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Acute Respiratory Distress With Impending Failure
Resuscitation and Universal Approaches
Approach to Unresponsive Patient
Approach to Airway Obstruction And Stridor
Approach to Acute Respiratory Distress With Impending Failure
Approach to Peri-arrest Hypotension
Approach to Post Resuscitation Care After Rosc
Approach to Cardiac Arrest Rhythms, Pea, Asystole
Approach to Cardiac Arrest Rhythms, Vf, Pulseless Vt
Approach to Severe Agitation With Safety Risk
Approach to Procedural Sedation
Chest and Cardiovascular
Approach to Pacemaker And Icd Related Presentations
Approach to Acute Limb Ischemia And Leg Pain
Approach to Suspected Deep Vein Thrombosis Symptoms
Approach to Hypertension
Approach to Chest Pain
Approach to Palpitations And Tachyarrhythmia Symptoms
Approach to Bradycardia Symptoms
Approach to Syncope And Presyncope
Approach to Syncope With Neurologic Concern
Approach to Unilateral Leg Swelling
Approach to Bilateral Leg Swelling
Approach to Calf Pain And Swelling
Respiratory
Approach to Wheezing, Undifferentiated
Approach to Wheezing In Infants
Approach to Stridor And Upper Airway Symptoms
Approach to Dyspnea
Approach to Aspiration Event
Approach to Cough
Approach to Hemoptysis
Approach to Upper Respiratory Infection Symptoms
Approach to Suspected Pulmonary Embolism Presentation
Approach to Smoke Inhalation Concern
Approach to Smoke Exposure And Inhalational Injury
Abdominal and Gastrointestinal
Approach to Abdominal Distension
Approach to Abdominal Pain, Undifferentiated
Approach to Acute Abdominal Pain (general)
Approach to Suspected Incarcerated Or Strangulated Hernia
Approach to Pancreatitis Concern
Approach to Biliary Colic And Cholecystitis Concern
Approach to Appendicitis Concern
Approach to Diverticulitis Concern
Approach to Rectal Pain And Anorectal Complaints
Approach to Dysphagia And Food Bolus Impaction
Approach to Foreign Body Ingestion
Approach to Refractory Vomiting And Recurrent Vomiting Syndromes
Approach to Cannabis Associated Hyperemesis
Approach to Upper Gastrointestinal Bleeding Symptoms (melena)
Approach to Lower Gastrointestinal Bleeding And Hematochezia
Approach to Constipation And Obstipation
Approach to Diarrhea
Approach to Acute Hepatitis And Jaundice Concern
Approach to Right Upper Quadrant Pain
Approach to Epigastric Pain
Approach to Left Upper Quadrant Pain
Approach to Right Lower Quadrant Pain
Approach to Left Lower Quadrant Pain
Approach to Suprapubic Pain
Renal and Urinary
Approach to Oliguria And Anuria
Approach to Catheter Related Urinary Complaints
Approach to Dialysis Patient Presentations
Approach to Flank Pain And Renal Colic Concern
Approach to Urinary Retention
Approach to Hematuria
Approach to Scrotal Pain
Neurologic
Approach to Transient Neurologic Deficits
Approach to Acute Aphasia And Speech Disturbance
Approach to Acute Confusion And Delirium
Approach to Postictal State And Seizure Recurrence Concern
Approach to Seizure
Approach to Acute Vision Loss
Approach to New Tremor And Involuntary Movements
Approach to Headache
Approach to Vertigo
Approach to Acute Weakness Or Numbness
Approach to Gait Instability And Ataxia
Back and Neck
Approach to Atraumatic Back Pain
Approach to Sciatica And Radicular Back Pain
Approach to Back Pain With Neurologic Deficit, Cauda Equina Concern
Approach to Back Pain With Fever Or Immunosuppression, Spinal Infection Concern
Approach to Atraumatic Neck Pain
Approach to Neck Pain After Trauma
Approach to Neck Pain With Meningismus Concern
