The treatment and disposition of patients with the myriad causes of dyspnea is beyond the scope of this article. However, a few points are in order.
Patients with respiratory distress need a rapid evaluation of their airway. Patients with altered mental status, inability to speak, or inadequate ventilations may require airway management. While intubation remains the most definitive airway, some dyspneic patients not in extremis may benefit from noninvasive positive pressure ventilation (BiPAP or CPAP). Research continues on the use of alternative gases such as heliox for patients with upper airway obstruction or asthma.
Pulse oximetry is a helpful, early intervention. It is sensitive to hypoxia and should trigger the administration of supplemental oxygen if the O2
saturation is less than normal.
Oxygen is good?even for patients with COPD who depend upon the hypoxic drive for ventilation. (See also the "Ten Excuses That Don't Work In Court" ) The only absolute contraindication to oxygen is acute paraquat toxicity.101
(I'll bet you didn't know that one!)
Sit the patient upright. The bolt-upright position maximizes accessory muscle use and may decrease pulmonary congestion in those with heart failure. Patients who are unable to sit upright because of shock or altered mental status may be placed in the supine position?and intubated.
Do not discharge patients without attempting to explain the cause of the dyspnea. The evaluation may be as simple as a history and physical examination, or it could be complex and expensive.