Acute assessment of breathing problems in adults

A medical consult is recommended where there is no specific protocol for a condition

  • Always consider sepsis — signs and symptoms can include
    • High or low temperature
    • Fast breathing
    • Fast pulse
    • Low BP or dizziness
    • Confusion and/or agitation
Red Flags — Urgent Medical Consult
  • Severe, rapidly increasing shortness of breath
  • Silent chest (may indicate severe asthma)
  • Sharp chest pain on breathing
  • Coughing up blood
  • Drowsiness — may indicate CO2 retention (slow breathing), severe hypoxia, low BP (shock)
  • Painful swollen leg
  • Immobility, confined to bed or chair
  • Chest injury
  • Pregnant or postnatal women, older person or person with cancer

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Table 1.11 Causes of breathing problems in adults

Signs and symptoms

Possible cause

Cold and clammy skin
Shallow, rapid breathing
Anxious/restless
Rapid or irregular heartbeat, weak pulse
Hypotension
Dizziness or light-headedness

Shock — may be from heart attack, sepsis, tension pneumothorax, large pulmonary embolus (PE), anaphylaxis, severe dehydration, internal haemorrhage (eg GIH, ectopic pregnancy) — medical consult

Fatigue/ weakness
Dizziness or light-headedness
Rapid heartbeat or pounding in the chest, may be chest pain

Heart arrhythmias — medical consult

Sudden onset of shortness of breath
Chest pain (worse with breathing)
Dizziness or light-headedness
Sweating
Racing or irregular heartbeat

Pulmonary embolism — medical consult

Chest pain
Shorten of breath and worse lying flat
Wheeze and/or crackles in lungs
May have pink, frothy sputum
High BP
Swollen legs
Anxious, fearful, exhausted
Hard to get to sleep, wakes up at night,
Missed dialysis
History of heart trouble, RHD, CAD, CCF

Pulmonary oedemamedical consult

Sharp pain on breathing
Decreased air entry and chest expansion on affected side
Worsens over minutes to an hour
May have history of chronic lung disease — don’t assume just COPD
May be young healthy person
May be after chest injury or after playing sport

Pneumothoraxmedical consult

Severe, rapidly increasing shortness of breath, anxiety
Fast pulse, low BP
Often after chest injury or in people with chronic lung disease

Tension pneumothoraxmedical consult

Fever, cough, looks unwell
May have sharp chest pain, worse on deep breathing
May have reduced breath sounds, crackles in lungs

Pneumonia

 — medical consult

History of chronic lung problems and/or long-term smoker
Usually no fever
Change in colour of sputum
Anxious and breathing fast — emphysema
Slow breathing and depressed level of consciousness — acute OR chronic bronchitis with CO2 retention

Exacerbation of chronic lung disease — medical consult

Cough with wheeze
Tripod posture, restless, fearful if severe
Drowsy or blue if peri-arrest
Usually known to have asthma

Acute asthma — medical consult

Swelling of the lips or tongue
Wheeze and short of breath
Stridor — harsh breaths
Light-headed/collapse
Hypotension
Welts

Anaphylaxis — medical consult

Anxious/fearful/upset
Strong feeling of dread, danger, losing control
Dizziness or light-headedness
Trembling, shaking
Tingling finger or lips
Sweating or hot flushes
Rapid/deep respiration
Rapid heart rate

Anxiety/panic attack — medical consult