Approach to Acute Torticollis
Women's Health, Pregnancy, and GU
Approach to Vaginal Discharge
Approach to Hyperemesis Gravidarum Concern
Approach to Hypertensive Disorders Of Pregnancy Symptoms
Approach to Postpartum Hemorrhage Concern
Approach to Postpartum Infection Concern
Approach to Sexual Assault Medical Evaluation Overview
Approach to Pelvic Pain
Approach to Vaginal Bleeding, Nonpregnant
Approach to Vaginal Bleeding In Pregnancy
Approach to Pelvic Pain In Pregnancy
Approach to Post Procedure Or Post Abortion Complications Concern
Infectious Disease and Fever Syndromes
Approach to Fever In The Immunocompromised Patient
Approach to Fever With Rash
Approach to Animal Bites And Rabies Risk Assessment
Approach to Tick Exposure And Tick Borne Illness Concern
Approach to Sepsis Concern Without Clear Source
Approach to Soft Tissue Infection Concern
Approach to Abscess And Skin Infection Concern
Approach to Sore Throat
Approach to Sore Throat And Pharyngitis Symptoms
Approach to Meningitis
Approach to Envenomation And Bites
Allergy and Dermatology
Approach to Pruritus Without Rash
Approach to Contact Dermatitis And Eczema Flare
Approach to Herpes Zoster Concern
Approach to Drug Eruption Concern And Severe Cutaneous Reaction Red Flags
Approach to Urticaria
Approach to Angioedema Concern
Approach to Unexplained Bruising Or Bleeding Symptoms
Musculoskeletal and Extremities
Approach to Shoulder Pain
Approach to Elbow Pain
Approach to Wrist Pain
Approach to Hand Pain
Approach to Hip Pain
Approach to Knee Pain
Approach to Ankle Pain
Approach to Foot Pain
Approach to Cast Or Splint Complication Symptoms
Approach to Wound Check And Suture Related Visits
Approach to Joint Swelling And Monoarthritis
Approach to Suspected Septic Joint Presentation
Approach to Suspected Tendon Rupture Presentation
Approach to Limp Or Refusal To Bear Weight
Trauma and Wounds
Approach to Motor Vehicle Collision Evaluation
Approach to Chest Wall Trauma And Rib Injury
Approach to Blunt Abdominal Trauma Evaluation
Approach to Penetrating Trauma Evaluation
Approach to Pediatric Minor Head Trauma
Approach to Pediatric Head Trauma
Approach to Facial Lacerations And Dental Trauma
Approach to Hand Lacerations With Tendon Injury Concern
Approach to Puncture Wounds And Retained Foreign Body Concern
Approach to Electrical Injury
Approach to Burn Injury
Approach to Fall Evaluation
Approach to Assault And Interpersonal Violence Evaluation
Approach to Eye Trauma And Hyphema Concern
ENT, Eye, Dental
Approach to Dysphagia And Odynophagia
Approach to Throat Pain
Approach to Ear Pain
Approach to Foreign Body In Ear Or Nose
Approach to Vision Loss Complaint
Approach to Flashes And Floaters
Approach to Atraumatic Eye Pain
Approach to Red Eye
Approach to Dental Abscess Concern
Approach to Post Extraction Pain And Complications
Endocrine, Metabolic, and Abnormal Labs
Approach to Hyperglycemia
Approach to Hypoglycemia
Approach to Hyponatremia Symptoms
Approach to Hyperkalemia Symptoms
Approach to Hypokalemia Symptoms
Approach to Rhabdomyolysis Concern
Approach to Anticoagulation Related Abnormal Coagulation Studies
Approach to Acute Kidney Injury And Elevated Creatinine Referral
Approach to Symptomatic Anemia Concern
Toxicology and Behavioral
Approach to Undifferentiated Overdose
Approach to Opioid Toxicity
Approach to Opioid Withdrawal
Approach to Alcohol Intoxication
Approach to Alcohol Withdrawal
Approach to Stimulant Toxicity
Approach to Pediatric Ingestion
Approach to Carbon Monoxide Exposure
