A word about the diagnostic framework - specifically the category of "hypoxemia". This is an oversimplification of the pathophysiology, since most pathologies listed in this category result in dyspnea via multiple mechanisms (e.g. reduced lung compliance in heart failure and ILD), of which hypoxemia may not be the most important.
I have discussions tomorrow and this will help me more more than my teacher does after I learned , you make it together all , 🥰✋🏻 thnz best teacher 👨🏫 keep it
Hi doctor strong medicine Thanks for converting theoretical knowledge into practical approaches by your videos.one request plz Can there b a video showing clinical approach to investigate pancytopenia with underlying cause
Hi doctor Thanks for your amazing lectures. I was wondering whether carbon monoxide poisoning could also be on the differentials list for acute dyspnea?
Carbon monoxide poisoning does not stimulate the respiratory center because the mechanism involves neither hypoxemia, hypercapnia nor acidosis. That is why it is called a silent killer.
Firstly, thank you for your video. It's very informative and helpful. However, I have a question, I really curious about how you decide to categorise the causes of acute dyspnea by the pathophysiology. I know that you had explained a little bit about it in the video but i still find it unclearly abt the reason why.
I'm so sorry - just seeing your comment now! I largely chose to categorize the etiologies of acute dyspnea by pathophysiology to provide some variety since the etiologies of chronic dyspnea in the corresponding video are categorized by organ system.
What is the possible cause of chronic dyspnea at rest without any other associated symptoms in a pt who is hypertensive (well controlled) and all his cardiac a pulmonary and blood tests are normal . And he is not stressed out
Yes. The presence of hypoxemia in an asthma exacerbation suggests either a very severe (i.e. life-threatening) exacerbation, or the presence of a concurrent problem such as pneumonia or mucus plugging.
Very instructional video again, thank you so much! Why is "upper airway obstruction" listed in Miscellaneous? Doesn't it lead to Hypoxemia as well and could therefore be listed there? Thanks so much!
Upper airway obstruction will first lead to dyspnea by causing increased airway resistance, which mechanically loads the respiratory system before it causes hypoxemia. A patient with an upper obstruction can eventually develop related hypoxemia, but it is a late consequence that implies either profound obstruction, exhaustion of the muscles of respiration, or both. The same phenomenon can be seen in asthma in which an asthma exacerbation accompanied by hypoxemia is extremely concerning for an imminent respiratory arrest.
A WELL PRESENTED GOOD CONCISE REVIEW. However, it seems to me that a few minor inaccuracies exist. In particular, coarse crackles are considered to be of upper (central) airway origin and result from inspiratory airflow through airway related secretions. They are not regarded to be characteristic of interstitial and alveolar edema that present as late fine inspiratory crackles or rales that is inconsistent with this presentation. Another example is the application of ultrasound imaging of the IVC for increased width or congestion with its noted advantages over naturetic peptides (ie BNP) in reference to heart failure as the possible etiology of acute dyspnea. Evidence does exist for the argument of the application of IVC assessment in terms of comparable accuracy when compared to naturetic peptides (ie BNP, pro-NT-BNP) and the benefit of significantly reduced time to investigate a cardiac origin of dyspnea. However, to my knowledge, this is not implemented in major guidelines for heart failure. Once again, I found that the overall brief review to be quite good.
Thanks for the feedback! This was actually one of the first 2-3 videos of this style that I made, and I thought about this issue too. In the subsequent 20+ videos in the series, I point out which diagnoses are the most common (sometimes breaking it up into the most common causes of acute vs. chronic symptoms, if the video topic itself isn't already broken up that way). One of the limiting factors to mentioning specific probabilities of individual diseases is that it is highly dependent upon the population. The most likely causes of acute dyspnea in the ER of a tertiary care academic center in New York City could be completely different than in a primary care clinic in rural India. But the video needs to be applicable to both situations. Thus, it can't be too specific. Also I need to balance the video being comprehensive while not being so information dense that viewers can't sit through it, or can't remember enough of the material to make it worth watching for them. I appreciate that the optimal balance between those two considerations won't be the same for every viewer, but this is the approximate balance that my own students seem to prefer.
A word about the diagnostic framework - specifically the category of "hypoxemia". This is an oversimplification of the pathophysiology, since most pathologies listed in this category result in dyspnea via multiple mechanisms (e.g. reduced lung compliance in heart failure and ILD), of which hypoxemia may not be the most important.
Finding your channel for my Cardiology and Pulmonology OSCE prep is my PA School Miracle!
Thank you so very much!!!
Thank you Dr. Strong for making these videos!
I just want to say thank you for all your works
Excellent video with simple explanations! Thank you!
Thanks for your great informative videos
Great and clear explanation, keep it up.
Thanks for this fast, dense, helpful explanation
waooo thnx for such precious videos...looking fwd to abdominal pain approch
Awesomely informative and perfectly explained! Thank you so much! 😊😊 15/9/2019
I have discussions tomorrow and this will help me more more than my teacher does after I learned , you make it together all , 🥰✋🏻 thnz best teacher 👨🏫 keep it
Thank you so much for this!!!
damn one of the best videos ive come across thank you sir
Great Work Sir👍
Is there any of your traditional videos coming soon?
I'm eagerly waiting for them ...
thank you dr Strong.
great videos. plss keep posting
Thank you so much. Please make videos on approach to young stroke, myaesthenia gravis, guillaine barre syndrome and myelopathy
Hi doctor strong medicine
Thanks for converting theoretical knowledge into practical approaches by your videos.one request plz
Can there b a video showing clinical approach to investigate pancytopenia with underlying cause
Kindly make videos on approach to other symptoms as well ct head,chest and abdomen
very great lecture thanks alot
Thank you
Thank you so much
Thank you .
beautiful
That's awesome ....tq so much sir
Million thx...can u please make a video about approach to dysphagea
thanks alot sir i wish you were my teacher
thanks i was diagnosed with acute dyspnea yesterday
Great!
