Hospital Workup for Facial Swelling and Shortness of Breath

Immediate Assessment and Stabilization

The American College of Anaesthesia recommends performing an immediate "ABC" assessment focusing on airway patency, as facial swelling with dyspnea may indicate impending airway compromise 1
The Thorax journal suggests measuring pulse rate, respiratory rate, blood pressure, and continuous pulse oximetry in all patients presenting with shortness of breath 2
The Anaesthesia journal recommends monitoring for warning signs including stridor, obstructed breathing pattern, or agitation, which should never be ignored even if objective signs initially appear absent 1

The Arthritis and Rheumatology society recommends ensuring continuous cardiac monitoring is available, as dyspnea with edema may indicate cardiac pathology 4
The Anaesthesia journal suggests having difficult airway equipment immediately available given the risk of progressive airway compromise with facial swelling 1

The American College of Cardiology recommends considering heart failure with preserved ejection fraction as a potential cause of dyspnea and edema 5
The Arthritis and Rheumatology society recommends obtaining an ECG in all patients with dyspnea and edema, as clinical manifestations may indicate Lyme carditis or other cardiac pathology including heart failure 4

The American College of Cardiology recommends obtaining an echocardiogram if cardiac etiology is suspected to assess ejection fraction, wall thickness, and estimated pulmonary artery pressures 5
The Arthritis and Rheumatology society recommends hospital admission with continuous monitoring for patients with significant PR prolongation (>300ms), arrhythmias, or clinical manifestations of myopericarditis 4

The Anaesthesia journal recommends continuing pulse oximetry and vital signs monitoring until the patient is stable 1
The Thorax journal suggests serial respiratory rate measurements, as this is a critical indicator of respiratory status 2
The Anaesthesia journal recommends not relying solely on a pulse oximeter for monitoring ventilation 1