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Snapshot Series on Respiratory Medicine

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Summary

This video explores the basic concepts of shortness of breath as a symptom, including key history questions and a rundown of acute and chronic causes. The discussion covers an in-depth assessment of the different diagnosis and the various symptoms and triggers associated with them, as well as examining the role of MRC Score as the gold standard. Join us to gain greater systemic understanding of shortness of breath and learn how to apply it in your own clinical practice.

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Description

First video in a series of videos covering concepts to consider in the OSCE but also clinically when assessing a patient in respiratory medicine.

Topic requests are welcome and hopefully these videos are useful in providing some of the key basics to consider when talking a patient in respiratory.

Learning objectives

Learning Objectives:

  1. Understand the causation and conceptual description of shortness of breath.
  2. Identify relevant key historical questions to guide diagnosis.
  3. Discuss the differential diagnoses related to shortness of breath.
  4. Analyze the systematic approach to consider the potential causes of shortness of breath.
  5. Utilize validated scoring systems to assess the severity of shortness of breath in patients.
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Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi. Welcome to the first video in the series of videos covering respiratory concepts for our skis. So in this video, are we sort of going through the basic concepts of shortness of breath as a symptom? Conceptually, What is it? What are some of the key quit history questions to consider? What are some of the acute and chronic causes? And what is the sort of systemic way you can really think about this symptom to develop and show good understanding in your skis? So conceptually shortness of breath is the perceived sensation of not having enough oxygen essentially being out of breath, and it can be caused by a wide variety of factors primarily associated with V. Q. Mismatch. So V. Q mismatch can come back in a wide variety of ways so potentially their environment has a reduced oxygen content. So if they're high altitude and so that can cause reduced ventilation that can cause reduced essentially because you have less oxygen in the environment. Therefore reduced oxygen in the blood and hypoxemia. You can get hypoxemia because you have a thickening in your diffusion distance, either because of fluid parcel, blood or fibrosis. In the case of interstitial lung disease, and that can cause issues with oxygen exchange and hypoxemia. Or it could just be because you have anemia. So in anemia, because you have reduced hemoglobin, you have reduced oxygen carrying capacity because oxygen is primarily transported, bound to hemoglobin as oxy hemoglobin and only a small amount of oxygen is present, dissolved in the blood as dissolved oxygen. But because there was such a wide variety of pathology that can contribute and cause, you came as much and as a result, cause peripheral chemo, sector stimulation and hyperventilation. There are a wide pathology and a wide amount of differentials, really to consider that can cause shortness of breath. Some of the key history questions to really consider would be, you know, think about it as a book. When you read a book, there's a beginning. There's a middle and the end. So the onset. When did this symptom begin? How long have they had this for? So did it begin a year ago? Did it begin five months ago? Did it begin two hours ago? You want to know? Is this acute or chronic? And that can happen, and that that the only thing you really need to do is immediately The first question should be. When did you first notice this? And they might tell you themselves if you just ask them a nice open question. But you can also ask, When did it begin? Duration will come sort of with the onset. So when you ask about the onset confirming, is it ongoing and is a chronic in its duration? So has it been long term? And with the character of this, is it persistent? So is it persistent chronic shortness of breath You be thinking more about interstitial lung disease, or COPD, or potentially even bronchiectases, whereas if somebody is complaining of chronic variable shortness of breath with episodes of normal breathing and normal functioning in dispersed with episodes of severe exacerbation or episodes of, um, weeds and dry coffee to be thinking about as much as in comparison to potentially the COPD, you want to know about the severity. So severity is very key in any symptoms. So you asked about severity of pain with the scale from 1 to 10. So with severity and shortness of breath, you're thinking about the MRC discipline your score as the gold standard you know, if you ask this in your skis, it shows you've developed understanding. You know, the validated scoring system for the symptom, and you're being a safe doctor. And it also helps you quantify how disabling is a symptom for my patient. You want to know about any associate symptoms? So do they have associate history of chest pain and shortness of breath? If you're thinking about new pneumothorax, do they have a history of cough, productive sputum fever and short of breath? If you're thinking about community acquired pneumonia, is this somebody