SOB is one of the commonest reason for which house officers are called for often during wee hours of the night. A poor response and action to such a call can cost lives as well as jeopardize the officers career.
Rule of Thumb : 1. Do Not assume the nurse is wrong
2. Keep the telephone conversation as short as possible - just ask the vital infos
3. Remember you will attend to the patient No Matter what !
Common mistakes that could cost lives :
1. Ordering supplemental Oxygen if oxygen saturation is low.
2. Not attending to patient with SOB if Saturation is good.
3. Thinking about respiratory causes alone for SOB.
4. Relying heavily on imaging and lab investigation results for diagnosis.
5. Inability to prioritize case causing delay in attending to patient.
6. Failure to seek help from senior colleagues.
Correct measures :
1. Attend to patient
2. Obtain brief history about the complaint with differential diagnosis in mind
- Respiratory causes - eg. Pneumothorax, exarcebation of Asthma / COPD, pneumonia,
- Cardiac causes - eg. Acute Coronary syndrome, Acute pulmonary edema, Left Heart Failure,
Pulm. Embolism
- GI causes - eg. severe dyspepsia / GERD, massive ascites with splinting of diaphragm
3. Examine patient - focused RS and CVS examination
4. Tests and Investigations - ECG, ABG , CXR - MUST be considered in all patients with SOB
- Cardiac markers - depending on risk factors and ECG changes
- Basic blood investigations if tests has not been done recently
5. Order treatment stat to alleviate SOB depending on the cause - eg. Nebulization, propping up bed, IV frusemide...etc
6. Inform senior / superior and manage the patient's diagnosis accordingly
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