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44 JULY 2016 | EMSWORLD.com neous pneumothorax? What clues should you look for in your history and physical examination to help you arrive at the cor- rect prehospital diagnosis? It is well known that differentiating between pneumonia and CHF can be dif- ficult in the prehospital arena. 1 It is also known that giving a diuretic like furose - mide to a patient with pneumonia can potentially cause harm. 2 W hile many agencies have pulled diuretics off their rescue vehicles in recent years, many others continue to administer them for cases of suspected CHF. This means that accurately making the correct prehospital diagnosis of CHF is even more important. Both diagnoses can present with crackles on lung exam. How can they be accurately differentiated in the field without the use of an x-ray? In this third installment of the series, we will review the simple strategies to accurately differentiate pneumonia from CHF in the field. In addition we'll examine several deadly causes of dyspnea as well as some of the common but less dangerous etiologies of shortness of breath (SOB). By performing a focused, systematic history and physical examination, you can rapidly diagnose and treat life-threatening respira- tory emergencies. However, as always, rapid stabilization and transport are top priorities. A focus on controlling the airway, correcting hypoxia, reversing bronchospasm and improving ventilatory rates and tidal volume comes first. After initial stabilization of the patient, gathering the necessary information will allow the skilled paramedic to refine the prehospital diagnosis and treatment. CHF vs. Pneumonia Before discussing the details of a history and physical examination for a chief com- plaint of SOB, let's begin with the simple strategies and clues to assist the street medic in correctly differentiating CHF and pneumonia. Some of these strategies necessarily oversimplify complex physi- ological problems. However, when used in combination with a thorough history and physical exam, these tricks of the trade can often make obtaining the correct diagnosis much easier. Pneumonia Pneumonia can be thought of as a disease of the lung. Patients with underlying lung disease can be thought to be at risk for more lung disease. This means your patients with a history of COPD, asthma or other lung pathology, or who take respiratory medications such as albuterol, should be considered high-risk for pneumonia. Since pneumonia is an infectious dis- ease, your patient is more likely to catch it from other people. Consider the patient's address in your diagnosis: Patients who reside in high-population-density living arrangements, such as nursing homes, are at particular risk. In addition to residing with many potential infectious contacts, these patients are often debilitated, run down and chronically ill. Infections are common in this population, since this Code #72657 Move with Speed & Safety The MegaMover ® Select™ Goes Where Stretchers Can't 800.558.6765 GrahamMedical.com • Transfer, transport, and rescue patients that can't be reached by stretchers • 14 multi-positioned handles provide ergonomic lifting • Pull straps for situations when pulling a patient is safer than lifting • Durable, nonwoven design holds up to 1000 lbs. • Light, space-saving, and portable NEW EMS Products from Graham Medical For More Information Circle 32 on Reader Service Card