with a history of sudden onset pleuritic, chest pain and shortness of breath? Maybe it could be pneumothorax, but it could also be pulmonary embolism. So associated symptoms are very key in quantifying the nature of this symptom in the context of that patient. And what are the differentials you really should be thinking about? So with shortness of breath, it's primarily the other respiratory and cardiac symptoms of chest pain. Palpitations, arrhythmias, I guess with that comes to palpitations as well as cough productive Sweden or hemoptysis, and you also want to know about any triggers. So if there's a reproducible trigger that could potentially be somebody with asthma. Is it better at home, away from work? If you're thinking about occupational asthma, you know, Is it worse lying flat? So is there any orthopnea that could maybe suggest that they've got fluid in their lungs? And is this potentially congestive heart failure, or do they have any paroxysmal nocturnal dispute? So do they wake from sleep feeling out of breath? And this is just an overview of shortness of breath and the different systems and within the different systems, two different conditions. And I put this slide here really to just emphasize the wide variety and pathology. And so how you should demonstrate this ability to understand this not just because of this one condition, there's a wide variety of conditions that can cause this. And I'm being a safe doctor, that I'm really considering as much as possible, really, the different conditions that can potentially contribute to the symptoms. So with acute respiratory causes your primarily thinking about acute asthma exacerbation, which can be quite common if they have a history of asthma. You might be instantly thinking about this, and you might consider severity scoring that is it mild, moderate, severe. What's their peak flow. If you're thinking about acute COPD exacerbation, do they have a history of significant smoking? Do they have a history of COPD? Do they have a family history of COPD, or family history of alpha one antitrypsin deficiency with community acquired pneumonia. Your primary looking primarily looking at any associate symptoms of shortness of breath, any cough, any fever, any mucus, purulent, sputum and with pulmonary embolism, what are their vte risk factors? So, you know, do they have a history of previous V T e A history of major limb lower limb surgery? You know, have they been immobilized for a long period of time? Do they have a thrombophilia or any malignancy with cardiac differentials who, primarily considering acute congestive, uh, very acute chronic acute congestive heart failure? So that might be a patient with orthopnea and paroxysmal nocturnal dyspnea, but also a patient with acute coronary syndrome. So is this a patient who potentially has classical crushing chest pain with truants of breath, which began suddenly and acutely with some other potential, causes shortness of breath you can consider psychological. Is there somebody with a panic attack or the hyperventilating? If there's an absence of any medical risk factors and absence of any other associate symptoms and all investigations. You know, blood tests imaging comes back normal. You might consider potentially somebody would shock if there's any obvious bleeding. Whatever your signs, obvious signs of infection. Potentially, this could be something with sepsis. Or it could be an anaphylactic allergic shock in response to a food allergy or medication. And I guess the core principle really is. What is the clinical picture of the patient and what examination findings are you looking for to confirm or deny your suspicions? So if you're suspecting pneumonia, you're expecting to see some dullness to percussion and increased local residents. If you're suspecting somebody with a pneumothorax, you might be expected to see hyper residents. And so those are some of the key things to really consider with acute short of breath and with the chronic cause of shortness of breath, you're primarily going to consider it in a systems based way once again, so in respiratory is obstructive with COPD, asthma and bronchiectasis. Is it restrictive with interstitial lung disease, where you can then consider occupation risk factors? So are they a farmer? Are there coal miner do the other history of any, um, you know, are they a pigeon owner there any any exotic birds? And then are there any constitutional symptoms to help rule out malignancy? So any history of chronic cough, any history of a fatigue night sweats Malay or maybe a history of lung cancer in a in a family member and potentially consider neuromuscular disease or obesity as well? And then the main cardiac cause of chronic shortness of breath would primarily be congestive heart failure, Babulal heart disease or anemia and with the and I just like to finish up by saying Thanks for listening. And hopefully this video has been useful in providing a more systematic way of thinking about shortness of breath as a symptom. I'd just like to give credit to Doctor or E and Dr Verma for helping me make this video and providing advice on this video, but also any other subsequent videos that we do end up making. Hopefully, this video's been useful, and if I've made any mistakes, please do let me know via the feedback form that's attached. And also let me know about any topic requests that any of you guys have for any respiratory conditions. Thanks for listening, and I'll see you guys in the next video