Dialysis patient with difficulty breathing


• Scene – O2 4L/min NC, cardiac monitor, IV 18g left AC, 0.16 nitro SL

• En route – 12-lead, 0.08mg nitro x2

• Hospital – unknown


• Response to treatment – during transport pt stated relief of breathing difficulty, breath sounds became clear = bilateral.

• Vitals en route – BP-127/74, RR-18, SaO2-97%, HR-90, GCS-15

• Disposition – Pt transported to Salem hospital code-one, with improvement.


Eric Boyd, Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Dyspnea
• Hypoxemia

Differential Diagnosis

• Pulmonary edema

• Congestive heart failure

• Pneumonia

• Pulmonary embolus

• Myocardial infraction

Patient Workup History

• Patient states – Sudden onset of breathing difficulty while relaxing in his chair.

• Denies any change in diet, medications, dialysis, or recent illness.

• No Hx of breathing difficulty

Physical Exam

• Bilateral breath sounds = with rales, non-productive cough.

• Upon arrival, patient was sitting in tripod position with labored breathing.

• Skin: pink, warm, dry; no edema noted.

• GCS – 15

• EKG – Sinus tach

Editor’s Notes

The management of patients who use routine dialysis can be complicated. “Fluid overload” symptoms can range from general body edema to pulmonary edema and associated dyspnea. Electrolyte abnormalities such as hyperkalemia and associated arrhythmias should also be considered.

-Dr. David Spiro


• Gender: Male

• Age: 79 years

• Height: Not Available


• Temperature: Not Available

• Blood Pressure: 211/60

• Heart Rate: 104

• Respiratory Rate: 24

• Pulse Oximetry: 88% RA

Signs and Symptoms

Sudden-onset difficulty breathing

History Medical

• PMH: Renal failure, hypertension (HTN)

• Allergies: PCN, sulfa

• Dispatch info: Conscious; difficulty breathing; alert; on kidney dialysis.


• PT lives at home with his wife. Pt states no alcohol or tobacco use.


• Metoprolol, lasix

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