Differential Diagnosis Common Problems

COPD
(Emphysema)
Mechanism:
destruction of
alveoli & some
thick mucus air
trap/poor air
movement
Resp symptoms:
dyspnea/ RR til
fatigued, hypoxia
Cardiovasc.status:
tachycardia
?cyanosis
Chest assessment:
retractions /acc.
muscle use/tripod
Symptoms:
chronic cough
Signs/Assessment:
pink cheeks, thin
speech, SpO2
? barrel chest
Lung sounds:
rhonchi/?wheezes
History:
+ PMH, meds
? home O2
Treatment:
air/vent*/O2 PRN

COPD (Chronic
Bronchitis)

Asthma

CHF left heart

Pulmonary
Pulmonary Edema Embolism

inflamed airways
& thick mucus
air trap/poor air
movement

bronchoconstriction
bronchospasm &
mucus production
poor air
movement

pressure in
vessels &/or poor
L heart function
fluid in alveoli &
poor O2 exchange

blood clot/air
bubble blocks lung
blood vessel
blood flow past
obstruction &
backup

dyspnea/ RR til
fatigued, hypoxia

dyspnea/ RR til
fatigued, hypoxia

dyspnea/ RR til
fatigued, hypoxia

dyspnea/ RR til
fatigued, ? hypoxia

tachycardia
cyanosis/dusky
retractions /acc.
muscle use/tripod

tachycardia
?cyanosis
retractions /acc.
muscle use/tripod

tachycardia, often
BP, ?cyanosis
retractions /acc.
muscle use/tripod

tachycardia/BP
?cyanosis
retractions /acc.
muscle use/tripod

chronic
productive cough

drycough

? acute cough with

pink/frothy fluid

acute chest pain

? acute hemoptysis

dusky,
edema/obese
barrel chest
speech, SpO2

speech, ?SpO2

speech ,SpO2
peripheral edema if
also R CHF

JVD /SpO2

rhonchi/?wheezes

wheezing/absent

rales/? wheezes

not unusual

+ PMH, meds
? home O2

+ PMH, meds

usually + PMH,
meds, ? home O2

acute event
?PMH DVT, recent
surgery/trauma

air/vent*/O2 PRN

Albuterol (1-65yr)
air/vent*/O2 PRN
air/vent*/O2 PRN
vent* - ? may use CPAP in future age >10yr & no contraindications
? = possible but not frequent

air/vent/O2 PRN
rapid transport

Pneumonia
Mechanism:
inflamed airways
& thick mucus
consolidation/poor
air movement due
to acute
bacterial/viral
infection
Resp symptoms:
dyspnea/ RR til
fatigued, hypoxia
Cardiovasc.
status:
tachycardia
cyanosis
Chest assessment:
retractions /acc.
muscle use/tripod
Symptoms:
acute productive
cough, fever, chills
chest/back pain
Signs/Assessment:
speech, SpO2
Lung sounds:
rhonchi/ lung
sounds
History:
acute onset URI
symptoms
Treatment:
air/vent/O2 PRN

Bronchiolitis

Anaphylaxis

Pneumothorax

Tension
Pneumothorax

bronchoconstriction
bronchospasm &
mucus production
air movement
due to virus usually
in infants

bronchoconstriction
due to allergic
reaction poor air
movement

collapse of alveoli
with air in lung
space

collapse of alveoli
with air in lung
space pressure
on heart, blood
vessels & other
lung

dyspnea/ RR til
fatigued, hypoxia

dyspnea/ RR til
fatigued, hypoxia

dyspnea/ RR til
fatigued, hypoxia

dyspnea/ RR til
fatigued, hypoxia

tachycardia
cyanosis

tachycardia/?BP
cyanosis

tachycardia
cyanosis

tachycardia/BP
cyanosis

retractions /acc.
muscle use, flaring,
grunting

retractions /acc.
muscle use

retractions /acc.
muscle use

retractions /acc.
muscle use

?acute fever/dry
cough

? pruritis/cough

sharp chest pain

sharp chest pain,

JVD / SpO2
tracheal shift (late)

speech, SpO2

? speech, SpO2
hives

SpO2

SpO2

wheezing/absent

wheezing/absent

sound over
affected lung

sound over
affected lung

acute onset URI

symptoms

acute event
? PMH of allergy

acute event
trauma or medical

acute event
trauma or medical

air/vent/O2 PRN

air/vent/O2 PRN
Epinephrine

air/vent/O2 PRN

air/vent/O2 PRN
ALS decomp.

