From the Guidelines
Evaluating shortness of breath in urgent care should start with a rapid 'ABC' assessment, followed by obtaining a quick history and measuring vital signs, including pulse rate, respiratory rate, and pulse oximetry, as recommended by the BTS guideline for oxygen use in adults in healthcare and emergency settings 1. When assessing a patient with shortness of breath, it is crucial to begin with a systematic approach to determine the severity and potential causes of the condition. This initial assessment should include:
- Measuring oxygen saturation, respiratory rate, heart rate, and pulse oximetry, as these are essential parameters to evaluate the patient's respiratory status 1.
- Obtaining a brief history from the patient or other informants to gather information about the onset, duration, and associated symptoms of the shortness of breath.
- Performing a focused physical examination, including lung auscultation, cardiac exam, and assessment for signs of respiratory distress. The BTS guideline for oxygen use in adults in healthcare and emergency settings 1 emphasizes the importance of pulse oximetry in patients with breathlessness or suspected hypoxaemia. Additionally, disease-specific measurements, such as peak expiratory flow in asthma or blood pressure in cardiac disease, should be recorded as part of the initial assessment. The evaluation of shortness of breath in urgent care should prioritize the identification of potential life-threatening causes, such as pulmonary embolism, heart failure, or pneumonia, and initiate appropriate treatment based on the findings. This may include the use of bronchodilators, supplemental oxygen, diuretics, or antibiotics, depending on the underlying cause of the shortness of breath.
From the Research
Evaluation of Shortness of Breath
To evaluate shortness of breath in urgent care, several factors need to be considered:
- The patient's medical history and previous diagnoses, such as obstructive airway disorders 2
- The presence of other conditions that may cause shortness of breath, such as heart failure and pulmonary hypertension 2
- The use of pulmonary function tests to confirm diagnoses and guide treatment 2
Diagnostic Approaches
Different diagnostic approaches can be used to evaluate shortness of breath, including:
- A thorough patient history and physical examination 3, 4
- Pulmonary function tests, such as spirometry and lung volume measurements 2
- Imaging studies, such as chest X-rays and computed tomography (CT) scans 4
- Laboratory tests, such as complete blood counts and blood chemistries 4
Management of Dyspnea
The management of dyspnea, or shortness of breath, depends on the underlying cause:
- For patients with chronic obstructive pulmonary disease (COPD), treatment may include bronchodilators, exercise training, and ambulatory oxygen 5
- For patients with severe breathlessness, opioid treatment may be considered, taking into account the patient's body mass index (BMI) 6
- A multidisciplinary approach, including pulmonary rehabilitation and palliative care, may be necessary to manage dyspnea effectively 5