Critical Pulmonary Symptoms In Emergency Medicine

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.

by: Carl Davidson

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