Approach to Inhalational Or Chemical Exposure
Approach to Suicidal Ideation And Self Harm Risk Assessment
Approach to Acute Psychosis And Mania Symptoms
Approach to Anxiety And Panic Symptoms
Approach to Capacity Assessment And Safe Disposition
Approach to Behavioral Escalation And Restraint Considerations
Pediatrics
Approach to Fever In The Neonate And Young Infant
Approach to Pediatric Fever By Age 0 To 28 Days
Approach to Pediatric Fever By Age 29 To 60 Days
Approach to Pediatric Fever By Age 2 To 24 Months
Approach to Pediatric Respiratory Distress
Approach to Croup And Stridor In Children
Approach to Pediatric Dehydration
Approach to Pediatric Abdominal Pain
Approach to Febrile Seizure
Approach to Rash In The Child
Approach to Poor Feeding And Lethargy In The Infant
Approach to Vomiting In The Child
Approach to Diarrhea In The Child
Approach to Pediatric Trauma Evaluation
Approach to Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern
Approach to Lethargy And Altered Mental Status In The Child
Environmental and Exposure
Approach to Heat Illness
Approach to Hypothermia And Cold Exposure
Approach to Frostbite Concern
Approach to Drowning And Submersion Injury
Acute Respiratory Distress With Impending Failure
POCUS
Procedures
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
History
Presenting pattern
Respiratory distress phenotype
▶
Dyspnea at rest
Dyspnea on exertion
Work of breathing progression
Ability to speak
Triggering event
OPQRST
OPQRST framework
▶
Onset
▶
Sudden onset
Gradual onset
Time course to peak
Provocation and palliation
▶
Exertion related
Positional change
Relief with bronchodilator
Relief with rest
Quality
▶
Chest tightness
Air hunger
Pleuritic quality
Region and radiation
▶
Upper airway localization
Central chest localization
Unilateral localization
Severity
▶
Unable to speak full sentences
Limited to single words
Unable to lie flat
Timing
▶
Intermittent episodes
Continuous symptoms
Diurnal variation
Associated symptoms
Key associated symptoms
▶
Fever
Cough
Sputum production
Wheeze
Stridor
Chest pain
Hemoptysis
Orthopnea
Paroxysmal nocturnal dyspnea
Leg pain
Leg swelling
Rash
Facial swelling
Vomiting
Aspiration event
Baseline and prior episodes
Baseline function and trajectory
▶
Baseline exertional tolerance
Baseline oxygen requirement
Home inhaler or nebulizer use
Prior ICU admission
Prior intubation
Recent ED visits
Special populations history
High risk contexts
▶
Pregnancy and postpartum status
Immunocompromised state
Neuromuscular weakness symptoms
Pediatric age group
Advanced age
Obesity hypoventilation risk
Alarm Features
Immediate escalation triggers
Resuscitation triggers
▶
Altered mental status
Exhaustion
Silent chest
Cyanosis
Stridor at rest
Inability to protect airway
Hemodynamic instability
Vital sign danger thresholds
High risk vital patterns
▶
SpO2 below 90 percent on room air
Respiratory rate above 30 per minute
Respiratory rate below 8 per minute
Systolic blood pressure below 90 mmHg
Heart rate above 130 per minute
Temperature above 38.5 C with distress
High risk exam findings
High risk signs
▶
Accessory muscle use with fatigue
Tripoding
Poor air movement
Unilateral absent breath sounds
Frothy sputum
JVD with shock
Urticaria with wheeze
High risk historical triggers
Time critical causes
▶
Anaphylaxis exposure
Foreign body aspiration event
Smoke inhalation
Recent neck surgery
Recent intubation
Trauma
Recent immobilization or surgery
Medications
Current and recent therapies
Medication exposures
▶
Bronchodilators
Inhaled corticosteroids
