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Prehospital care
4 Shortness of breath
  1. M Woollard,
  2. I Greaves
  1. Pre-hospital Care Research Unit, Department of Academic Emergency Medicine, The James Cook University Hospital, Middlesbrough, UK
  1. Correspondence to:
 Mr M Woollard
 The James Cook University Hospital, Department of Academic Emergency Medicine, Education Centre, Marton Road, Middlesbrough TS4 3BW, UK; Malcolm.woollardukgateway.net

https://doi.org/10.1136/emj.2004.014878

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    Shortness of breath is the chief complaint for about 8% of 999 calls to the ambulance service, and is the third most common type of emergency call. It can also be an important symptom in patients with a wide range of conditions. Reference should therefore be made to other relevant articles—particularly that discussing chest pain. The conditions covered in this paper include asthma, chronic obstructive pulmonary disease, acute pulmonary oedema, and chest infections. The objectives for this paper are listed in box 1.

    Box 1 Article objectives

    • To consider the causes of breathlessness

    • To describe the recognition of primary survey positive patients and treatment of immediately life threatening problems

    • To describe the recognition and treatment of primary survey negative patients requiring immediate hospital admission

    • To describe the findings and treatment of primary survey negative patients suggesting delayed admission, treatment and referral, or treatment and discharge may be appropriate

    • To consider a list of differential diagnoses.

    The common causes of shortness of breath are asthma, chronic obstructive pulmonary disease, and pulmonary oedema but there are many other conditions that can pose diagnostic problems (box 2).

    Box 2 Causes of breathlessness

    Very common

    • Asthma

    • Chronic obstructive pulmonary disease

    • Pulmonary oedema attributable to left ventricular failure

    Common

    • Pneumonia

    • Pneumothorax

    • Pulmonary embolus

    • Pleural effusion

    • Pregnancy

    Rare

    • Metabolic acidosis

    • Aspirin poisoning

    • Renal failure

    PRIMARY SURVEY POSITIVE PATIENTS

    Recognition

    Patients with a life threatening respiratory emergency will present in either respiratory failure or respiratory distress. Patients with respiratory distress are still able to compensate for the effects of their illness, and urgent treatment may prevent their further deterioration. They present with signs and symptoms indicating increased work of breathing but findings suggesting systemic effects of hypoxia or hypercapnia will be limited or absent. Conversely, patients with respiratory failure may have limited evidence of increased work of breathing as they become too …

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