Respiratory Emergencies

Comprehensive guide to respiratory emergencies and management

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Respiratory Emergencies

Respiratory Distress is a Medical Emergency!

Immediate assessment and intervention can prevent respiratory failure

Key signs: Tachypnea, accessory muscle use, altered mental status

Initial Assessment - ABCDE Approach

A - Airway

  • Patency assessment
  • Foreign body obstruction
  • Stridor or hoarseness
  • Ability to speak

B - Breathing

  • Respiratory rate and pattern
  • Accessory muscle use
  • Chest wall movement
  • Breath sounds

C - Circulation

  • Heart rate and rhythm
  • Blood pressure
  • Capillary refill
  • Skin color

D - Disability

  • Level of consciousness
  • Pupillary response
  • Motor function
  • AVPU scale

Acute Asthma Exacerbation

Clinical Presentation

  • Wheezing (expiratory)
  • Dyspnea and chest tightness
  • Increased work of breathing
  • Prolonged expiratory phase
  • Use of accessory muscles
  • Pulsus paradoxus

Severity Assessment

Mild

Speaks in sentences, PEF >50%

Moderate

Speaks in phrases, PEF 25-50%

Severe

Speaks in words, PEF <25%

Treatment Algorithm

1

Oxygen Therapy

Maintain SpO2 >90% (94-98% in pregnancy)

2

Short-acting Beta-2 Agonists

Albuterol 2.5-5mg via nebulizer or 4-8 puffs via MDI

3

Systemic Corticosteroids

Prednisone 40-60mg PO or methylprednisolone 40-80mg IV

4

Ipratropium Bromide

0.5mg via nebulizer (add to albuterol)

COPD Exacerbation

Clinical Presentation

  • Increased dyspnea
  • Increased sputum production
  • Change in sputum color
  • Barrel chest appearance
  • Pursed-lip breathing
  • Decreased breath sounds

Risk Factors

  • Smoking history
  • Environmental exposures
  • Alpha-1 antitrypsin deficiency
  • Recurrent infections
  • Poor medication compliance
  • Comorbid conditions

Treatment Algorithm

1

Oxygen Therapy

Target SpO2 88-92% (avoid hyperoxia in COPD)

2

Bronchodilators

Combination SABA + SAMA via nebulizer

3

Corticosteroids

Prednisone 40mg PO daily for 5-7 days

4

Antibiotics

If purulent sputum or signs of infection

Acute Respiratory Failure

Type I (Hypoxemic)

  • PaO2 < 60 mmHg
  • Normal or low PaCO2
  • Pneumonia, ARDS, PE
  • Pulmonary edema
  • Diffuse alveolar damage

Type II (Hypercapnic)

  • PaCO2 > 50 mmHg
  • Acidemia (pH < 7.35)
  • COPD exacerbation
  • Neuromuscular disease
  • Chest wall disorders

Management Principles

1

Immediate Assessment

ABC approach, vital signs, mental status

2

Oxygen Therapy

High-flow nasal cannula or non-invasive ventilation

3

Treat Underlying Cause

Address precipitating factors

4

Consider Intubation

If respiratory arrest or severe acidosis

Non-Invasive Ventilation (NIV)

Indications

  • COPD exacerbation with acidosis
  • Cardiogenic pulmonary edema
  • Immunocompromised patients
  • Post-extubation support
  • Palliative care

Contraindications

  • Respiratory arrest
  • Severe facial trauma
  • Inability to protect airway
  • Severe hemodynamic instability
  • Altered mental status

NIV Settings

IPAP: 8-20 cm H2O
EPAP: 4-8 cm H2O
Backup Rate: 12-16/min
FiO2: As needed
Mode: BiPAP/CPAP
Interface: Full face mask

Monitoring and Disposition

Continuous Monitoring

  • Pulse oximetry
  • Respiratory rate and pattern
  • Blood pressure
  • Mental status
  • Arterial blood gases
  • Peak flow (asthma)

Discharge Criteria

  • Stable vital signs
  • Improved symptoms
  • PEF >70% predicted (asthma)
  • Stable oxygen requirements
  • Follow-up arranged
  • Medication compliance

Key Points

  • Always assess airway patency first
  • Oxygen therapy targets vary by condition
  • Early use of bronchodilators in asthma/COPD
  • Systemic steroids for inflammatory conditions
  • Consider NIV before intubation
  • Monitor response to therapy closely
  • Arrange appropriate follow-up care