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Emergency shortness of breath

Medical Emergency - This page is about emergency shortness of breath. If you're after the more bog-standard symptom go to: shortness of breath.

Differential Diagnosis

There are loads:

Clinical and Associated Features

In a emergency situation, you basically need a quick way to be able to differentiate between the different causes of shortness of breath.


  • Acute asthma - breathless, hyperventilating, wheezing, history of asthma.
  • Acute exacerbation of COPD - breathless; increasing cough; wheeze; decreased exercise capacity; home oxygen, smoking, exercise capacity all help in deciding management
  • Anaphylaxis - breathlessness, oedema (larynx, lids, lips, tongues), cyanosis, wheeze, urticaria
  • Acute heart failure (severe pulmonary oedema) - breathless, orthopnoea (PND), pink frothy sputum, pale, sweaty, tachycardia, tachypnoea, pulsus alternans (alternating weak and strong pulse), raised JVP, fine crackles, gallop rhythm, wheeze


  • If it's a foreign body, hopefully, that'll be in the history.
  • Epiglottitis - if suspected, do not examine the throat. Call an anaesthetist and get airway access immediately. The child will be quiet and not moving in order to maintain the airway.
  • Anaphylaxis - see above
  • Airway trauma will hopefully be evident with a history of trauma.

More on the stridor page!



  • Pneumothorax: hyperesonant - respiratory:shortness of breath, pleuritic chest pain, diminished breath sounds, reduced chest expansion; cardiac: tachycardia, hypotension; neck: deviated trachea, distended neck veins
  • Pleural effusion: "stony dull" - breathless, dull chest pain, tracheal deviation (away from effusion), reduced chest expansion on affected side, reduced vocal fremitus, absent/reduced breath sounds,

Clear Chest

Now you've ruled out a large proportion of respiratory causes, you go on to what can in this description be called "the rest".