High respiratory rate

Act now

1. 1

   Sit up; oxygen to target (94–98%, or 88–92% if at risk of hypercapnia).

3. 2

   Calculate NEWS2. Suspected sepsis: follow the sepsis pathway.

Assess

• ABCDE: SpO₂, work of breathing, chest sounds, heart rate, BP, temperature, GCS.
• Lungs: pneumonia, asthma or COPD, pleural effusion, pneumothorax.
• Heart and vessels: pulmonary oedema, PE, arrhythmia.
• Metabolic acidosis (deep, sighing breaths): sepsis, DKA, AKI, salicylate or toxic alcohol.
• Pain, fever, anaemia.

Investigations

• Blood gas: pH, CO₂, lactate, glucose; ketones if diabetic.
• CXR, ECG, FBC, U&E, CRP; Wells score and D-dimer or CTPA if PE is possible.

Manage

• Treat the cause: antibiotics for pneumonia, diuretic for pulmonary oedema, bronchodilators for asthma or COPD, anticoagulation for PE, analgesia for pain.
• Reassess the respiratory rate after each intervention.

Escalate when