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Surgical sieve
🫁 Breathlessness
Is this airway, lung, heart, blood, or acid-base? A-E first, then narrow.
| Acute pulmonary oedema Must exclude | Orthopnoea, PND, pink frothy sputum, bibasal crepitations, raised JVP.Sit up, O₂, IV furosemide, consider GTN and CPAP. |
|---|---|
| Pulmonary embolism Must exclude | Sudden onset, tachycardia, hypoxia with clear chest.Wells → CTPA. Anticoagulate if high probability. |
| Anaphylaxis Must exclude | Stridor, wheeze, urticaria, angioedema, hypotension after a trigger.IM adrenaline 500mcg immediately. |
| Tension pneumothorax Must exclude | Unilateral absent breath sounds with haemodynamic compromise.Needle decompression — do not wait for CXR. |
| Upper airway obstruction Must exclude | Inspiratory stridor, hoarse voice, drooling. Neck swelling post-surgery.Call anaesthetics + ENT immediately. Do not sedate. |
| Acute severe asthma Time-sensitive | Wheeze, PEFR <50%, unable to complete sentences. Silent chest is pre-arrest.Nebulised salbutamol + ipratropium, steroids. |
| Infective exacerbation of COPD Time-sensitive | Increased sputum volume/purulence, wheeze, known COPD.Controlled O₂ 88–92%, air-driven nebs, steroids, ABG. |
| Pneumonia Time-sensitive | Fever, focal signs, purulent sputum.CXR, CURB-65, antibiotics. |
| Sepsis (any source) Time-sensitive | Tachypnoea is often the earliest sign of sepsis — before fever or hypotension.Sepsis 6 within 1 hour. |
| Metabolic acidosis (Kussmaul) Time-sensitive | Deep sighing respiration, clear chest. DKA, renal failure, sepsis, toxins.ABG/VBG, glucose, ketones, lactate. |
| Anaemia Common | Exertional, pallor, gradual onset. Look for a bleeding source. |
| Pleural effusion Common | Stony dull percussion, reduced breath sounds, reduced expansion.CXR, USS-guided aspiration, Light's criteria. |
| Drug-induced (opioids, beta-blockers) Consider | Opioids: reduced RR, pinpoint pupils. Beta-blockers: bronchospasm in asthmatics. |
| Hyperventilation / anxiety Consider | Perioral and peripheral paraesthesia, normal saturations. Exclude organic causes first. |
14 differentials · 10 open a full pathway in the app.