Hi doctor
Thanks for your amazing lectures.
I was wondering whether carbon monoxide poisoning could also be on the differentials list for acute dyspnea?
Carbon monoxide poisoning does not stimulate the respiratory center because the mechanism involves neither hypoxemia, hypercapnia nor acidosis. That is why it is called a silent killer.
Firstly, thank you for your video. It's very informative and helpful. However, I have a question, I really curious about how you decide to categorise the causes of acute dyspnea by the pathophysiology. I know that you had explained a little bit about it in the video but i still find it unclearly abt the reason why.
I'm so sorry - just seeing your comment now! I largely chose to categorize the etiologies of acute dyspnea by pathophysiology to provide some variety since the etiologies of chronic dyspnea in the corresponding video are categorized by organ system.
What is the possible cause of chronic dyspnea at rest without any other associated symptoms in a pt who is hypertensive (well controlled) and all his cardiac a pulmonary and blood tests are normal . And he is not stressed out
Thanks!
Superb
Would a diaphragma paralysis also be a cause? Is that then neuromuscular?
Course crepitations only in bronchiectasis and resolving pneumonia....while fine crepitations are found in acute pulmonary edema and ILD..
Hi Dr. Eric .. Is it unusal for asthma exacerbations to cause isolated hypoxemia ?
Yes. The presence of hypoxemia in an asthma exacerbation suggests either a very severe (i.e. life-threatening) exacerbation, or the presence of a concurrent problem such as pneumonia or mucus plugging.
Very instructional video again, thank you so much! Why is "upper airway obstruction" listed in Miscellaneous? Doesn't it lead to Hypoxemia as well and could therefore be listed there? Thanks so much!
Upper airway obstruction will first lead to dyspnea by causing increased airway resistance, which mechanically loads the respiratory system before it causes hypoxemia.
A patient with an upper obstruction can eventually develop related hypoxemia, but it is a late consequence that implies either profound obstruction, exhaustion of the muscles of respiration, or both. The same phenomenon can be seen in asthma in which an asthma exacerbation accompanied by hypoxemia is extremely concerning for an imminent respiratory arrest.
Thank you sir for the informative video.How does one differentiate alveolar vs interstitial opacities on a chest x ray?
The whole linked video focuses on this question, but is summarized near the end here: ua-cam.com/video/mNLd4DKtGs4/v-deo.html
@@StrongMed thank you sir for the immediate reply .
Tq verymuch sir ♥️
Hey, is the Chronic dyspnea video out yet?
Not yet. In about 2 weeks...
Strong Medicine This video was fantastic BTW!
Strong Medicine Any plans of making a new video regarding resources for the USMLE exam, as an update to the previous one?
I'm sorry, but no immediate plans for that specific topic. It's hard to keep up to date on USMLE resources.
It seems that my previous comment contains a minor oversight. "pro-NT BNP" should be NT-proBNP.
Hello sir What will be the immediate care for such patients
It depends on the cause of the dyspnea.
A WELL PRESENTED GOOD CONCISE REVIEW. However, it seems to me that a few minor inaccuracies exist. In particular, coarse crackles are considered to be of upper (central) airway origin and result from inspiratory airflow through airway related secretions. They are not regarded to be characteristic of interstitial and alveolar edema that present as late fine inspiratory crackles or rales that is inconsistent with this presentation. Another example is the application of ultrasound imaging of the IVC for increased width or congestion with its noted advantages over naturetic peptides (ie BNP) in reference to heart failure as the possible etiology of acute dyspnea. Evidence does exist for the argument of the application of IVC assessment in terms of comparable accuracy when compared to naturetic peptides (ie BNP, pro-NT-BNP) and the benefit of significantly reduced time to investigate a cardiac origin of dyspnea. However, to my knowledge, this is not implemented in major guidelines for heart failure. Once again, I found that the overall brief review to be quite good.
Well said, fine crackles, rales and crepitations are found in cardiogenic pulmonary edema. Thanks for the video, excellent presentation.
Intonixia bluroxia fluroxia
What the hell I don't get a thing what do they all mean could you please explain we all are not doctors
any one can explain why some people dislike these videos, especially this one?
Except for a deadhead
🥰
This style of presentation would be much more useful if there were probabilities with each of the too many causes, or risk factors with each cause
Thanks for the feedback! This was actually one of the first 2-3 videos of this style that I made, and I thought about this issue too.
In the subsequent 20+ videos in the series, I point out which diagnoses are the most common (sometimes breaking it up into the most common causes of acute vs. chronic symptoms, if the video topic itself isn't already broken up that way). One of the limiting factors to mentioning specific probabilities of individual diseases is that it is highly dependent upon the population. The most likely causes of acute dyspnea in the ER of a tertiary care academic center in New York City could be completely different than in a primary care clinic in rural India. But the video needs to be applicable to both situations. Thus, it can't be too specific.
Also I need to balance the video being comprehensive while not being so information dense that viewers can't sit through it, or can't remember enough of the material to make it worth watching for them. I appreciate that the optimal balance between those two considerations won't be the same for every viewer, but this is the approximate balance that my own students seem to prefer.
@@StrongMed thank you for responding. I did notice the other videos were balanced so I thought maybe I'm just getting cranky as I'm getting older
Hindi
I can't fucking breathe help
Thank you.
Thank you so much