An Algorithm for the Evaluation of the Pt with Dyspnea - Flowchart
An Algorithm for the Evaluation of the Pt with Dyspnea - Flowchart
«Flowchart»

History

History

History

Quality of sensation, timing, positional disposition
Persistent vs. intermittent

Quality of sensation, timing, positional disposition
Persistent vs. intermittent

Quality of sensation, timing, positional disposition
Persistent vs. intermittent


Physical Exam

Physical Exam

Physical Exam

General appearance: Speak in full sentences? Accessory muscles? Color?
Vital Signs: Tachypnea? Pulsus paradoxus? Oximetry-evidence of desaturation?
Chest: Wheezes, rales, rhonchi, diminished breath sounds? Hyperinflated?
Cardiac exam: JVP elevated? Precordial impulse? Gallop? Murmur?
Extremities: Edema? Cyanosis?

General appearance: Speak in full sentences? Accessory muscles? Color?
Vital Signs: Tachypnea? Pulsus paradoxus? Oximetry-evidence of desaturation?
Chest: Wheezes, rales, rhonchi, diminished breath sounds? Hyperinflated?
Cardiac exam: JVP elevated? Precordial impulse? Gallop? Murmur?
Extremities: Edema? Cyanosis?

General appearance: Speak in full sentences? Accessory muscles? Color?
Vital Signs: Tachypnea? Pulsus paradoxus? Oximetry-evidence of desaturation?
Chest: Wheezes, rales, rhonchi, diminished breath sounds? Hyperinflated?
Cardiac exam: JVP elevated? Precordial impulse? Gallop? Murmur?
Extremities: Edema? Cyanosis?

General appearance:
Vital Signs:
Chest:
Cardiac exam:
Extremities:

At this point, diagnosis may be evident—if not, proceed to further evaluation

At this point, diagnosis may be evident—if not, proceed to further evaluation

At this point, diagnosis may be evident—if not, proceed to further evaluation

Chest radiograph
Assess cardiac size, evidence of CHF
Assess for hyperinflation
Assess for pneumonia, interstitial lung disease, pleural effusions

Chest radiograph
Assess cardiac size, evidence of CHF
Assess for hyperinflation
Assess for pneumonia, interstitial lung disease, pleural effusions

Chest radiograph
Assess cardiac size, evidence of CHF
Assess for hyperinflation
Assess for pneumonia, interstitial lung disease, pleural effusions




ECG and echocardiogram to assess left ventricular function and pulmonary artery pressure

ECG and echocardiogram to assess left ventricular function and pulmonary artery pressure

ECG and echocardiogram to assess left ventricular function and pulmonary artery pressure

Pulmonary function testing—if diffusing capacity reduced, consider CT angiogram to assess for interstitial lung disease and pulmonary embolism

Pulmonary function testing—if diffusing capacity reduced, consider CT angiogram to assess for interstitial lung disease and pulmonary embolism

Pulmonary function testing—if diffusing capacity reduced, consider CT angiogram to assess for interstitial lung disease and pulmonary embolism

Hematocrit, thyroid function tests

Hematocrit, thyroid function tests

Hematocrit, thyroid function tests

If diagnosis still uncertain, obtain cardiopulmonary exercise test

If diagnosis still uncertain, obtain cardiopulmonary exercise test

If diagnosis still uncertain, obtain cardiopulmonary exercise test

End

End

End

Suspect low cardiac output, myocardial ischemia, or pulmonary vascular disease

Suspect low cardiac output, myocardial ischemia, or pulmonary vascular disease

Low cardiac output

Suspect respiratory pump or gas exchange abnormality

Suspect respiratory pump or gas exchange abnormality

Respiratory pump

Suspect high cardiac output

Suspect high cardiac output

High cardiac output