References
The assessment and management of acute dyspnoea: a case study
Abstract
Dyspnoea — a broad term that describes an unpleasant awareness of one's breathing, often synonymous with breathlessness — is a presenting complaint of significant burden to emergency care. In this case study the authors reflect on the assessment and treatment of a patient presenting to the emergency department (ED) with breathlessness. The importance of effective history taking and physical examination is highlighted, and an overview of the techniques used to elicit information is provided. Appropriate investigations are discussed alongside their limitations. Differential diagnoses are considered; however, particular focus is given to chronic obstructive pulmonary disease. Existing treatment options, both pharmacological and non-pharmacological, are critiqued, and recommendations are made for further research and future practice. Review of this article will equip advanced clinical practitioners to effectively assess, diagnose and treat patients presenting to the ED with dyspnoea.
Dyspnoea is a broad term that is used to describe an unpleasant awareness of one's respiratory effort and is thought of as synonymous with breathlessness (Kendall, 2020). As a presenting symptom, dyspnoea lacks specificity, therefore its assessment, management and diagnosis can be complex. Importantly, it is also recognised that the intensity of dyspnoea is only loosely associated with the severity of the underlying pathology (Santus et al, 2023), making recognition of significant illness challenging. There is a paucity of contemporary data regarding the prevalence of dyspnoea as a presenting complaint to UK emergency departments (EDs). Data from the Asia-Pacific region, although not necessarily generalisable to the UK, shows that patients with dyspnoea account for 5.2% of all presentations to the ED (Kelly et al, 2017), highlighting the significant burden on emergency care.
In this case study, the authors discuss the assessment, diagnosis and management of John Brown a 58-year-old man presenting to the ED complaining of acute dyspnoea. The complexities related to the assessment and safe management of a condition frequently seen in the ED setting by advanced clinical practitioners are highlighted. A pseudonym has been used to maintain patient confidentiality (Nursing and Midwifery Council, 2018).
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