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Respiratory Distress, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

Respiratory distress, shortness of breath, or dyspnea is a common complaint for patients presenting to the ED. 

Etiology

  • Upper airway obstruction:

    • Epiglottitis

    • Croup syndromes

    • Laryngotrac...

Diagnosis

Signs and Symptoms

  • Tachypnea

  • Dyspnea

  • Tachycardia

  • Anxiety

  • Diaphoresis

  • Cough (“barking,” productive)

  • Stridor

  • Hoarse voice

  • Difficulty swallowing or handling oral secretions

  • Upper airway rhonchi (wheezes)

  • ...

Treatment

Pre-Hospital

  • Assume a position of comfort for patient.

  • 100% oxygen:

    • Assisted bag-valve mask (BMV) ventilation if obtunded

  • Airway adjunct devices (oral or nasal) to maintain patency if tolerated

  • I...

Follow-Up

Disposition

Admission Criteria

  • Continued supplemental oxygen requirement

  • Cardiac or hemodynamic instability:

    • Requiring IV therapy or hydration

    • Requiring close airway observation or repeated treat...

Pearls and Pitfalls

  • Consider immune-compromised state.

  • Consider “novel” flu strains (H1N1).

  • Start antibiotic treatment within 6 hr of ED arrival (JCAHO Quality Measure).

Additional Reading

  • Ausiello  D, Goldman  L, eds. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: WB Saunders; 2004:492–583, 1523–1524.

  • Barton  ED, Collings  J, DeBlieux  PMC, et al., eds. Emer...

Codes

ICD9

  • 786.00 Respiratory abnormality, unspecified

  • 786.05 Shortness of breath

  • 786.09 Other respiratory abnormalities

  • 464.4 Croup

  • 464.30 Acute epiglottitis without mention of obstruction

  • 490 Bronchitis, ...

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