pulmonary oedema

Yes

Yes

Yes

No

No

No