Respiratory Emergencies for Paramedics
Build confidence assessing and managing breathlessness prehospital. Asthma, COPD, pulmonary oedema, pneumonia — know the differences and what to do.
Start Free TodayRespiratory Emergencies: A Systematic Approach
Breathlessness is one of the most common reasons people call 999. The spectrum ranges from anxiety to life-threatening respiratory failure — and the paramedic's job is to rapidly identify where on that spectrum the patient sits and intervene accordingly.
Always start with ABCDE. In respiratory emergencies, your A (airway) and B (breathing) assessment is critical — and your findings here will guide everything else.
The Silent Chest
In severe asthma, the absence of wheeze can be a sign of critical deterioration — not improvement. A silent chest means so little air is moving that there's nothing to wheeze. Treat as immediately life-threatening.
Key Respiratory Conditions
🌬️ Acute Asthma
Bronchospasm, wheeze, dyspnoea. Severity classified: moderate, severe, life-threatening.
🚬 COPD Exacerbation
Worsening breathlessness in known COPD. Target SpO2 88–92% to avoid suppressing hypoxic drive.
💧 Pulmonary Oedema
Cardiac failure causing fluid in alveoli. Frothy sputum, orthopnoea, raised JVP. Time-critical — early recognition is key.
🦠 Pneumonia
Infection causing consolidation. Fever, productive cough, localised crackles. CURB-65 for severity.
💨 Pneumothorax
Air in pleural space. Sudden pleuritic pain, reduced breath sounds. Tension pneumothorax is immediately life-threatening.
🩸 Pulmonary Embolism
Clot in pulmonary vasculature. Pleuritic pain, haemoptysis, tachycardia, risk factors. Massive PE = obstructive shock.
Differentiating Respiratory Conditions
Wheeze
Both asthma and COPD cause wheeze. Key differentiators: age of onset, smoking history, response to bronchodilators, severity classification, and SpO2 targets. In a patient with known COPD presenting acutely, consider infection as a trigger.
Crackles
Fine crackles at bases = pulmonary oedema (cardiogenic). Coarser crackles with fever and productive cough = pneumonia. Crackles + reduced breath sounds + dull percussion = pleural effusion.
Absent Breath Sounds
Unilateral absent breath sounds: pneumothorax (hyper-resonant), pleural effusion (dull), haemothorax (dull, trauma context). Bilateral absent/reduced: severe bronchospasm (silent chest), large bilateral effusions.
Oxygen Targets Matter
Standard target SpO2 94–98% applies to most patients — but in COPD, target 88–92% to avoid suppressing hypoxic drive. Always document the SpO2 target and rationale in your clinical record.
Respiratory Emergency Practice Tools
AI Patient Scenarios Pro
Work through respiratory emergency cases — from moderate asthma attacks to tension pneumothorax — and practise your assessment and decision-making.
Chat with Hollie Free
Ask Hollie to explain the pathophysiology of any respiratory condition, or quiz you on differentiating features between presentations.
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Frequently Asked Questions
How do paramedics assess breathlessness?
Paramedics use ABCDE assessment with a focused respiratory history: onset, severity, associated symptoms (wheeze, cough, sputum, chest pain), exacerbating/relieving factors, and relevant history (known COPD/asthma, cardiac history, smoking). Examination includes respiratory rate, SpO2, work of breathing, air entry, and breath sounds.
What is the difference between asthma and COPD management for paramedics?
Both use bronchodilators (salbutamol, ipratropium) but have key differences. COPD patients often have a hypoxic drive — aim for SpO2 88–92% rather than the standard 94–98%. In severe acute asthma, life-threatening features (silent chest, SpO2 <92%, exhaustion, altered consciousness) require urgent hospital admission. COPD exacerbations may also benefit from nebulised ipratropium alongside salbutamol.
What is the difference between Type 1 and Type 2 respiratory failure?
Type 1 (hypoxic) respiratory failure involves low oxygen with normal or low CO2 — seen in conditions like pneumonia and pulmonary oedema. Type 2 (hypercapnic) respiratory failure involves low oxygen and high CO2 — seen in COPD exacerbations and severe asthma. Understanding which type a patient has influences oxygen therapy targets.