If the patient is conversationally dyspneic at the time of a telemedicine encounter, refer them on for immediate evaluation and treatment.
Briefly check to see if they are having any other symptoms that would trigger a recommendation for a 9-1-1 call and then tell them they need to see a clinicians “right now.”
Some telemedicine service providers will hassle you over this, criticizing you for not triaging the patient fully before making the call.
Outside of having typical chest pain, there is no additional information you can glean which will change the recommendation for immediate medical evaluation.
This should really go without saying, but it’s amazing how many clinicians will even document conversational dyspnea and then treat the patient in place.
If they can’t breathe now, assume they won’t be able to breathe later, even if you give them a strong dose of oral steroids. That treatment will take 12-24 hours to work, who knows what trouble they can get in by then.
I review telemedicine cases for lawsuits and this situation far more common that you would think.
Don’t let this happen to you.
Always remember, a telemedicine encounter isn’t an office visit. It isn’t even an “incredible simulation.”
Keep yourself and your patient safe.