Shortness of Breath Triage
Recognize the dyspnea that can’t wait — severity cues, cardiac red flags, and safe routing.
Learning Objectives
- 1.Gauge the severity of a shortness-of-breath call.
- 2.Recognize cardiac and emergency causes of dyspnea.
- 3.Route SOB calls by urgency.
Purpose
Shortness of breath ranges from deconditioning to flash pulmonary edema or PE. The key is gauging severity and catching the emergencies.
What to ask
- •Severity: can they speak in full sentences? Worse with lying flat (orthopnea)? Waking at night gasping?
- •Onset: sudden vs. gradual? At rest or only on exertion?
- •Associated: chest pain, swelling, weight gain, cough, fever, leg swelling/pain?
- •History: heart failure, COPD, recent surgery/immobility (PE risk)?
- •Home O2 sat if available.
Red flags — escalate now
- •Can’t speak in full sentences / gasping / using accessory muscles.
- •Sudden severe dyspnea, especially with chest pain (PE/ACS).
- •Low oxygen saturation; blue lips.
- •Dyspnea with chest pain, fainting, or confusion.
Stop and escalate
Severe or sudden dyspnea, inability to speak in sentences, or low O2 sat → 911/ED now and notify the provider.
Sort the urgency
- •Emergent (911/ED): severe/sudden, can’t speak, low sat, with chest pain.
- •Urgent (provider today): worsening orthopnea, weight gain, known HF.
- •Routine: mild, stable, clearly chronic/exertional — route per protocol.
- •Default up when unsure.
What to send the provider
- •Severity (sentence test), onset, associated symptoms, weight/edema, O2 sat, history, urgency read.
Patient education script
- •"You’re too short of breath to finish sentences — call 911 now." / "Weigh yourself and call us if you’re gaining weight or waking up breathless."
Spanish phrase
Are you able to speak in full sentences right now?
¿Puede hablar en oraciones completas en este momento?
PWEH-deh ah-BLAR en oh-rah-SYOH-nes kom-PLEH-tas en ES-teh moh-MEN-toh
Mini case
A heart failure patient calls, breathless, can only say a few words at a time, sleeping in a recliner because they can’t lie flat.
What now?
Show answer
Inability to speak in full sentences + orthopnea signals severe dyspnea/possible decompensation — emergent. Direct to 911/ED and notify the provider; don’t schedule a routine visit.
Checklist
- Used the "speak in sentences" severity test.
- Screened for sudden onset, chest pain, low sat.
- Asked about orthopnea/weight gain in HF patients.
- Routed by urgency and escalated emergencies.