[Algorithms and protocols for acute dyspnea in the Emergency Department]

Area of Science:

• Emergency Medicine
• Cardiopulmonary Medicine
• Clinical Diagnostics

Context:

• Dyspnea evaluation is critical in Emergency Departments (EDs), particularly for suspected cardiopulmonary disease.
• The symptom of dyspnea involves diverse afferent mechanisms, necessitating consideration of numerous potential underlying causes.
• Variability in breathing difficulty necessitates broad differential diagnoses and standardized protocols under emergency time constraints.

Purpose:

• To compare a family practitioner-published standardized work-up for dyspnea with an Emergency Department (ED)-proposed protocol.
• To highlight the importance of considering all serious underlying conditions simultaneously in the ED setting.
• To propose a protocol for emergency physicians that addresses the most frequent causes of dyspnea.

Summary:

• The article contrasts a multi-step algorithmic approach for dyspnea with an ED-centric protocol.
• It emphasizes that ED protocols must consider all serious conditions concurrently, unlike some practitioner algorithms.
• Over 90% of ED dyspnea cases stem from seven disease groups, which should be simultaneously addressed.

Impact:

• Facilitates a more efficient and comprehensive diagnostic approach for dyspnea in emergency settings.
• Aims to improve diagnostic accuracy and patient outcomes by ensuring critical conditions are not overlooked.
• Provides a framework for EDs to develop or refine their dyspnea diagnostic protocols.