Systemic corticosteroids
Diuretics
Home oxygen
CPAP or BiPAP use
Recent antibiotics
High risk medication classes
Medication related precipitants
▶
Opioids
Benzodiazepines
Sedative hypnotics
Beta blockers
ACE inhibitor
Chemotherapy agents
Allergies and reactions
Allergy profile
▶
Antibiotic allergy history
Contrast reaction history
NSAID induced bronchospasm history
Adherence and access
Treatment gaps
▶
Missed controller inhalers
Running out of inhalers
Nebulizer access issues
Diet
Intake and hydration
Recent intake pattern
▶
Poor oral intake
Dehydration risk
Recent vomiting
Exposures
Relevant exposures
▶
Caffeine and energy drinks
Alcohol use
Recreational substances
Salt and fluid pattern
Heart failure relevant patterns
▶
High salt intake pattern
Recent weight gain pattern
Review of Systems
Respiratory
Respiratory ROS
▶
Wheeze
Stridor
Cough
Sputum change
Hemoptysis
Pleuritic pain
Cardiovascular
Cardiovascular ROS
▶
Chest pressure
Palpitations
Syncope
Orthopnea
Paroxysmal nocturnal dyspnea
Peripheral edema
Infectious and inflammatory
Systemic ROS
▶
Fever
Chills
Myalgias
Sick contacts
Neurologic and toxicologic
Neuro and tox ROS
▶
Confusion
Somnolence
Headache
Seizure
Ingestion concern
Collateral History and Family History
Collateral source
Collateral information
▶
EMS report
Family or caregiver report
Baseline mental status reliability
Family history
Familial risk
▶
Early coronary disease
Sudden cardiac death
Asthma history
Thrombophilia history
Exposure and environment
Shared exposures
▶
Household illness cluster
Occupational inhalants
Home oxygen equipment issues
Risk Factors
Pulmonary and airway
Respiratory risk factors
▶
Asthma
COPD
Interstitial lung disease
Obstructive sleep apnea
Aspiration risk
Prior airway edema
Thrombosis
Venous thromboembolism risk
▶
Recent surgery
Immobilization
Prior VTE
Active malignancy
Estrogen exposure
Pregnancy and postpartum
Cardiac
Cardiovascular risk
▶
Heart failure
Coronary disease
Valvular disease
Arrhythmia history
Infection and immunocompromise
Infection risk factors
▶
Diabetes mellitus
Chronic kidney disease
Chronic liver disease
HIV
Transplant status
Chronic steroid use
Environmental and travel
Exposure risks
▶
Recent travel
High altitude exposure
Smoke exposure
Carbon monoxide exposure
Differential Diagnosis
Life threatening
Immediate threats
▶
Upper airway obstruction
▶
Foreign body
Angioedema
Anaphylaxis
Tension pneumothorax
▶
Unilateral absent breath sounds
Hypotension with distended neck veins
Pulmonary embolism (I26.99)
▶
Pleuritic pain
Hemoptysis
VTE risk factors
Acute cardiogenic pulmonary edema (I50.9)
▶
Orthopnea
Crackles
Hypertension pattern
Severe asthma exacerbation (J45.901)
▶
Silent chest
Prior intubation history
Acute COPD exacerbation (J44.1)
▶
Hypercapnia pattern
Increased sputum
Sepsis with respiratory failure (A41.9)
▶
Fever or hypothermia
Lactate elevation pattern
Toxicologic hypoventilation
▶
Opioid exposure
Sedative exposure
Common
Frequent causes
▶
Pneumonia (J18.9)
▶
Fever
Focal crackles
Viral respiratory infection
▶
Upper respiratory symptoms
Sick contacts
Bronchospasm
▶
Wheeze
Response to bronchodilator
Heart failure exacerbation (I50.9)
▶
Weight gain pattern
Peripheral edema
Pleural effusion
▶
Dullness to percussion
Decreased breath sounds at base
Less common and cannot miss in population
Important alternatives
▶
Acute coronary syndrome (I21.9)
▶
Dyspnea equivalent
Diaphoresis
Pericardial tamponade (I31.4)
▶
Hypotension
Muffled heart sounds
Pulmonary hypertension crisis
▶
Syncope
Right heart strain pattern
