ABSTRACT
La disnea es definida como la sensación subjetiva de ahogo o falta de aire y es un motivo muy frecuente de consulta. Su presentación clínica puede variar, desde manifestaciones leves hasta insuficiencia respiratoria catastrófica, con elevada mortalidad y requerir de terapias invasivas complejas. En los servicios de urgencia se inicia el estudio etiológico del paciente agudo, al mismo tiempo que se realizan intervenciones terapéuticas destinadas a la estabilización y manejo tiempo-dependiente del paciente que consulta por disnea. En vista de las múltiples causas de disnea, es necesario que el especialista en medicina de urgencia conozca los distintos diagnósticos diferenciales y sepa orientar su manejo y estudio. Este manuscrito pretende dar un marco teórico acerca de la presentación del paciente con disnea en el servicio de urgencia, describir sus principales características y orientar el estudio y tratamientos tiempo-dependientes desde su primera evaluación por el equipo médico. Se expone un caso clínico y revisan los componentes esenciales de la fisiopatología que explica la disnea, así como la descripción de herramientas para su evaluación, tratamiento y disposición en el servicio de urgencia. Finalizaremos con la resolución del caso.
Dyspnea, defined as the subjective feeling of shortness of breath, it's a common complaint in emergency departments all over the world. The clinical presentation may include mild symptoms to severe respiratory distress with the requirement of mechanical ventilation. This implies high mortality rates and complex decision-making involving diagnostics, treatment, and invasive management in all groups of ages.It is paramount for the emergency medicine physician to acknowledge its vastly differential diagnostics and be familiarized with time-dependent actions to properly stabilization and treatment. This article aims to review the presentation of dyspneic patients in the Emergency Department, describes the main physiologic characteristics, guide diagnosis, and treatment since the very first-minute patient steps into the hospital. It will present clinical scenarios and handle valuable tools for evaluation and treatment strategies in dyspneic patients while they stay in the Emergency Department.
Subject(s)
Airway Obstruction , Dyspnea , Emergency Service, Hospital , PatientsABSTRACT
Introduction: Acute dyspnea is one of the most common reasons for admission to emergency rooms. It could be due to potentially life-threatening cardiac or respiratory conditions. Differentiation among these three disorders is frequently needed. In the condition of heart failure, where there is clinical need for early and appropriate treatment but no objective method for rapid diagnosis, the potential benefits are enormous for any biomarker that can reliably rule in or rule out this syndrome. Objectives: The objectives of this study are as follows: (i) To evaluate the role of point of care of brain natriuretic peptide (BNP) in acute dyspnea and (ii) To determine the cutoff level of BNP to differentiate between cardiogenic and noncardiogenic causes of dyspnea. Materials and Methods: This was an in-hospital cross-sectional study conducted at a tertiary care center. Patients were evaluated using predetermined performa. All these patients were subjected to routine blood investigations, digital chest X-ray, and 12-lead electrocardiography. At the same time point of care, BNP was done in each patient after obtaining informed written consent. All patients with BNP >100 or clinical suspicion for heart failure underwent two-dimensional echocardiography (ECHO) with color Doppler. Results: A cross-sectional study was conducted on 238 patients presenting with acute dyspnea. Almost all patients with BNP level >415 pg/ml had <45% ejection fraction, but patients with BNP level <415 pg/ml had echocardiographic findings not suggestive of heart failure. Conclusion: This study gives us a reliable cutoff level of 415 pg/ml of BNP which clearly distinguishes between cardiogenic versus noncardiogenic dyspnea.