[Various aspects of respiratory emergencies in non-hospital practice]

Classical symptoms and signs common to most pulmonary diseases, such as dyspnea, cough, chest pain and cyanosis, are reviewed to assess their significance for diagnosis and evaluation of the degree of impairment in acute respiratory failure. While frequently useful for diagnosis, they are often inadequate to determine the degree of emergency. In each particular etiology other information is needed to obtain an objective and quantitative assessment. Two examples selected for their frequency are considered: barbiturate intoxication and severe exacerbations of asthma. The severity of barbiturate poisoning can be assessed clinically in the light of the degree of central nervous depression. Classical signs and wheezing are poorly correlated with the intensity of acute asthmatic attacks, but high-risk patients can be identified by seeking neglected physical findings such as pulsus paradoxus and sternomastoid muscle contraction. In many other pulmonary emergencies further studies are required to assess the usefulness of various clinical signs as objective indices of the severity of respiratory impairment.