Neuromuscular failure
▶
Myasthenic crisis
Guillain Barre syndrome
DKA with Kussmaul breathing (E10.10)
▶
Polyuria
Ketosis
Mimics and pitfalls
Mimics
▶
Anxiety and panic
▶
Normal oxygenation pattern
Perioral tingling
Metabolic acidosis
▶
Tachypnea with clear lungs
Elevated anion gap
Anemia
▶
Pallor
Low hemoglobin pattern
Past Medical History
Pulmonary history
Chronic lung disease
▶
Asthma severity history
COPD severity history
Prior pulmonary embolism
Interstitial lung disease
Prior pneumothorax
Cardiac history
Cardiac conditions
▶
Heart failure baseline
Coronary disease
Valvular disease
Pulmonary hypertension
Procedures and devices
Relevant procedures
▶
Recent intubation
Tracheostomy
Home ventilator
Pacemaker or ICD
Baseline function
Functional baseline
▶
Home supports
Baseline mobility
Baseline cognition
Physical Exam
General and vitals interpretation
Severity and trajectory
▶
Work of breathing
Speech limitation
Mental status
Skin perfusion
Temperature pattern
Airway and breathing
Respiratory exam cluster
▶
Stridor
Wheeze
Crackles
Rhonchi
Prolonged expiratory phase
Unilateral breath sound decrease
Tracheal deviation
Circulation and volume status
Hemodynamic assessment
▶
Capillary refill
JVD
Peripheral edema
Hepatomegaly
Mucous membrane dryness
Cardiac exam
Cardiac findings
▶
New murmur
Gallop
Muffled heart sounds
Neurologic and fatigue
Neurologic risk
▶
Somnolence
Agitation
Asterixis
Weak cough
Skin and allergic signs
Allergy and exposure signs
▶
Urticaria
Angioedema
Flushing
Track marks
Lab Studies
Core labs
Baseline evaluation
▶
CBC
Electrolytes
Creatinine
Glucose
Blood gas and ventilation
Gas exchange assessment
▶
VBG
ABG if severe distress
pH trend
PaCO2 trend
Sepsis and perfusion
Perfusion markers
▶
Lactate
Blood cultures if febrile or septic physiology
Cardiac and heart failure
Cardiac evaluation
▶
Troponin
BNP or NT proBNP
Thrombosis workup
PE rule out support
▶
D dimer in low risk pathway
Avoid D dimer in high pretest probability
Infection respiratory testing
Respiratory infection tests
▶
Viral PCR local protocol dependent
Sputum culture if severe or ICU pathway
Toxicology and special labs
Selected tests by context
▶
Carboxyhemoglobin if smoke exposure
Serum ketones if metabolic acidosis pattern
Pregnancy test if pregnancy possible
Imaging
Scoring Systems
Clinical decision tools
▶
PERC rule
▶
Low risk pretest probability only
Not for moderate or high suspicion
Wells score for PE
▶
Low risk plus negative D dimer pathway
High risk direct imaging pathway
CURB 65
▶
Pneumonia severity support
Disposition support only
MRI
Limited role
▶
Spinal cord lesion with ventilatory weakness concern
Mediastinal mass characterization
Local protocol dependent availability
CT
CT indications
▶
CTPA for PE evaluation
CT chest for alternative diagnosis
CT neck for upper airway pathology
Contrast nephropathy risk assessment
Ultrasound
POCUS applications
▶
Lung ultrasound
▶
B lines pattern
Pleural effusion
Pneumothorax signs
Cardiac ultrasound
▶
LV function estimate
RV strain pattern
Pericardial effusion
IVC assessment
▶
Collapsibility pattern
Volume responsiveness support
Compression ultrasound for DVT
▶
Proximal femoral and popliteal
Positive DVT supports PE probability
Special Tests
Bedside monitoring
Immediate monitoring tools
▶
Continuous pulse oximetry
Cardiac monitor
Capnography if hypoventilation risk
Serial respiratory rate and mental status
Pulmonary function and response
Airflow assessment
▶
Peak expiratory flow if cooperative
Bronchodilator response trend
