Last updated: September 15, 2020
Dyspnea, or shortness of breath, is a commonly reported symptom in acute care and outpatient settings. Causes of dyspnea include pulmonary (e.g., pneumonia, asthma exacerbation), cardiac (e.g., acute coronary syndrome, congestive heart failure), toxic-metabolic (e.g., metabolic acidosis, medications), and upper airway (e.g., epiglottitis, foreign body) pathologies. On initial presentation, it is important to immediately evaluate the patient for any urgent or life-threatening causes of dyspnea with patient history, physical examination, and diagnostic testing. Once immediately life-threatening causes are ruled out, a more detailed patient history should be obtained and further testing should be done to narrow the differential diagnoses.
Approach to management
- ABCDE survey
- Establish IV access, cardiac and pulse oximetry monitoring.
Start supplemental oxygen as needed.
Assess the need for ventilation support and airway management.
- Stabilize cardiovascular function (e.g., IV fluid resuscitation).
Perform focused history, examination, and diagnostics to rule out life-threatening reversible causes (see “Diagnostics” below).
- Once life-threatening causes have been ruled out:
- Treat the underlying cause.
Red flags for dyspnea
Immediately life-threatening causes
The diagnostic workup should be guided by the pretest probability of the diagnoses under consideration. The following list includes some commonly used diagnostic tools that can help to diagnose or rule out possible etiologies in patients with acute dyspnea.
Initial workup 
Further diagnostics to consider
Upper airway causes
Toxic-metabolic and other causes
The differential diagnoses listed here are not exhaustive.
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