This case describes a patient who comes in with cough and shortness of breath. The course of inhalational anthrax can progress from initial nonspecific viral symptoms to severe respiratory distress, hypotension, hypoxia, tachypnea, cyanosis, and hemorrhage within days. Pathognomonic imaging findings include mediastinal widening due to hemorrhagic mediastinitis, pleural effusion, and mediastinal lymphadenopathy.

This chapter describes the case of a 60-year-old female with shortness of breath and neck swelling. The patient has a known history of small cell lung cancer and is currently undergoing chemotherapy. The primary survey reveals a patent airway, no apparent respiratory distress, and warm, flushed skin with equal peripheral pulses. The secondary survey shows distended superficial veins of the neck and upper chest, but clear lungs and normal abdomen. The diagnosis is superior vena cava syndrome, which is the obstruction of blood flow through the superior vena cava. The chapter highlights the importance of careful and thorough work-up of potential etiology in all cases. Treatment options include elevation of the head of the bed, diuretics, steroids, percutaneous transluminal stent placement, or bypass surgery.

The chapter describes the case of a 45-year-old male with stage 3 HIV who presents to the ED with fever, shortness of breath, pleuritic chest pain, and nonbloody diarrhea. The patient exhibits tachycardia, hypoxia, and a warm, diaphoretic appearance. Initial actions include oxygen supplementation, IV fluids, and labs. The patient is diagnosed with HIV pneumonia, likely Pneumocystis jirovecipneumonia (PCP), and is treated with antibiotics and steroids. Early recognition of fever and hypoxia, along with respiratory isolation, is critical to prevent sepsis. Tests ordered should include CBC, electrolytes, liver function tests, urinalysis and culture, blood cultures, and CXR. Focal infiltrates suggest bacterial pneumonia, while a diffuse interstitial or perihilar, granular pattern on CXR is associated with PCP. Steroids should be given to patients with a partial pressure of arterial oxygen <70 mmHg or an alveolar–arterial gradient of >35 mmHg.

This chapter describes a case of a 45-year-old male with stage 3 HIV who presented to the ED with fever, shortness of breath, pleuritic chest pain, and nonbloody diarrhea. The patient was diagnosed with HIV pneumonia, likely Pneumocystis jiroveci pneumonia(PCP), and was treated with antibiotics, steroids, oxygen supplementation, and IV fluids. The chapter emphasizes the importance of recognizing the symptoms of pneumonia in HIV patients and providing early treatment to prevent sepsis. The chapter also provides guidelines for diagnostic tests and highlights the significance of CD4 counts in the development of pulmonary disorders in HIV patients.

The chapter describes the case of a 10-day-old male with shortness of breath, poor feeding, and lethargy. The patient exhibits respiratory distress, intercostal and subcostal retractions, and a systolic murmur. Initial actions include oxygen supplementation, IV placement, and labs. The patient is diagnosed with critical aortic coarctation, which is dependent upon a patent ductus arteriosus to maintain blood flow to the body. Prostaglandin E1 administration and cardiology consultation are critical actions. Congenital heart disease should be considered in any newborn in shock or severe distress, and early recognition and intervention are important. Differential blood pressure and oxygen saturation can be clues to congenital heart disease.

This chapter presents a case of a 82-year-old female with acute pulmonary edema due to hypertensive acute decompensated heart failure. The case highlights the proper use of noninvasive positive pressure ventilation as well as appropriate medical intervention with nitroglycerin and diuretics to prevent progression of respiratory failure.

This is a case of pediatric respiratory distress in which airway foreign body should be very high on the differential. The physician can wait for ENT assistance as the child is not immediately crashing, but needs to prepare for emergent airway management.

This chapter is about managing severe asthma exacerbations up to the rare critical need for intubation. Intubation of asthmatics in respiratory distress is usually not needed and generally avoided; however, it is critical for the emergency physician to recognize when this intervention is appropriate and necessary. Additionally, the emergency physician must know and implement the less invasive standard therapies and adjunct treatments before resorting to intubation. The emergency physician must be able to articulate which clinical and objective findings lead him or her to this final decision of intubation and disposition to the ICU.

1. The diagnosis of cancer-related pericardial effusion is usually incidental, but cancer accounts for approximately one third of all cardiac tamponades.

2. IV fluids may assist in expanding the right ventricle to avoid compression in tamponade.

3. Beck’s triad includes hypotension, jugular venous distention (JVD), and muffled heart sounds. However, shortness of breath and chest pain are the most common presenting symptoms.

4. Echocardiogram is the gold standard for diagnosis of pericardial effusion. Assess for fluid collection, diastolic collapse beginning with the right atrium, and inferior vena cava (IVC) and/or hepatic vein flow.

5. Drainage, typically through pericardiocentesis, is needed when cancer or treatment-related pericardial effusion leads to hemodynamic compromise.

1. Transfusion-associated cardiovascular overload (TACO) is most common in critically ill patients receiving a large amount or rapid infusion of blood products who have a history of cardiac or renal dysfunction.

2. TACO will present with signs of fluid overload, including tachypnea, hypoxia, jugular venous distention (JVD), and/or rales on exam.

3. Bedside ultrasound and chest x-ray can be useful in the diagnosis of TACO.

4. Treatment of TACO consists of oxygenation and ventilation as needed, diuretics, and pausing transfusion until the patient’s fluid status is optimized.

5. To reduce risk of TACO in high risk patients, blood given should be limited to what is necessary, rates should be reduced, and diuresis during/after should be considered.

• Heart failure (HF) is a clinical syndrome marked by elevated filling pressures to maintain acceptable cardiac output. Current guidelines use left ventricular ejection fraction (LVEF) to distinguish between reduced (HFrEF; LVEF < 40%), preserved (HFpEF; LVEF > 50%) and midrange ejection fractions (HFmrEF; LVEF between 40–49%).

• Beta blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor neprilysin inhibitors (ARNI), sodium-glucose transporter-2 (SGLT2) inhibitors and cardiac resynchronization therapy, among other therapies, improve outcomes in HFrEF. HFpEF management focuses on comorbidity management with recent data showing benefit from SGLT-2 inhibitor, empagliflozin.

Asthma is one of the leading respiratory complaints presenting to Emergency Departments and a prevalent cause of hospitalizations. Urban environments present special issues related to the pathophysiology, underlying causative conditions, management, and long-term outcomes. Environmental pollutants and traffic-related pollution are two important factors affecting urban asthmatics. There are also significant socioeconomic and numerous social determinants of health that impact urban environments in the management of asthma. These conditions affect prevalence, morbidity, and mortality, so a holistic approach to management and treatment is crucial for patient’s outcome. Understanding these differences can help identify opportunities for improved management on the individual and population basis.