Airway evaluation
Airway focused bedside tests
▶
Voice change pattern
Drooling pattern
Tripod position pattern
ECG
Indications and timing
ECG workflow
▶
Dyspnea with chest pain equivalent
Dyspnea with syncope
Dyspnea with hypotension
High risk patterns
High risk ECG findings
▶
STEMI pattern
New ischemic ST changes
Rapid atrial fibrillation
Ventricular tachycardia
Bradyarrhythmia with instability
S1Q3T3 supportive of PE
Right heart strain pattern
Assessment
Severity stratification
Respiratory failure characterization
▶
Hypoxemic failure
Hypercapnic failure
Mixed failure
Impending fatigue
Likely cause synthesis
Working diagnosis basket
▶
Obstructive airway disease flare
Cardiogenic pulmonary edema
Pneumonia and sepsis
Pulmonary embolism
Upper airway process
Response to initial therapy
Early response markers
▶
Work of breathing improvement
Oxygen requirement trend
Mental status trend
Capnography trend if used
Plan
First 5 minutes
Immediate stabilization workflow
▶
Airway readiness
▶
Suction and BVM available
Difficult airway predictors
Monitoring and access
▶
Continuous pulse oximetry
Cardiac monitor
Two IV lines if severe
Oxygenation strategy
▶
Nasal cannula escalation
Non rebreather escalation
High flow nasal cannula if available
Noninvasive ventilation if indicated
Time critical bedside checks
▶
Glucose
Temperature
Focused lung auscultation
POCUS if available
Oxygen and ventilation targets
Targets and cautions
▶
SpO2 target 92 to 96 percent for most adults
SpO2 target 88 to 92 percent in COPD with chronic CO2 retention risk
Avoid excessive oxygen in chronic hypercapnia risk
Noninvasive ventilation
NIV indications and parameters
▶
COPD hypercapnic failure with acidosis
Cardiogenic pulmonary edema
Avoid NIV in inability to protect airway
Avoid NIV in refractory vomiting
Intubation and RSI considerations
Advanced airway pathway
▶
Indications
▶
Worsening hypercapnia with acidosis
Persistent hypoxemia despite escalation
Altered mental status with airway risk
Exhaustion
Preoxygenation
▶
High flow nasal cannula if available
NIV preoxygenation if tolerated
Peri intubation hypotension prevention
▶
Fluid bolus if hypovolemic pattern
Vasopressor ready
Induction examples
▶
Ketamine IV 1 to 2 mg per kg
Etomidate IV 0.3 mg per kg
Paralysis examples
▶
Rocuronium IV 1.2 mg per kg
Succinylcholine IV 1.5 mg per kg
Cause directed therapy
Obstructive airway disease
▶
Albuterol nebulized
▶
Adult dose 2.5 to 5 mg
Repeat dosing based on response
Ipratropium nebulized
▶
Adult dose 0.5 mg
Combine with albuterol for severe asthma or COPD
Systemic corticosteroid
▶
Prednisone PO 50 mg
Methylprednisolone IV 125 mg
Magnesium sulfate IV for severe asthma
▶
Adult dose 2 g over 20 minutes
Avoid in significant renal failure risk
Cardiogenic pulmonary edema
▶
NIV early if tolerated
▶
CPAP pathway
BiPAP pathway
Nitroglycerin if hypertensive and no contraindication
▶
SL 0.4 mg every 5 minutes as needed
IV infusion local protocol dependent
Loop diuretic if volume overload pattern
▶
Furosemide IV 40 mg typical starting dose
Higher dose if chronic diuretic use
Pneumonia and sepsis
▶
Antibiotics local protocol dependent
▶
Timing within 1 hour in septic shock pathway
Coverage based on risk factors and local resistance
Fluids and vasopressors
▶
Crystalloid 30 mL per kg in shock local protocol dependent
Norepinephrine first line vasopressor local protocol dependent
Pulmonary embolism
▶
Anticoagulation if no contraindication and high suspicion
▶
Heparin infusion local protocol dependent
Avoid anticoagulation in major bleeding risk
