Emergency admission of patients with dyspnoea

According to emergency admissions data in UK hospitals around 25% of patients admitted to the emergency department have COPD as a main diagnosis (1). Severity of the breathlessness and the need for emergency admission should be assessed by checking the vital signs (like pulse, blood pressure, temperature, respiratory rate and oxygen saturation), PEFR (peak expiratory flow rate) and level of consciousness (1,2).

Patients with any of the following should be admitted to the hospital immediately

• heart rate more than 130 beats per minute
• respiratory rate of more than 30 breaths per minute
• altered level of consciousness
• systolic blood pressure less than 90 mmHg or diastolic blood pressure less than 60 mmHg
• oxygen saturation less than 92%, or central cyanosis
• PEFR less than 33% of predicted (1,2,3,4)

Reference:

• 1. O'Driscoll BR et al. British Thoracic Society. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. June 2017 Volume 72 Supplement 1
• 2. British Thoracic Society Scottish Intercollegiate Guidelines Network. SIGN158. British guideline on the management of asthma - a national clinical guideline First published 2003. Revised edition published July 2019
• 3. Bauer TT et al. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006;260(1):93-101
• 4. Subbe CP et al. Validation of a modified Early Warning Score in medical admissions. QJM. 200;94(10):521-6