How to manage a patient with tachypnea?

Management of Tachypnea (RR 38)

A patient with tachypnea (RR 38) requires immediate oxygen supplementation, assessment of airway patency, and investigation of underlying causes while preparing for possible airway intervention if respiratory distress worsens.

Initial Assessment and Management

Immediate Actions

• Administer supplemental oxygen to maintain SpO2 >94% (unless at risk for hypercapnia) 1
• Position patient in head-up/upright position 1
• Obtain vital signs including heart rate, blood pressure, temperature
• Assess for signs of airway compromise:
  • Stridor
  • Obstructed breathing pattern
  • Arterial oxygen desaturation
  • Agitation 1

Monitoring

• Implement continuous pulse oximetry 1
• Initiate cardiac monitoring 2
• Establish venous access 1
• Increase frequency of observations 1
• Use Early Warning Score (EWS) system alongside pulse oximetry 1

Diagnostic Evaluation

Immediate Bedside Assessment

• Arterial or arterialised capillary blood gases to assess:
  • PaO2 (oxygen level)
  • PCO2 (carbon dioxide level)
  • pH (acid-base status) 1
• 12-lead ECG to assess for cardiac causes 2

Laboratory Tests

• Complete blood count (to evaluate for anemia)
• Thyroid function tests
• Arterial blood gas analysis 2

Imaging

• Consider point-of-care lung ultrasound if available 3
• Consider chest imaging based on clinical suspicion

Differential Diagnosis and Management

Respiratory Causes

• Acute heart failure:

  • Administer oxygen with target saturation >94%
  • Consider sublingual/IV nitrates (titrated to blood pressure)
  • Consider IV diuretics (furosemide)
  • For respiratory distress: initiate non-invasive ventilation (CPAP) 1

• Pulmonary edema/congestion:

  • Position upright
  • Administer oxygen
  • Consider diuretics 1

Cardiac Causes

• Tachycardia-induced tachypnea:
  • Treat underlying tachycardia according to rhythm
  • For SVT: vagal maneuvers, adenosine if no response
  • For ventricular tachycardia: amiodarone 2

Other Causes

• Anxiety/pain-induced tachypnea:

  • Provide appropriate analgesia (avoid sedative analgesia if respiratory compromise) 1
  • Consider non-pharmacological measures

• Metabolic acidosis:

  • Identify and treat underlying cause
  • Correct electrolyte imbalances

Escalation of Care

Indications for Airway Intervention

• Progressive respiratory distress despite initial measures
• Oxygen saturation <90% despite supplemental oxygen
• Signs of impending respiratory failure:
  • Altered mental status
  • Inability to protect airway
  • Severe respiratory distress 1

Preparation for Possible Intubation

If respiratory status deteriorates:

• Call for senior anaesthetic help immediately 1
• Prepare for rapid sequence induction (RSI) 1
• Use videolaryngoscope if available for first attempt 1
• Ensure vasopressors available for managing post-intubation hypotension 1

Special Considerations

Pitfalls to Avoid

• Never ignore a patient who is agitated or complains of difficulty breathing, even if objective signs are absent 1
• Do not attribute tachypnea to anxiety without adequate evaluation of cardiac and respiratory causes 2
• Pulse oximetry may be unreliable when SpO2 falls below 85% 1
• Tachypnea may be an early sign of deteriorating respiratory function and should not be dismissed 1

Disposition

• Consider transfer to higher level of care (ICU/HDU) for patients with:
  • Persistent tachypnea despite initial interventions
  • Need for non-invasive or invasive ventilation
  • Hemodynamic instability 1

Remember that tachypnea (RR 38) represents significant respiratory distress and requires prompt assessment and management to prevent further deterioration and potential respiratory failure.