Dyspnea on Exertion

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Dyspnea on Exertion

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Dyspnea on exertion
-DDx includes: Acute myocardial ischemia, heart failure, cardiac tamponade, bronchospasm, pulmonary embolism, pneumothorax, bronchitis, COPD,  pneumonia, asthma attack, aspiration, anaphylaxis, etc.
-Rapid assessment of the ABC status performed. Stable, does not need intubation at this point.
-Continuous monitor vital signs and O2 saturation.
-Obtain chest x-ray,  echocardiogram + STAT ECG + bedside spirometry for NIF (if <70% consider intubation and pulmonology consult).
-Follow ABG, proBNP, d-dimer, CBC, BMP, and troponins.
-If fever, will order blood culture, sputum culture, and start broad spectrum antibiotics.
-Bronchodilators + steroids due to history of obstructive pulmonary disease. May add magnesium, if hx of asthma and dyspnea worsens. 
-CT-chest PE protocol, VQ scan if AKI.
-Supplemental O2/NIPPV as needed.
-Will order stress testing, if no clear etiology of dyspnea and increased clinical suspicion of CAD.