From the Guidelines
Evaluating shortness of breath in urgent care should start with a rapid 'ABC' assessment, followed by obtaining a quick history and measuring vital signs, including pulse rate, respiratory rate, and pulse oximetry, as recommended by the BTS guideline for oxygen use in adults in healthcare and emergency settings 1. When evaluating shortness of breath, it is essential to consider the patient's overall appearance and determine the severity of their condition.
- The initial assessment should include:
- Measuring pulse and respiratory rate in all cases
- Pulse oximetry to assess for hypoxaemia
- Recording disease-specific measurements, such as peak expiratory flow in asthma or blood pressure in cardiac disease
- A brief history should be taken from the patient or other informant to identify potential causes of shortness of breath, including onset, duration, associated symptoms, and relevant medical history.
- The physical examination should include lung auscultation, cardiac exam, and assessment for peripheral edema, jugular venous distention, or accessory muscle use. According to the BTS guideline 1, pulse oximetry should always be measured in patients with breathlessness or suspected hypoxaemia, and disease-specific measurements should also be recorded. The goal of this approach is to quickly identify the underlying cause of shortness of breath and provide appropriate treatment, while also determining the need for hospitalization or safe discharge with follow-up.
From the Research
Evaluation of Shortness of Breath
To evaluate shortness of breath in urgent care, the following steps can be taken:
- Identify the underlying cause of shortness of breath, which can be challenging due to the various potential causes 2
- Use an evidence-based approach to determine the etiology of shortness of breath, considering factors such as the patient's medical history, physical examination, and laboratory results 3
- Consider the patient's symptoms, such as dyspnea, cough, and sputum production, and assess their severity 4
Assessment and Management
The assessment and management of shortness of breath may involve:
- Targeted oxygen therapy, titrated to an SpO2 of 88-92% 4
- Arterial blood gases to assess gas exchange in patients with COPD exacerbation 4
- Inhaled short-acting bronchodilators, which can be provided by nebulizer, pressurized metered-dose inhaler, or dry powder inhaler 4
- Noninvasive ventilation (NIV) for patients with COPD exacerbation, as supported by clinical practice guidelines 4
Patient Characteristics and Improvement
Patient characteristics, such as baseline breathlessness and body mass index (BMI), may be associated with improvement in breathlessness after treatment with morphine 5