AMI/Angina
Mechanism:
decreased blood
flow to
myocardium
ischemia and for
AMI infarction
(cell death)
Resp symptoms:
? dyspnea
Cardiovasc.
status:
tachycardia or
bradycardia
Chest assessment:
usually no
retractions, etc.
Symptoms:
crushing, dull
pressure,
squeezing chest
pain +/- radiation
to L arm, jaw,
neck, or back, N/V,
?syncope
Signs/Assessment:
looks anxious,
diaphoretic

Lung Sounds:
usually normal
History:
? PMH

Treatment:
ASA, nitro if SBP
> 120 & no
contraindications
air/vent/O2 PRN

Cardiogenic Shock Aneurysm

Cardiac
Tamponade

Cardiac Arrest

pump not working

sufficiently
blood flow with
fluid in extremities
&/or lungs

ballooning of blood
vessel may leak
or rupture

blood accumulated
in pericardium
(heart sac)
squeezing heart and
major blood vessels
blood flow

no (asystole/PEA)
or erratic
(VF/pulseless VT)
electrical activity in
heart

? dyspnea

? dyspnea

? dyspnea

apnea

BP, tachycardia or
bradycardia, poor
peripheral pulses,

tachycardia or
bradycardia

BP ,tachycardia
narrow pulse
pressure,

no pulse

usually no
retractions, etc.

usually no
retractions, etc.

usually no
retractions, etc.

occasionally
gasping

variable CHF
symptoms, syncope

syncope/dizziness
If problem severe
tearing chest/back
pain & shock
symptoms

dull pressure

+/- symptoms prior

to collapse

pale, cool,
diaphoretic,
?peripheral edema

pale, cool,
diaphoretic
pulse/BP
differences in
extremities

pale, cool,
diaphoretic, JVD

pale, cool, limp

rales if pulmonary
edema occurs

usually normal

usually normal

none except with

BVM

? PMH

? PMH

usually acute
trauma, but ?
medical PMH
possible

? PMH

air/vent PRN
shock treatment
flat, warm, O2

air/vent/O2 PRN
shock treatment
PRN

air/vent/O2 PRN
shock treatment
PRN

compressions
air/vent/O2
(30:2. 15:2 or 3:1)

Altered Level of Consciousness

Stroke(CVA)/TIA
Mechanism:
blood flow to
brain due to
occlusion or bleed
If TIA, <24 hr
Resp symptoms:
RR usually normal
Cardiovasc.status:
tachycardia
Chest assessment:
usually no
retractions, etc.
Symptoms:
ALOC symptoms
inability to walk,
talk, etc.
Signs/Assessment:
or altered
speech, motion &
sensation on
affected side,
facial droop
(Cincinnati scale),
visual changes
Lung Sounds:
usually normal
History:
? PMH, meds for
hypertension, etc

Treatment:
air/vent/O2 PRN

Hypoglycemia

Hyperglycemia

Seizure

Head Trauma

blood glucose
due to lack of
food or too much
insulin/oral
diabetic meds

blood glucose due erratic brain

to glucose inability electrical activity
to get into cells due many causes
to or ineffective
insulin

ICP or
bleeding/hypoxia in
brain due to head
injury

may be RR

may be RR
(Kussmaul)

RR may be
irregular

RR may be
irregular

tachycardia
? BP

? tachycardia
? BP

often tachycardia &

BP

HR may with
BP (Cushings)

usually no
retractions, etc.

usually no
retractions, etc.

usually no
retractions, etc.

usually no
retractions, etc.

ALOC symptoms
? N/V

ALOC symptoms
polyuria,
polydipsia,
polyphagia
? N/V or abd. pain

ALOC symptoms

ALOC symptoms
head pain if alert

?slurred or
confused speech,
?combative or
drunk
cool, pale, &
clammy skin

?combative or
drunk
dry/dehydrated skin
? fruity breath

Grand mal
tonic/clonic motion
Absence staring

eye pupil changes

if ICP
? posturing

usually normal

usually normal

usually normal or
decreased

usually normal

? PMH or acute
history, meds
for diabetes
rapid onset

? PMH, meds
for diabetes (type I
IDDM or type II
NIDDM)
longer onset

? PMH, meds for

seizure control, ?
aura

acute event

air/vent/O2 PRN
oral glucose if
alert enough to
swallow

air/vent/O2 PRN

air/vent/O2 PRN
protect body

air/vent/O2 PRN
rapid transport

Hypothermia
Mechanism:
body
temperature
Resp symptoms:
RR
Cardiovasc.status:
bradycardia if
severe
Chest assessment:
usually no
retractions, etc.
Symptoms:
ALOC, feeling
cold if alert,
numbness
Signs/Assessment:
or altered
speech,
or stiff motion,
cool skin
shivering til late
stages

Lung Sounds:
usually normal
History:
acute history
environmental
exposure
Treatment:
air/vent/O2 PRN
warming measures

Hyperthermia
body temperature
may be RR , deep
then shallow if heat
stroke
tachycardia
? BP
usually no
retractions, etc.
ALOC, feeling
hot/thirsty if alert
? weak, dizzy, faint,
HA, N/V,
?slurred or
confused speech,
?combative or
drunk
-----------------warm/pale/clammy
with temp up to
104 if heat
exhaustion
-----------------hot/flushed/dry
with temp 104-106
if heat stroke
usually normal
acute history
environmental
exposure
air/vent/O2 PRN
cooling measures