What are the key questions for Emergency Medical Services (EMS) to ask when assessing a patient with dyspnea (difficulty breathing)?

From the Guidelines

When assessing a patient with difficulty breathing in an EMS setting, focus on gathering critical information quickly, including the onset and duration of symptoms, severity, and associated symptoms like chest pain, cough, fever, or dizziness, as recommended by recent guidelines 1. To determine the cause of respiratory distress, ask about the patient's history of respiratory conditions, such as asthma, COPD, heart failure, or allergies, and inquire about recent activities, exposures to irritants, or trauma. Medication history is crucial, including any recently used inhalers or breathing treatments. Some key questions to ask include:

• Onset and duration of symptoms
• Severity of breathing difficulty
• Associated symptoms like chest pain, cough, fever, or dizziness
• History of respiratory conditions, such as asthma, COPD, heart failure, or allergies
• Recent activities, exposures to irritants, or trauma
• Medication history, including any recently used inhalers or breathing treatments For treatment considerations, assess oxygen saturation and administer supplemental oxygen if levels are below 94%, as suggested by recent studies 1. For bronchospasm, consider albuterol 2.5mg via nebulizer. For severe allergic reactions, epinephrine 0.3-0.5mg IM may be needed. Position the patient upright to ease breathing unless contraindicated, as recommended by recent guidelines 1. These questions and interventions help determine the cause of respiratory distress and guide appropriate interventions while en route to definitive care, ultimately improving patient outcomes in terms of morbidity, mortality, and quality of life 1.

From the Research

Assessment and Treatment of Difficulty Breathing Patients

• The first step in assessing a difficulty breathing patient is to evaluate their oxygenation status and respiratory rate, as studies have shown that high-flow nasal oxygen therapy can decrease respiratory rate 2.
• In cases of acute hypoxemic respiratory failure, non-invasive respiratory support strategies such as high-flow nasal oxygen and noninvasive ventilation can be effective in improving oxygenation and reducing the need for intubation 3.
• High-flow nasal cannula oxygen therapy has been shown to be effective in reducing dyspnea and improving oxygenation in respiratory failure from a variety of etiologies, and can be used as an alternative to conventional oxygen therapy and noninvasive ventilation 4.

Use of High-Flow Nasal Oxygen Therapy

• High-flow nasal oxygen therapy can provide oxygen at high flows with an optimal degree of heat and humidification, and can be used to treat de novo hypoxaemic respiratory failure, exacerbation of chronic obstructive pulmonary disease (COPD), and postintubation hypoxaemia 4.
• The use of high-flow nasal oxygen therapy in acute respiratory failure has been shown to be effective in alleviating respiratory distress and reducing the need for intubation, and can be used in combination with noninvasive ventilation to prevent respiratory failure after extubation 5.
• High-flow nasal oxygen therapy has also been used successfully in patients with COVID-19-related acute respiratory distress syndrome (ARDS) 6.

Monitoring and Adjustment of Oxygen Therapy

• Strict physiological monitoring is essential to promptly detect the need for endotracheal intubation and not delay protective ventilation 3.
• The optimal parameters of conservative oxygen therapy, including the suitable patient populations and oxygenation targets, are still being researched and debated 5.
• Future studies should focus on verifying the optimal parameters of conservative oxygen therapy, assessing oxygen needs in different patient populations, evaluating the long-term effects of oxygen treatment, and developing novel oxygen therapy technologies and devices 5.