COPD – Chronic Obstructive Pulmonary Disease (COPD), the long-term pathophysiological condition covering Pulmonary Emphysema and/or Chronic Bronchitis. Sufferers can have episodes where ‘flare ups’ cause difficult/distressed breathing due to new infection, agitation of the airway, etc. The effects of COPD can range depending on the individual, their general health, age, the stage of the disease, and surrounding circumstances. During an exacerbation episode, Salbutamol nebulisation treatment can be given to alleviate the condition. If this fails, Ipratropium Bromide nebulisation can be given. When nebulising, limit administration to 6 minutes. If journey time to hospital is significant consider a further 6 minutes of nebulisation. This is due to some COPD patients being chronically hypoxic due to the condition, and when given Oxygen, may cause adverse effects to their respiratory drive. Due to this also, SPO2 target saturations should be between 88-92% when looking at Oxygen administration and management. If respiration fails, then supportive means via BVM may be required whilst rapidly transporting to hospital.

Pulmonary Embolism (PE) – A PE consists of a clot forming on one of the lungs, potentially affecting a large area of tissue and gaseous exchange. Symptoms can include sudden shortness of breath and chest pain. The Wells criteria can assist in identifying the risk likelihood of the event being a PE. Treatment is limited in the pre-hospital environment requiring Oxygen therapy to maintain SPO2 levels and transport to hospital. If respiration fails, then supportive means via BVM may be required whilst rapidly transporting to hospital.

Heart Failure – Heart failure is a circulatory issue, however, it can cause pulmonary oedema to collect in the lungs causing difficulty in breathing for the patient. Symptoms can present with difficulty in breathing, crackles or ‘bubbling’ on the chest, and pink frothy sputum. Treatment involves administering Oxygen, Glyceryl Trinitrate (GTN), and Furosemide. If respiration fails, then supportive means via BVM may be required whilst rapidly transporting to hospital.

Pneumothorax/Haemothorax – Where either through trauma or medical means a pocket of air or bleeding forms within the pleural space, causing the lung to collapse. A pneumo/haemothorax will cause the patient to feel difficulty in breathing. Oxygen may be required to help treat any hypoxia and the patient will need urgent care at a hospital. If the pocket of air/bleeding continues to exert greater tension on the lung and thoracic structures, a tension pneumothorax can form. Treatment required for a tension pneumothorax includes Oxygen and a needle thoracocentesis. This involves penetrating the chest wall in the mid-clavicular, 2^nd intercostal space, just above the 3^rd rib. Many different ambulance services have specialised equipment for aiding in this. The patient may need BVM assistance due to positive ventilation pressure helping re-inflate the affected lung. If respiration fails, then supportive means via BVM may be required whilst rapidly transporting to hospital.

Chest injuries – Chest injuries can present in many different forms. Broken ribs may require analgesia to help manage pain and make it easier for the patient to breath. A sucking chest wound will require a non-occlusive dressing placed over it. There are many purpose-fit dressings available specifically for these kinds of wound. A flail segment of the chest can cause difficulty in breathing and the patient may require BVM support. If SPO2 levels are abnormal then further Oxygen is required. If respiration fails, then supportive means via BVM may be required whilst rapidly transporting to hospital.