Respiratory Emergencies
Respiratory complaints are one of the top three reasons EMS is called. Distinguishing between upper airway, lower airway, and cardiac causes decides your entire treatment path.
EMT · AEMT · Paramedic
Asthma and reactive airway disease
Bronchoconstriction plus inflammation and mucus. Look for expiratory wheezing, accessory muscle use, and tripod positioning. Silent chest is a late, ominous sign.
- First line: albuterol nebulizer 2.5 mg (or MDI + spacer)
- Ipratropium 500 mcg added for moderate/severe attacks
- IM epinephrine 0.3 mg for severe/impending arrest
- Consider CPAP if the patient can tolerate it
COPD exacerbation
Chronic disease with acute worsening. Target SpO2 88–92% — over-oxygenation can suppress hypoxic drive and worsen hypercapnia. Bronchodilators, steroids (in-hospital), and CPAP are mainstays.
Acute pulmonary edema (CHF)
Left-heart failure backs blood into the lungs. Wet lung sounds bilaterally, pink frothy sputum, sitting up gasping. CPAP is the game-changer — reduces preload and improves oxygenation. Nitro if BP > 100 systolic. Avoid fluid.
Pulmonary embolism
Sudden dyspnea with clear lung sounds, tachycardia out of proportion, sometimes pleuritic chest pain. Risk factors: recent surgery, immobilization, cancer, OCP use. Supportive care and transport — definitive treatment is in-hospital.
Pneumonia
Fever, productive cough, focal crackles or rhonchi, sometimes pleuritic chest pain. Sepsis can be brewing — check vitals for SIRS criteria and consider a fluid bolus if hypotensive.
Frequently asked
- When should you use CPAP prehospital?
- Awake, cooperative patient with respiratory distress, SpO2 < 90% on high-flow O2, adequate BP, and a patent airway. Contraindicated in vomiting, altered mental status, or hypotension.
- Why target SpO2 88–92% in COPD?
- Hyperoxia in chronic CO2 retainers can worsen hypercapnia via V/Q mismatch and reduced hypoxic drive. Titrate oxygen, don't slam it.
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