Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • direct trauma to the thorax and neck
  • dyspnoea
  • confusion
  • tachypnoea
  • accessory breathing muscle use
  • stridor
  • inability to speak
  • retraction of intercostal spaces
  • loss of airway/gag reflex
  • cyanosis

Other diagnostic factors

  • anxiety
  • headache
  • hypoventilation
  • cardiac rhythm disturbances
  • underlying neuromuscular disorder
  • drug use
  • seizure
  • coma
  • asterixis
  • papilloedema

Risk factors

  • cigarette smoking
  • young age
  • elderly age
  • pulmonary infection
  • chronic lung disease
  • upper airway obstruction
  • lower airway obstruction
  • alveolar abnormalities
  • perfusion abnormalities
  • cardiac failure
  • peripheral nerve abnormalities
  • muscle system abnormalities
  • opiate and sedative medicines
  • toxic fumes and gases
  • traumatic spinal injury
  • traumatic thoracic injury
  • central nervous system (CNS) disorders
  • acute vascular occlusion
  • pulmonary effusion
  • pneumothorax
  • hypercoagulable states

Diagnostic investigations

1st investigations to order

  • pulse oximetry
  • arterial blood gases
Full details

Investigations to consider

  • FBC
  • D-dimer
  • serum bicarbonate (HCO3)
  • ECG
  • CXR
  • pulmonary function tests
  • Urine or serum toxicology
  • chest CT
  • CT pulmonary angiography (CTPA)
  • ventilation/perfusion lung scan
  • capnometry
  • cardiothoracic ultrasound
Full details

Emerging tests

  • transcutaneous CO2 monitoring
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Samuel J. Stratton

Professor

Fielding School of Public Health

David Geffen School of Medicine at UCLA

Los Angeles

Deputy Health Officer

Orange County Health Care Agency

Health Disaster Management/Emergency Medical Services

Santa Ana

CA

Disclosures

SJS declares that he has no competing interests.

Peer reviewers VIEW ALL

Consultant Physician

Barts Health

London

UK

Disclosures

CMR declares that he has no competing interests.

University of California

Irvine and Orange County Fire Authority

Irvine

CA

Disclosures

KM declares that he has no competing interests.

Assistant Professor of Clinical Emergency Medicine

Department of Emergency Medicine

University of California

Irvine and Orange County Fire Authority

Irvine

CA

Disclosures

CK declares that he has no competing interests.

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