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Respiratory Emergencies

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Respiratory Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Acute Asthma Exacerbation	Shortness of breath, wheezing, and chest tightness. Accessory muscle use, tachypnea, and possible cyanosis in severe cases. Decreased breath sounds and prolonged expiratory phase.	Peak expiratory flow (PEF) or spirometry to assess severity. Arterial blood gas (ABG) may show hypoxemia and hypercapnia in severe cases. Chest X-ray to rule out pneumonia or pneumothorax if clinically indicated.	Immediate administration of inhaled short-acting beta-agonists (e.g., salbutamol/albuterol) via nebulizer or MDI with spacer. Systemic corticosteroids (e.g., prednisone) to reduce inflammation. Supplemental oxygen to maintain SpO2 >92%. Consider IV magnesium sulfate for life-threatening exacerbations.
Pneumothorax	Sudden onset of unilateral pleuritic chest pain and shortness of breath. Decreased breath sounds and hyperresonance on the affected side. Tracheal deviation toward the contralateral side in tension pneumothorax.	Chest X-ray showing collapsed lung and pleural air. CT scan may be used for detailed assessment in complicated cases. ABG may show hypoxemia in severe cases.	Needle decompression followed by chest tube insertion for tension pneumothorax. Observation and oxygen therapy for small, stable pneumothorax. Chest tube thoracostomy for large or symptomatic pneumothorax. Surgical intervention (e.g., pleurodesis) may be needed for recurrent cases.
Pulmonary Embolism (PE)	Sudden onset of pleuritic chest pain, shortness of breath, and hemoptysis. Tachypnea, tachycardia, and hypoxia. Possible signs of deep vein thrombosis (DVT), such as leg swelling or pain.	CT pulmonary angiography (CTPA) showing filling defects in the pulmonary arteries. D-dimer test to rule out PE in low-risk patients. ECG may show sinus tachycardia, right heart strain (e.g., S1Q3T3 pattern).	Immediate anticoagulation with IV heparin or low-molecular-weight heparin (LMWH). Thrombolytic therapy for massive PE with hemodynamic instability. Consider surgical embolectomy or catheter-directed thrombolysis in severe cases. Long-term anticoagulation and investigation for underlying causes (e.g., malignancy, thrombophilia).
Acute Respiratory Distress Syndrome (ARDS)	Severe shortness of breath, tachypnea, and hypoxemia refractory to oxygen therapy. Bilateral infiltrates on chest X-ray without evidence of cardiac failure. Often occurs in the context of sepsis, trauma, or severe pneumonia.	ABG showing severe hypoxemia with PaO2/FiO2 ratio <300. Chest X-ray showing bilateral alveolar infiltrates ("white-out" appearance). CT scan may show diffuse alveolar damage.	Mechanical ventilation with low tidal volumes and PEEP to maintain oxygenation. Treat underlying cause (e.g., antibiotics for sepsis, supportive care for trauma). Prone positioning to improve oxygenation in severe cases. Close monitoring and supportive care in an ICU setting.
Acute COPD Exacerbation	Worsening dyspnoea, increased sputum production, and cough. Wheezing, tachypnea, and use of accessory muscles. May present with signs of respiratory failure, including confusion and cyanosis.	ABG showing hypoxemia and hypercapnia. Chest X-ray to rule out pneumonia, pneumothorax, or heart failure. Sputum culture if infection is suspected.	Bronchodilators (e.g., albuterol, ipratropium) via nebulizer or MDI with spacer. Systemic corticosteroids (e.g., prednisone) to reduce airway inflammation. Antibiotics if bacterial infection is suspected (e.g., amoxicillin/clavulanate). Non-invasive ventilation (e.g., BiPAP) if respiratory failure is present.
Anaphylaxis	Sudden onset of shortness of breath, wheezing, and stridor. Generalized urticaria, angioedema, and hypotension. May occur after exposure to allergens (e.g., foods, insect stings, medications).	Clinical diagnosis based on rapid onset of symptoms following allergen exposure. ABG may show hypoxemia and respiratory acidosis in severe cases. Serum tryptase levels may be elevated, but not required for diagnosis.	Immediate intramuscular injection of epinephrine. IV fluids, oxygen, and antihistamines (e.g., diphenhydramine). Systemic corticosteroids to prevent biphasic reactions. Close monitoring and possible admission to ICU for severe cases.
Foreign Body Aspiration	Sudden onset of coughing, choking, and stridor. Decreased breath sounds on the affected side. Cyanosis and respiratory distress in severe cases.	Chest X-ray may show the foreign body if radiopaque; otherwise, may show air trapping on the affected side. Bronchoscopy is the gold standard for diagnosis and removal. ABG may show hypoxemia and hypercapnia.	Immediate Heimlich maneuver if complete airway obstruction is present. Urgent bronchoscopy for removal of the foreign body. Oxygen therapy and monitoring for complications such as pneumonia or pneumothorax.
Carbon Monoxide Poisoning	Headache, dizziness, confusion, and shortness of breath. Cherry-red skin color (late sign), nausea, vomiting, and loss of consciousness in severe cases. Exposure to smoke, faulty heating systems, or enclosed spaces with engine exhaust.	ABG with co-oximetry to measure carboxyhemoglobin levels. ECG to assess for myocardial ischaemia, especially in older patients. Chest X-ray may be performed to rule out other causes of symptoms.	Immediate administration of 100% oxygen via non-rebreather mask or endotracheal tube. Hyperbaric oxygen therapy in severe cases or if carboxyhemoglobin levels are >25%. Continuous monitoring of cardiac and neurological status. Supportive care and monitoring for delayed neurological sequelae.
Acute Epiglottitis	Severe sore throat, dysphagia, drooling, and muffled voice. Stridor, high fever, and respiratory distress in severe cases. Rapid progression, often seen in children but can occur in adults.	Lateral neck X-ray showing the "thumbprint sign" (enlarged epiglottis). Clinical diagnosis based on history and physical examination. ABG may show hypoxemia in severe cases.	Immediate airway management; intubation may be required. IV antibiotics (e.g., ceftriaxone or cefotaxime). IV corticosteroids to reduce inflammation and airway swelling. Close monitoring in an ICU setting for airway obstruction.

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