6 Integrated Respiratory Emergency Scenarios

Scope and safety

These adult practice scenarios integrate rapid assessment, airway support, oxygen delivery, ventilation, reassessment, and escalation. They are for training and do not replace hands-on certification, clinical judgment, or local protocols. Use personal protective equipment, summon emergency help early, and work within your training and scope. Use pediatric-specific guidance for children.

Rapid assessment

Begin by checking scene safety and the person’s response. Call for help and activate EMS or the facility emergency response for severe or worsening distress. Assess responsiveness and breathing; check a pulse if trained.

For an unresponsive adult who is not breathing normally, check for a pulse for no more than $10$ seconds. If no definite pulse is felt, begin CPR and use an AED as soon as available. Gasping is not normal breathing.

Assess airway patency, ability to speak, respiratory rate and effort, chest movement, skin color, mental status, and breath sounds if equipped and trained. Watch for exhaustion, reduced alertness, cyanosis, or worsening work of breathing.

Airway, oxygen, and ventilation

Position the person to ease breathing if appropriate. Open the airway and clear only visible material; use suction or an airway adjunct only if trained and equipped. Give Supplemental oxygen for suspected hypoxemia, choosing and adjusting the device according to the person’s condition, monitoring, and local protocol.

Oxygen supports oxygenation, but it does not replace Ventilation when breaths are absent or inadequate. If an adult has a definite pulse but is not breathing normally, a trained rescuer should provide $1$ breath every $6$ seconds, each just sufficient to produce visible chest rise. Avoid excessive ventilation and reassess. If no definite pulse is felt, follow the cardiac-arrest pathway instead.

Reassessment and escalation

After each intervention, check responsiveness, breathing effort and rate, chest rise, pulse when appropriate, oxygen saturation, and the overall trend. Do not let a reassuring oxygen-saturation reading delay action when breathing or mental status is deteriorating.

Request advanced help for severe distress, inadequate ventilation, falling oxygen saturation, altered mental status, or failure to improve. Prepare for transport and give a concise handoff that includes onset, suspected cause, initial and current findings, interventions, and response.

Oxygen saturation targets

For adults receiving oxygen in acute care, the usual recommended oxygen-saturation range is $94\text{–}98\%$. For patients with COPD who require oxygen, the recommended range is $88\text{–}92\%$. These are clinical targets, not reasons to withhold urgently needed oxygen from a severely hypoxemic patient. Follow individualized orders and local protocols.

Severe wheezing and fatigue

An adult with asthma is sitting forward, speaking only a few words at a time, breathing rapidly, and using accessory muscles. Oxygen saturation is low and trending downward. Wheezing becomes quieter while the person looks more tired.

Recognize severe, worsening respiratory distress and call EMS or activate the emergency response immediately. Keep the person in a position that eases breathing if tolerated. Give oxygen for hypoxemia and assist with the person’s prescribed rescue treatment only if trained and authorized. Reassess breathing effort, speech, alertness, chest movement, and oxygen saturation.

Quieter breath sounds in a tiring patient are not reassuring. Worsening fatigue, reduced air movement, confusion, or declining oxygen saturation require urgent advanced airway and ventilatory support. Do not wait for oxygen alone to fix inadequate ventilation or a deteriorating patient.

Suspected opioid-related respiratory depression

An adult is difficult to wake and breathing very slowly and shallowly. A pulse is definite, drug paraphernalia is nearby, and oxygen saturation is falling.

Activate EMS. Open the airway and provide breaths or bag-mask ventilation if trained and equipped. For an adult with a pulse who is not breathing normally, give $1$ breath every $6$ seconds, aiming for visible chest rise. Give naloxone if available and authorized, but do not delay ventilation, emergency activation, or other resuscitation while waiting for a response.

Continuously reassess breathing and alertness because respiratory depression can persist or recur. If the pulse is lost or cannot be confidently identified, start CPR and use an AED as indicated. In respiratory arrest with a pulse, ventilation is urgent; naloxone is an additional intervention, not a substitute for it.

Choking at a meal

An adult suddenly cannot speak or cough effectively and is clutching their throat. Treat this as severe foreign-body airway obstruction and call for help and activate EMS.

Give repeated cycles of $5$ back blows followed by $5$ abdominal thrusts until the object is expelled or the person becomes unresponsive. If the person becomes unresponsive, begin CPR starting with chest compressions. When opening the airway to give breaths, remove an object only if you can see it; do not perform blind finger sweeps.

A person who can cough forcefully should be encouraged to keep coughing while watched closely for worsening obstruction. Inability to speak, weak or absent coughing, or color change signals severe obstruction.

Putting the response together

Respiratory emergencies call for early recognition and action: assess airway, breathing, and circulation; summon help; provide oxygen for hypoxemia; and provide ventilation when breathing is absent or inadequate. Reassess after every intervention, watch for fatigue or altered mental status, and escalate promptly if the person worsens.

For choking, follow the obstruction sequence. If the person becomes unresponsive, start CPR and remove only visible objects.