Acute dyspnea

Introduction Acute dyspnea is an important symptom of respiratory insufficiency. It is subjectively characterized by insufficient air or difficulty in breathing. This symptom is more acute and makes the patient uncomfortable, and objectively shows changes in respiratory rate, depth, and rhythm. . Common in the throat, tracheal stenosis, such as inflammation, edema, foreign body and tumors, such as inspiratory dyspnea.

Cause

Common in the throat, tracheal stenosis, such as inflammation, edema, foreign body and tumors, such as inspiratory dyspnea; acidosis caused by various reasons, can increase blood carbon dioxide, lower pH, stimulate peripheral chemoreceptors or Directly excited the respiratory center, increased respiratory ventilation, manifested as deep and large breathing difficulties; respiratory inhibitors such as morphine, barbiturates and other poisoning, can also inhibit the respiratory center, making breathing shallow and slow. Severe anemia can be caused by red blood cell reduction, hypoxia and hypoxia, especially after activity; hemorrhage is caused by ischemia and blood pressure during hemorrhage or shock, which stimulates the respiratory center.

Severe brain diseases such as encephalitis, cerebrovascular accidents, brain tumors, etc. directly involve the respiratory center, abnormal respiratory rhythms, resulting in difficulty breathing; myasthenia gravis crisis causes respiratory muscle paralysis, leading to severe breathing difficulties; There may be an episode of dyspnea, which is characterized by a significant rate of respiration and superficiality. Respiratory sputum poisoning is often accompanied by hand and foot sputum.

an examination

Related inspection

Pulmonary impedance blood flow map

1. Laboratory tests for difficulty breathing:

Blood routine examination showed an increase in white blood cell count, an increase in neutrophils during infection, and an increase in eosinophil count in allergic diseases. Bronchial-lung disease should pay attention to the amount, nature, smell and bacterial culture, fungal culture, and tuberculosis in the sputum have certain diagnostic value.

2. Instrumental examination of difficult breathing. X-ray examination has obvious cardiopulmonary X-ray signs of dyspnea caused by heart and lung disease. Bronchial angiography diagnoses bronchiectasis, bronchial adenoma, and cancer. Patients with heart disease can do electrocardiogram, echocardiography and other tests. Pulmonary function tests for chronic lung diseases such as chronic obstructive pulmonary disease (COPD), bronchial asthma, etc., to diagnose the nature and extent of lung function damage. Fiberoptic bronchoscopy is used for the diagnosis and treatment of bronchial tumors, stenosis and foreign bodies. Pulmonary biopsy is of great significance for pulmonary fibrosis and tumors.

Inhalation dyspnea index:

Once: no breathing difficulties when quiet, appearing during activities.

Second degree: mild breathing difficulties when quiet, increased during activities, but does not affect sleep and eating, no obvious lack of oxygen.

Third degree: obvious inhalation dyspnea, heavy throat sound, three concave signs (between the ribs, sternum, soft tissue in the clavicle, like the air ball), obvious lack of oxygen and irritability, can not fall asleep.

Four degrees: extremely difficult breathing, severe hypoxia and increased carbon dioxide, pale or cyanotic lips, decreased blood pressure, incontinence, weak veins, and then coma, heart failure, until death.

Differential diagnosis

Acute dyspnea symptoms need to be identified as follows:

1. Acute pulmonary edema: The main clinical manifestation is that under the action of pathogenic factors, the patient develops chest tightness, cough, difficulty breathing, cyanosis and coughing up a lot of white or light red foamy sputum, and is irritated, sweaty, and limbs. Wet and cold symptoms. Auscultation of diffuse large, medium and small wet rales in both lungs. The chest radiograph shows a butterfly shadow extending outward from the shadow of the bilateral hilar.

2, acute pulmonary embolism: common symptoms of pulmonary thromboembolism include difficulty breathing and shortness of breath, chest pain, syncope, irritability, panic and even sudden death, hemoptysis, fever and so on. Physical examination showed shortness of breath, pulse number, hypotension, and even shock, cyanosis, jugular vein filling or pulsation, lung audible and wheezing sounds and/or fine wet rales, and pleural effusions.

Signs. Plasma D-dimer content > 500 ug / L. Pulmonary angiography is the gold standard for diagnosis. Lung amniotic fluid embolism often manifests as a sudden onset of difficulty in breathing, cyanosis, convulsions, or both shock and coma.

3, acute lung injury and acute respiratory distress syndrome: clinical manifestations of respiratory frequency and respiratory distress, refractory hypoxemia, and arterial blood carbon dioxide partial pressure normal, early pulmonary auscultation no significant abnormalities, the disease progresses the lungs can be heard To dry and wet rales. Chest radiograph shows diffuse infiltration of the lungs, often complicated by multiple organ failure.

4, foreign body in the throat and trachea: more than 5 years old children and comatose patients. Foreign matter stuck in the throat can cause high breathing difficulties and suffocation. Chest X-rays can be found in X-rays, localized emphysema, atelectasis or obstructive pneumonia.

5, cardiogenic dyspnea: the patient has severe heart disease, mixed dyspnea, sitting or standing position relief, increased weight in the supine position, acute dyspnea, middle and small wet rales at the bottom of the lung; chest X-ray There is an abnormal change in the heart shadow, congestion in the hilar and its vicinity, or pulmonary edema; normal or elevated venous pressure, prolonged arm-tongue circulation time.

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