Evaluation and initial management of the patient in respiratory distress.

Evaluation of the patient in acute respiratory distress poses a complex problem to the emergency physician. Because of the heterogeneity of the population of patients presenting in acute respiratory distress, there is a paucity of evidence-based medicine recommendations. Practice habit dictates most of our diagnostic and therapeutic approach. It is of paramount importance to understand the limitations of history, physical examination, and diagnostic screening studies in evaluating and treating patients with respiratory distress. The emergency physician should become aware of the benefits of NPPV in the management of respiratory failure. Essential to the management of these patients is the ability to anticipate difficulty in airway management and the formulation of alternative airway strategies.