Option 2: Shortness of breath with stable vital signs

The patient is not in immediate respiratory failure. He is short of breath and using accessory muscles of respiration but is able to breathe independently. A portable vital signs monitor is already connected to the patient, and the last reading shows blood pressure of 142/94 mm Hg, heart rate of 90 beats/minute, and oxygen saturation of 97% on room air.

Work through the next steps (bonus if you can identify all four song references).

Question: What should you quickly establish while you begin the focused H&P?

Make your choice, then click on the explanation bubble to reveal the answer.

• The patient’s organ donation status
• IV access and cardiac monitoring

During the focused history, you ask the patient about the onset and duration of dyspnea and whether there are any associated symptoms.

• You: “Mr. Smith, can you please tell me more about your symptoms?”
• Patient: “I feel like I can’t catch my breath.”
• You: “Every breath you take?”
• Patient: “Yes, since about 30 minutes ago.”
• You: “Do you have any pain?”
• Patient: “It only hurts when I’m breathing.”
• You: “I’d like to listen to your lungs now. Just breathe…”

As you evaluate the patient, it's important to keep immediately life-threatening causes of dyspnea in mind.

Question: What are three immediate life-threatening causes of dyspnea for each of the following?

Think of your three, then click on the explanation bubble to see some examples.

• Upper airway
• Pulmonary
• Cardiac

In real life, if you need a reminder, check out “Dyspnea” for an expanded list. See also “Rapidly reversible causes of respiratory failure.”

The severity of symptoms reported by the patient may not correlate with disease severity. Remain vigilant for life-threatening causes of dyspnea.

Having considered the possibilities, it’s time to start the workup.

Question: What diagnostics should you order for most patients with undifferentiated dyspnea?

Think of the studies you'd like to order, then click on the explanation bubble for more information.

• Laboratory studies
• Imaging
• Other

Yup, you guessed it. Check out “Dyspnea” to double-check your initial orders, review what a study is looking for, or see additional studies that might be indicated.

Order basic tests for all patients and tailor advanced diagnostics based on clinical suspicion.

You ordered a portable chest x-ray (strong work!), and the x-ray technician has come and gone. Now, you'll probably be the first to lay eyes on the resulting image. Want some practice before it’s time to make the call (or, at least, a call to radiology)?

CXR interpretation

Test your eyes on the following images. Identify the pertinent findings, then apply the AMBOSS overlay to check.

There's lots more where that came from. For a systematic approach to interpretation (and many more examples of common abnormal findings), check out “Chest x-ray.”

If you haven't explored the other scenario yet, jump over to “Option 1: Impending respiratory failure.” You can also return to the main module to wrap up “Take my breath away.”