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 oedema — medical 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	Pneumothorax — medical consult
Severe, rapidly increasing shortness of breath, anxiety Fast pulse, low BP Often after chest injury or in people with chronic lung disease	Tension pneumothorax — medical 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