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CHAPTER 5 Respiratory distress
Matthew R. Neth and Mohamud R. Daya
Introduction
Respiratory distress is a common reason for 9‐1‐1 activation, approaching 14% of EMS calls [1]. Patients who activate EMS for respiratory distress frequently require hospital admission. They have high in‐hospital mortality, similar to acute myocardial infarction (MI) and stroke [2]. Diagnosis can be challenging due to subtle and overlapping signs and symptoms. Incorrect management is potentially detrimental, while a correct diagnosis can provide lifesaving interventions and rapid improvement. The landmark Ontario Prehospital Advanced Life Support study demonstrated a significant survival benefit for respiratory distress with interventions including nebulized beta‐agonists, sublingual nitroglycerin, intubation, and intravenous medications and fluids [3].
Prehospital assessment and diagnosis
The approach to a patient with difficulty breathing must always begin with addressing immediate life threats (e.g., hypoxemia, upper airway obstruction, tension pneumothorax). After this primary assessment, possible causes of the presentation can be considered to guide specific therapy. Accurate diagnosis of