The best book for assessing patients with dyspnea and shortness of breath is Dr. Phillipe Rola’s 2019 book, Bedside Ultrasound: a primer for clinical integration. No matter how many POCUS books, courses, and videos you have reviewed, you still want to buy this book. It is awesome! It is available as an e-book at the Apple Store and as a print book at Amazon.
In this post I do a search of and make a list of my posts related to shortness of breath and dyspnea.
I typed each term into my search box and then listed the posts that come up. I then review the posts most relevant to the topics (dyspnea and shortness of breath).
As I review again each of these posts I will place the date of the review and any particular thoughts about the post. [I like making lists and then checking off items.
For shortness of breath, here are the results:
- Links To And Excerpts from The 2019 ACC Decision Pathway On Patients Hospitalized With Heart Failure
Posted on July 7, 2020 by Tom Wade MD- Reviewed 11-6-2020.
- This article is an awesome detailed how to manual.
- This Pathway Is For Outpatient Heart Failure: Links To And Excerpts From “2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction” With Links To Additional Resources
Posted on July 7, 2020 by Tom Wade MD- Reviewed 11-6-2020
- This article together with the 2019 article above are a complete how to for CHF. Review both together.
- Link To Dr. Rola’s “POCUS Assessment Of Venous Congestion” With A Demo Of The VExUS Exam
Posted on November 2, 2020 by Tom Wade MD- Reviewed 11-7-2020
- At 20:00 to 25:00 is a demonstration on how to do the Vexus scan.
- At 40:30 to 44:44, Dr Rola shows us how to use a hand held POCUS machine’s color doppler to perform a “VExUS Lite” if you hand held does not have CW or PW. [And the newest Butterfly, the Butterfly IQ+ now has PW. I don’t know yet know if the instrument can make the more sophisticated doppler measurements Dr. Rolla shows us.]
- Link To Vimeo Video “The Fastest Way to Diagnose RV Dysfunction”
Posted on November 2, 2020 by Tom Wade MD - Link To And Excerpts From “POCUS Cases 1: Pulmonary Embolism and Right Heart Strain” From EMC
Posted on May 5, 2020 by Tom Wade MD- Reviewed on November 11, 2020.
- Although I made notes of this POCUS Case 1 (because it helps me reinforce my learning), the best and fastest review is to simply watch again the 16 minute video.
- RV strain has a differential diagnosis that includes but is not limited to pulmonary embolus. You need to consider the clinical context.
- Wheezes do not always mean COPD. Approximately 10% of acute PEs present with wheezing.
- POCUS can help narrow your differential diagnosis in shortness of breath.
- POCUS can help distinguish acute PE from chronic conditions of RV strain.
- RVOT excursion on POCUS is a specific sign of PE.
- Massive Pulmonary Embolus From EM Quick Hits 1
Posted on January 21, 2020 by Tom Wade MD- Reviewed on Nov. 11, 2020
- Massive pulmonary embolus is defined as a PE with hemodynamic compromise or signs of end organ malperfusion.
- This is the severe end of the PE spectrum where seconds and minutes matter and we have to make rapid decisions.
- EMS reports from the field that he is hypotensive and tachycardic with a lot 02 sat.
- And on arrival he’s got vital signs with a heart rate of 153; a BP of 80/43; oxygen sat is 94% on a non-rebreather and a respiratory rate of 32.
- There are only a couple of things that cause shortness of breath or low 02 sats with clear lungs.That list to me is: -Anemia
-Pericardial tamponade
-Metabolic acidosis from things like aspirin overdose and DKA
-MI
-Pulmonary hypertension
-and, of course, PE
-Now you can also throw pneumothorax in the mix because maybe it’s too loud [in the environment] or you’re getting transmitted breath sounds. And some people say that carbon monoxide can have that similar appearance.This patient looks far to sick to go to CT at this point and so a quick ultrasound can help us parse some of these things out if we’re not sure.
- “#150 HFpEF With Dr. Yancy” – Another AWESOME Podcast From The Curbsiders
Posted on May 23, 2019 by Tom Wade MD- Reviewed on 11-12-2020
- Basic treatment plan should include: diuresis for dyspnea, spironolactone (if elevated proBNP), SGLT2i if diabetes.
- Up to 50% of heart failure patients have preserved EF.
- New HFpEF: High likelihood of CAD.
- For new HFpEF, there should be a coronary work-up. This may be initially done with coronary CT rather than catheterization.
- Pulmonary Hypertension – Episode #80 Awesome Help From The Curbsiders – With Additional Resources
Posted on August 24, 2018 by Tom Wade MD - “Causes And Evaluation Of Chronic Dyspnea” – Help From The American Family Physician
Posted on December 9, 2017 by Tom Wade MD - Introduction to Pulmonary Ultrasound By Critical Care Specialist Liz Turner MD
Posted on September 24, 2013 by Tom Wade MD - Advanced Pulmonary Ultrasound by Critical Care Specialist Dr. Liz Turner
Posted on September 25, 2013 by Tom Wade MD - A protocol for exercise oximetry
Posted on July 16, 2013 by Tom Wade MD - “Multi-Organ Point-Of-Care Ultrasound (MOPOCUS) For Respiratory Difficulty, Chest Pain, Or Shock” – A Great Teaching Review
Posted on September 4, 2016 by Tom Wade MD
For dyspnea, here are additional results:
- Dyspnea – Diagnostic Schema From The Clinical Problem Solvers
Posted on March 29, 2020 by Tom Wade MD - “The Differential Diagnosis of Dyspnea” – Help From Drs Berliner, Schneider, Welte, and Bauersachs
Posted on July 22, 2017 by Tom Wade MD - Pleural Effusion – Diagnostic Schema From The Clinical Problem Solvers
Posted on March 30, 2020 by Tom Wade MD - Link To And Excerpts From #86: COPD: Diagnosis, treatment, PFTs, and nihilism From The Curbsiders
Posted on March 9, 2020 by Tom Wade MD - [Community Acquired] Pneumonia From Dr. Farkas’ Internet Book Of Critical Care
Posted on December 20, 2019 by Tom Wade MD - Pulmonary Hypertension: Emergency Management, Primary Care Diagnosis, And Echocardiographic Evaluation
Posted on May 5, 2019 by Tom Wade MD - Excerpts From “A Simplified Ultrasound Comet Tail Grading Scoring to Assess Pulmonary Congestion in Patients with Heart Failure”
Posted on February 21, 2019 by Tom Wade MD - Emergency Recognition And Management Of Pulmonary Hypertension And RV Failure – Help From Drs. Wilcox and Weingart (EMCrit 181)
Posted on July 25, 2018 by Tom Wade MD - Interpreting Pulmonary Function Tests From The Cleveland Clinic Journal
Posted on December 9, 2017 by Tom Wade MD - Lung Ultrasound Signs From “BLUE-Protocol and FALLS-Protocol: Two Applications of Lung Ultrasound in the Critically Ill”
Posted on September 9, 2016 by Tom Wade MD - Lung Ultrasound Profiles From the BLUE Protocol – “BLUE-Protocol and FALLS-Protocol: Two Applications of Lung Ultrasound in the Critically Ill”
Posted on September 13, 2016 by Tom Wade MD