Dyspnea It is normal with all of us when we exert excessively.. But Dyspnea that is greater than expected with the degree of exertion... is a symptom of disease. Most cases of dyspnea result from asthma, heart failure and myocardial ischemia, chronic obstructive pulmonary disease, interstitial lung disease, pneumonia, or psychogenic disorders.. Below mentioned are the pathological causes of Dyspnea by Organ System…. CARDIO-VASCULAR…     Pulmonary edema Acute valvular disease Myocardial infarction Cardiac tamponade    Heart failure Angina Constrictive pericarditis RESPIRATORY… Acute exacerbations or persistent chronic asthma Acute exacerbation or persistent chronic obstructive lung disease Pulmonary embolism Pneumothorax Pneumonia ARDS Anaphylaxis    COPD Asthma Interstitial lung diseases Pulmonary hypertension Malignancy (tumor related obstructive lesions and lymphangitic spread) Pleural effusions Sleep apnea Foreign body aspiration GASTROINTESTINAL/HEPATIC Acute liver failure and its consequences Abdominal distention of various causes Ascites Portopulmonary hypertension Hepatopulmonary syndrome RENAL CAUSE Acute or chronic renal failure and its consequences HEMATOLOGICAL… Hemorrhage    Anemia NEUROMUSCULAR     High cervical cord lesions Trauma to phrenic nerves    Central apneas Myasthenia gravis Myopathies Amyotrophic lateral sclerosis ENT cause Vocal Cord Dysfunction Laryngeo-tracheal obstruction PSYCHOGENIC  BREATHLESSNESS I hope this list of causes will be HELPFUL to diagnose the aetiology of DYSPNEA…

46/male known lupus nephritis on steroids now had past history of pulmonary thromboembolism came with breathing difficulty and fever since 3-4 days; interpret cxr

A 75-year old man with a history of hypertension, hemorrhagic cerebral infarction one year before, right-sided hemiparesis, and atrial fibrillation was brought to my hospital because of suspicious COVID-19 infection. He was seen in the ER because of a few days of dyspnea which became progressed and bad clinical condition. 7 days before the current presentation patient fell from its bed, and after that, he started to feel pain in his right part of the chest. He also noticed purple discoloration of his feet and left hand, which was painful and progressed further during the next days. He started to have DYSPNOEA, which also progressed. CBC: showed leukocytosis (26,9) and chest X-ray was described as bilateral pneumonia. On exam, the patient was alert, disoriented in time, immobile on the bed, with an obvious right hemiparesis, afebrile, tachypneic (R: 24/min), and bradycardic (P: 55/min), hypoxic (SpO2: 80%), with normal blood pressure. PHYSICAL EXAMINATION: showed dusky purple discoloration of both feet and fingers of the left hand. The patient's right feet showed some darker areas, which could be hematomas. CHEST EXAMINATION: showed the painful right side & we spotted the fracture of the 7th rib. Auscultation of lungs revealed bilateral inspiratory crackles, predominantly on the right side. The heart rhythm was regularly-regular. The rest of the examination was unremarkable. LAB ANALYSIS: revealed elevated urea (11,1) and creatinine (371), hypoalbuminemia (22), elevated LDH (705), and slightly elevated CK (201). The CRP was elevated (272,5), and coagulation panel was highly abnormal - aPTT 85,1s, PT 15%, INR >6,0, fibrinogen 2,4, and D-dimer 162 (normal <0,5). My (differential) diagnosis list for this patient was: - Fat embolism - Warfarin overdose - Bilateral pneumonia - Sepsis He didn't have any criteria for COVID-19, and also, its clinical presentation and disease course was not consistent with COVID-19 infection. The patient was transferred to ICU for further treatment. What do you say on this? I am mostly inclined to fat embolism in the first place, which was complicated, but I do not have experience with this diagnosis. What is your opinion on this case, what would be your further diagnostics and treatment?

72 y/o woman with a h/o CAD with stents to the RCA and circ, mild aortic stenosis, h/o ischemic cardiomyopathy, EF 25%, and h/o heart failure, and with ICD for primary prevention, presented with a c/o chest and back pain intermittent for several nights, relieved by isosorbide. On the evening of admission, she could not find her isosorbide and she became progressively SOB, in addition to chest and back pain. She called 911, and she felt better on CPAP by EMS. On arrival, her O2sat was 88%, then rose to 100% on BiPAP in the ED. Her BP was 140/50, pulse 90. She clearly had pulmonary edema. She also had some peripheral pitting edema. She was treated with intravenous nitroglycerin and furosemide.

## MEDICAL EMERGENCIES: SHOCK ## Condition of severe impairment of tissue perfusion leading to cellular injury and dysfunction. Rapid recognition and treatment are essential to prevent irreversible organ damage and death. APPROACH TO THE PATIENT: Obtain history for underlying causes, including cardiac disease (coronary disease, heart failure, pericardial disease), recent fever or infection leading to sepsis, drug effects (e.g., excess diuretics or antihypertensives), conditions leading to pulmonary embolism and potential sources of bleeding. LABORATORY INVESTIGATIONS: Hematocrit, WBC, electrolytes, platelet count, PT, PTT, DIC screen, electrolytes. Arterial blood gas usually shows metabolic acidosis (in septic shock, respiratory alkalosis precedes metabolic acidosis). If sepsis suspected, draw blood cultures, perform urinalysis, and obtain Gram stain and cultures of sputum, urine, and other suspected sites. Obtain ECG (myocardial ischemia or acute arrhythmia) and chest x-ray (heart failure, tension pneumothorax, pneumonia). Echocardiogram is often helpful (cardiac tamponade, left/right ventricular dysfunction, aortic dissection). source: Harrison's