Option 1: Impending respiratory failure

The patient has signs of severe respiratory distress. He is diaphoretic, cyanotic, and grunting with each breath. The nurse says the patient looks even worse now than 10 minutes ago when the page was sent.

Question: What do you do next?

Make your choice, then click on the explanation bubble to reveal the answer.

• Ask the patient to tell you about their symptoms and start at the very beginning.
• Call for help!

Anticipate rapid clinical deterioration in patients with red flags in dyspnea.

Question: Backup is on the way! Now what?

Do the following steps concurrently while you wait for the rapid response team. Click on the explanation bubbles for more information.

• Perform an ABCDE survey while assisting the patient into a position of comfort.
• Begin oxygen therapy.
• Provide respiratory support.
• Monitor pulse oximetry, ECG, and end-tidal CO₂.
• Establish IV access.
• Treat rapidly reversible causes of respiratory failure.

Know where oxygenation and airway equipment is stored in every patient care location.

Now it’s time to dust off your physical examination skills!

Lung auscultation

As part of your focused ABCDE survey, you’ll be listening to the lungs, and what you hear (or don’t hear) will inform your initial differential and the first steps for you and the rapid response team. We know that hearing abnormal lung findings and describing them correctly—especially amid hospital noise and when under pressure—can be challenging. Here’s a chance to practice with some audio clips of common findings.

Hopefully your swift intervention will prevent the need for intubation in this patient. However, if intubation is required, you can always check out “Airway management” for indications, intubation checklists, and step-by-step procedure instructions.

Related resources

• Pulmonary examination
• Immediate management of respiratory failure and arrest
• Mechanical ventilation

Want to explore the other scenario? Jump over to “Option 2: Shortness of breath with stable vital signs.” You can also return to the main module; see “Take my breath away wrap-up.”