Red flags
- SpO₂ <90% on room air
- RR >30 or silent chest
- Altered sensation, cyanosis, accessory muscle use
First steps
- Sit upright, high-flow O₂ to SpO₂ ≥94%
- IV access, monitor, ABG
Key investigations
- ABG, CBC, BNP, troponin
- CXR, ECG
- POCUS lung + cardiac
Differentials
- Acute pulmonary oedema
- COPD/asthma exacerbation
- Pneumonia
- PE
- Pneumothorax
- Metabolic acidosis
Initial management
- Bronchodilator nebs if wheeze (salbutamol 2.5–5 mg + ipratropium)
- Furosemide 40–80 mg IV + GTN if APO
- Empirical antibiotics if pneumonia suspected
- NIV (BiPAP) for COPD/APO if no contraindication
Referral
- ICU if hypercapnia/refractory hypoxia
- Pulmonology / Cardiology
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