Dyspnoea, also known as shortness of breath, is a common symptom that can be caused by a variety of underlying conditions, such as asthma, chronic obstructive pulmonary disease (COPD), heart failure, pneumonia, or a pulmonary embolism.
An acute dyspnoea crisis can occur when an individual experiences sudden and severe difficulty breathing, which can lead to respiratory failure and potentially life-threatening complications.
Assessment
The first step in managing an acute dyspnoea crisis is to assess the patient’s airway, breathing, and circulation (ABCs).
The assessment should include measuring oxygen saturation with a pulse oximeter, evaluating the respiratory rate and pattern, checking for signs of respiratory distress, and assessing the patient’s mental status.
Oxygen Therapy
Supplemental oxygen should be administered to patients with an acute dyspnoea crisis in order to increase the oxygen saturation levels in their blood.
The flow rate of oxygen should be adjusted based on the patient’s oxygen saturation levels and respiratory effort. If the patient is not improving with oxygen therapy, non-invasive ventilatory support may be required.
Bronchodilators
If the patient has a history of asthma or COPD, bronchodilators should be administered to help open up their airways and improve their breathing.
Inhaled beta-agonists, such as albuterol, are often used and can be delivered via a nebulizer or metered-dose inhaler (MDI).
Corticosteroids
Corticosteroids can be used in combination with bronchodilators to reduce airway inflammation and improve breathing.
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Intravenous corticosteroids, such as methylprednisolone, are often used in the acute setting, although oral corticosteroids, such as prednisone, can also be effective.
Diuretics
If the patient has heart failure or fluid overload, diuretics may be used to help remove excess fluid from the body and reduce the workload on the heart. Furosemide is a commonly used diuretic in the acute setting.
Blood Thinners
If the patient is suspected to have a pulmonary embolism, blood thinners may be used to prevent further clot formation and reduce the risk of complications.
Heparin is often used in the acute setting, although newer oral anticoagulants, such as rivaroxaban and apixaban, may also be used.
Intubation and Mechanical Ventilation
If the patient is not improving with non-invasive ventilatory support, they may require intubation and mechanical ventilation.
This involves placing a breathing tube down the patient’s airway and using a mechanical ventilator to assist with breathing. This is considered a last resort, as it comes with significant risks and should only be done if absolutely necessary.
Monitoring and Follow-up
Once the patient’s breathing has stabilized, it is important to continue monitoring their vital signs and oxygenation levels.
The patient may require admission to the hospital for further treatment and monitoring, or they may be discharged with instructions for follow-up with their primary care provider or a specialist.
