Be reassured# | Reassure patient and carer; a reassuring and expert presence is sometimes sufficient to start “unwinding” escalating breathlessness | [25, 26] |
Resting position | Check posture; find the most comfortable and efficient position to maximise ventilation | [25, 27, 28] |
Exercises (breathing) | Use to slow breathing rate and encourage breathing out to prevent air trapping (e.g. pursed lip or “breathing rectangle”); pursed lip breathing also provides increased end-expiratory pressure | [25–29] |
Airflow | Use hand-held fan; airflow across lower face/nasal passages can reduce breathlessness and recovery time | [30–32] |
Time# | “Take it easy, nice and slow”# | [25–27] |
Help with fears and worries# | Simple techniques to manage panic and fear# | [25–27] |
Education of patient and carer | Information booklet and laminated card with BREATHE intervention | [25–28] |
Intervention points:
a) the techniques are often simultaneously delivered and tailored to the individual b) #: denotes anxiety-focused management c) The laminated BREATHE card, the information booklet and hand-held fan will be packaged in a “BREATHE folder” for paramedics to take into the house of a breathless patient.
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Usual care | | JRCALC Guidelines [21] |
Immediate clinical assessment | History, baseline vital signs and targeted examination (e.g. chest auscultation, peak flow, 12-lead ECG) | |
Reassurance | Reassurance is a mainstay of high-quality patient care | |
Oxygen | Time critical feature: oxygen saturations of <94% or less for those patients without chronic lung diseases Target range oxygen saturation in patients with chronic lung diseases: 88–92% If SpO2 >92%, oxygen would not be administered | |
Nebuliser | Depending on the initial assessment, the paramedic may ask the patient to use their own inhalers, or proceed to nebulisation | |