Thrombolysis for massive PE with shock local protocol dependent
▶
Contraindications review
Critical care and specialty consultation
Anaphylaxis and angioedema
▶
Epinephrine IM
▶
Adult dose 0.3 to 0.5 mg of 1 mg per mL
Repeat every 5 to 15 minutes if needed
H1 antihistamine
▶
Diphenhydramine IV 25 to 50 mg
Sedation risk
Steroid adjunct
▶
Dexamethasone IV 10 mg
Delayed onset
Airway early if progressive swelling
▶
Difficult airway activation
Surgical airway readiness
Pneumothorax
▶
Tension physiology
▶
Immediate needle decompression
Tube thoracostomy definitive
Non tension
▶
Imaging confirmation pathway
Chest tube criteria by size and symptoms
Monitoring and reassessment loop
Reassessment cadence
▶
Every 5 to 15 minutes in unstable patients
Work of breathing trend
Oxygen requirement trend
Lung exam trend
Repeat gas if hypercapnia concern
Consults
Consultation triggers
▶
ICU for impending failure
Anesthesia for difficult airway
Respiratory therapy for NIV
Cardiology for suspected ACS or cardiogenic shock
Pulmonary or critical care for severe asthma or COPD
Surgery for airway obstruction or pneumothorax complications
Disposition
ICU criteria
ICU level of care triggers
▶
Need for invasive mechanical ventilation
NIV with persistent acidosis
Refractory hypoxemia on high flow
Vasopressor requirement
Altered mental status from respiratory failure
Inpatient admission criteria
Ward admission triggers
▶
Ongoing oxygen requirement above baseline
Moderate distress requiring frequent bronchodilators
Pneumonia with hypoxemia
Heart failure requiring IV diuresis
Observation pathway criteria
Observation suitable patterns
▶
Rapid improvement with stable oxygen requirement
Short interval bronchodilator requirement spacing
Reliable follow up and return ability
Discharge criteria
Copy
Discharge requirements
▶
Stable oxygenation on room air or baseline oxygen
Work of breathing minimal
Ambulatory oxygen saturation acceptable
Etiology addressed with clear plan
Reliable supports and return precautions
Transfer criteria
Transfer triggers
▶
No ICU capability locally
Need for advanced airway expertise
Need for ECMO consideration local protocol dependent
Discharge Instructions
Copy discharge instructions
Copy
Discharge text
▶
Seen for trouble breathing that improved with treatment today
Take prescribed medicines exactly as directed
Use inhaler or nebulizer as instructed if this was an asthma or COPD flare
If antibiotics were prescribed take the full course
Avoid smoking and inhaled irritants
Follow up with primary care within 1 to 3 days
Follow up with pulmonology or cardiology if arranged
Return to the ER now for worsening breathing
Return to the ER now for lips or face turning blue
Return to the ER now for chest pain
Return to the ER now for fainting
Return to the ER now for confusion or extreme sleepiness
Return to the ER now for swelling of lips tongue or throat
Return to the ER now for inability to speak in full sentences
References
Guidelines and key sources
Evidence based sources
▶
ATS and ERS guideline for COPD exacerbation management 2023
GINA global strategy for asthma management and prevention 2024
ESC guideline for acute and chronic heart failure 2023
IDSA and ATS guideline for community acquired pneumonia 2019
ESC guideline for acute pulmonary embolism 2019
Surviving Sepsis Campaign international guidelines 2021
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
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Acute Respiratory Distress With Impending Failure