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Respiratory Emergencies in the Emergency Department or Primary Care Setting

By Carl Davidson

Republish: EasyPublish™ Published: 03Jun2010 Word count: 407 Viewed: 380 time(s) Get Free Content For Your Site

Out of 100 that present with pulmonary symptoms to an emergency department or primary care setting, how many are really sick? How many have a true respiratory emergency?

Pulmonary symptoms range from bronchitis, a self-limiting problem, to a life-threatening problem, such as pulmonary embolism or congestive heart failure. If you evaluate acute pulmonary symptoms, you need a system of evaluation that is consistent, reproducible and to the highest standards of care. I struggled with this early in my career.

For four years I worked as a nighttime house officer. It was my responsibility to care for those patients that were sick enough to be admitted to the hospital, yet not quite in the ICU. I covered a respiratory wing of the hospital where I frequently responded to respiratory emergencies. I felt inadequate in my assessment skills, and I mismanaged a number of patients, until I changed my approach.

I finally made it my personal quest to master this part of my job. I immediately started ordering arterial blood gasses (ABGs) and chest radiographs on all acute pulmonary complaints. I didn’t have a physician close at hand, so I had to master the interpretation of a chest radiograph was also a skill I also needed to master, as a physician assistant (PA,) radiology was brushed over in my education.) I learned to apply laboratory data to take optimal care of these pulmonary patients. It was from this quest for excellence in patient care, and applying this to scores of patients, that I developed the “HOIRD” approach to pulmonary patients. For the last 8 years I have run an emergency department, performing rapid sequence intubation countless times. I still practice using the “HORID” mnemonic; I swear by it, and I have taught it to literally thousands of providers.

Anyone with pulmonary complaints, you don’t want to make a “HORID” mistake. “HORID” is a mnemonic to the approach of the pulmonary patient. I am saying that any patient that their primary complaint is respiratory, if you apply this mnemonic, you will follow a reasonable and logical evaluation.

H=Heart (Acute heart failure, or acute CHF) O=Obstruction (Foreign body, Croup/Epiglottisitis) R=Reactive (Such as COPD/Emphysema or Acute Asthma) I=Infection (Pneumonia) D=Death! (From a PE or pneumothorax)

I will cover all these in length, from patient presentation to diagnosis and treatment. We will cover the landmines that will get you burned when caring for the respiratory emergency.

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