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Pulmonary Embolism
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Jennifer Lynde, Ana M. Velez-Rosborough, Enrique Ginzburg
Clinical recognition of PE is difficult as presentation is often vague. Symptoms include dyspnea, tachypnea, chest pain, and cough. The differential diagnosis ranges from myocardial infarction to peptic ulcer to asthma. Clinical assessment alone is insufficient to diagnose or rule out PE. No single noninvasive test has both high sensitivity and specificity. Laboratory tests include D-dimer, troponin I, pro-B-type natriuretic peptide (BNP), and arterial blood gas showing hypoxemia. D-dimer alone should not be used to diagnose a recurrent VTE event as the concentration may remain elevated in patients that completed treatment. Electrocardiogram (ECG) is abnormal in 85% of patients with PE. Patients should be assessed by the intensivist and their VTE probability calculated and the appropriate labs ordered based on the clinical picture (Goldhaber).
Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
A significant number of individuals with terminal illness will experience breathlessness, or shortness of breath with activity, and/or at rest. Dyspnea is also used to describe shortness of breath, and in particular, on exertion (DOE). Conditions that commonly present with dyspnea include respiratory diseases such as primary and metastatic lung cancer, COPD, and pulmonary fibrosis, and conditions such as pneumonia, pleural effusion, and pneumothorax (see Chapter 11). However, a number of individuals with non-cardiopulmonary life-limiting conditions will also experience breathlessness. Cardiovascular conditions such as recent myocardial infarction, pericardial effusion, and CHF are also associated with dyspnea. Other physiological sources of dyspnea may include anemia, electrolyte imbalances, pulmonary embolism, dehydration, anxiety, and/or exacerbations of dyspnea secondary to episodes of severe coughing. New or worsening dyspnea should be evaluated by a medical professional to rule out differential diagnoses such as pulmonary embolism, pneumonia, or pleural effusion.
Symptom Control in Hospice-State of the Art
Published in Inge B. Corless, Zelda Foster, The Hospice Heritage: Celebrating Our Future, 2020
J. Cameron Muir, Lisa M. Krammer, Jacqueline R. Cameron, Charles F. von Gunten
Dyspnea is a frequent and devastating symptom experienced by many patients with advanced illness. It has been reported to occur in 21%–75% of patients in the days or weeks before death.28–33 Dyspnea is the subjective experience of labored or difficult breathing which, akin to pain, is often challenging to assess. The intensity of dyspnea can be quantified using visual analogue, numerical, and verbal scales,29 such as the Edmonton Symptom Assessment System34 and the Support Team Assessment Schedule.30
A case of Hb Rothschild (HBB: c.112T>A) with low pulse oximetry: a first familial presentation in China
Published in Hematology, 2022
Diandian Li, Qunfang Wan, Chunyu Li, Hongbing Ma, Gang Wang
His compete blood count revealed a hemoglobin of 14.7 g/dL and basic chemistry panel was unremarkable. As the likeliest causes of dyspnea are diseases involving the pulmonary or cardiac systems, a computed tomography (CT) scan of the chest was performed the same day, which showed almost clear lung fields except for some strips and calcifications. Pulmonary function tests (PFTs) showed FEV1 3.74 L (predicted value 3.53 L), FVC 4.48 L (predicted value 4.2 L), FEV1/FVC ratio 83.3% (normal ≥ 70%), carbon monoxide diffusing capacity (DLCO) 32.79 mL/min/mmHg (predicted value 29.44 mL/min/mmHg) which was 111.4% of the predicted value (normal ≥ 80% predicted). Assessment of airway responsiveness with methacholine provocation was negative. Electrocardiography demonstrated normal sinus rhythm. Echocardiogram suggested normal cardiac structure and function. No evidence of pulmonary hypertension or anatomic shunting was revealed. Ventilation and perfusion scan indicated a low likelihood of pulmonary embolus. Fiberoptic bronchoscopy showed no abnormality in all levels of bronchus. Cultures of bronchial alveolar lavage fluid (BALF) and sputum were negative.
‘Involve me and I learn’: an experiential teaching approach to improve dyspnea awareness in medical residents
Published in Medical Education Online, 2022
Maxens Decavèle, Laure Serresse, Frédérick Gay, Nathalie Nion, Sophie Lavault, Yonathan Freund, Marie-Cécile Niérat, Olivier Steichen, Alexandre Demoule, Capucine Morélot-Panzini, Thomas Similowski
Dyspnea is a ubiquitous symptom of cardiac or respiratory dysfunction and of many other disorders. It stems from an upsetting or distressing awareness of breathing sensations [1] that has been defined as ‘a subjective experience of breathing discomfort made of various sensations that can vary in intensity’ [1]. Acute dyspnea is a frightening experience that is very common, being reported by more than 15% of patients at hospital admission [2], 50% of patients seen in the emergency room [2], and up to 50% of critically ill mechanically ventilated patients [3,4]. It independently predicts hospital death [5] and post-intensive care stress disorders [3]. Chronic dyspnea, in turn, shapes the lives of affected patients, for whom it represents a major physical, psychological, and social burden. Given the epidemiology of chronic respiratory diseases, congestive heart failure and neuromuscular disorders, chronic dyspnea affects millions worldwide.
Pathophysiology and clinical evaluation of the patient with unexplained persistent dyspnea
Published in Expert Review of Respiratory Medicine, 2022
Andi Hudler, Fernando Holguin, Meghan Althoff, Anne Fuhlbrigge, Sunita Sharma
Dyspnea refers to unpleasant or uncomfortable respiratory sensations subjectively experienced by individuals [1]. It is a symptom frequently reported in large population studies of otherwise healthy individuals even after controlling for smoking [2]. In Norway, self-reported moderate or severe dyspnea was present in 5% and 13%, respectively, among nearly twenty thousand participants in a prospective cohort study [2]. In the general population, the prevalence of chronic breathlessness that limits exertion on a daily basis has been estimated 9%, and is more common in females, increased with age, and higher among those with less education or lower incomes [3]. Persistent dyspnea is one of the most common reasons why patients seek medical care in primary or subspecialty clinics [1]. It is a common and debilitating symptom that affects up to 50% of patients admitted to hospitals and as many as 25% of those seeking care in outpatient facilities [1]. According to the National Center for Health Statistics’ Vital and Health Statistics report in 2006, dyspnea-related encounters accounted for nearly 3 million visits outpatient visits per year [4]. Chronic dyspnea can be due to an underlying disease process, or it can be a symptom that occurs in the absence of any discernable organic etiology. Patients may also have persistent dyspnea despite optimal treatment of underlying pathologic processes resulting in chronic, persistent dyspnea, a condition referred to by many experts as Residual Exertional Dyspnea, which can be life altering for patients suffering from this disorder [5]