Wheeze DDx

OVERVIEW

Wheeze indicates lower airway obstruction, which can be  due to the following factors:

  • luminal (e.g. secretions)
  • intramural (e.g. bronchospasm, or bronchogenic tumour)
  • extramural (e.g. mass causing external compression)

DIFFERENTIAL DIAGNOSIS

Monophonic wheeze (large airway)

  • ETT malposition
  • foreign body
  • blood
  • secretions
  • tumour
  • compression by lymph nodes

Polyphonic wheeze (small airways + multiple sites)

  • aspiration
  • unilateral emphysema
  • contralateral pneumothorax
  • asthma in a pneumonectomised patient

ASSESSMENT

Perform Simultaneous Assessment and Management

History

  • events leading up to onset (eating)
  • onset
  • severity
  • associated with pain
  • voice change
  • depressed LOC
  • trauma
  • significant PMHx – dysphagia, aspirations, CVA’s, bulbar dysfunction, oesophageal ca, asthma, previous lung surgery

Examination

  • observations: T, P, BP, RR, SpO2
  • airway – patent and protected, tracheal position,
  • breathing – WOB, chest expansion, percussion, auscultation, vocal resonance, pneumothorax, intrinsic PEEP
  • circulation – depressed venous return, hypotension
  • clubbing, lymphadenopathy

Investigations

  • CXR: ET position, contralateral disease, foreign body
  • bronchoscopy: luminal pathology (blood, foreign body, tumour, compression)
  • CT Chest: if necessary

CCC 700 6

Critical Care

Compendium

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