Critical Pulmonary Symptoms In Emergency Medicine

Critical Pulmonary Symptoms In Emergency Medicine

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Asthma, bronchitis, CHF or pulmonary embolism; how can one tell the difference acutely? The treatments are drastically different, the physiology is drastically different. How do you evaluate an acute presenting pulmonary patient?

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 ordered a lot of test, to include arterial blood gasses and chest radiographs. I didnt 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. I wanted to be a better provider. I needed that to better care for my patients. So, I developed the "HORID" mnemonic. For the last 8 years I have run an emergency department, performing rapid sequence intubation countless times. I still practice using the HORID mnemonic; This system I have taught to thousands of providers, and it is how I practice clinically.

If you make a "HORID" mistake, your patient may die. I have developed and approach to the pulmonary approach with the mnemonic "HORID". 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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