Respiratory distress

Respiratory distress is a common chief complaint in EMS, and initial evaluation should be focused on preserving life and determining the need for an immediate intervention such as non-invasive positive pressure ventilation, bag-valve-mask ventilation, or endotracheal intubation. Once this evaluation is completed, focus should be placed on identifying a provisional underlying cause for the respiratory distress. Respiratory distress may be caused by a primary pulmonary problem (e.g. asthma or COPD), a cardiac problem (e.g. acute coronary syndrome or congestive heart failure), an infectious problem (e.g. pneumonia or sepsis), or another problem for which the respiratory system is compensating (e.g. metabolic acidosis from an overdose or diabetic ketoacidosis). In general, treatment should include titrated oxygen and continuous monitoring of cardiac rhythm, SpO2,and EtCO2 while ensuring timely transport. In stable situations, the emphasis should be on avoiding unnecessary treatments and resisting the urge to give multiple medications in an undirected fashion. Prehospital focused chest ultrasound can assist with diagnosis and help guide therapeutic interventions.