If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
Asthma
- Acute exacerbation of asthma not responding to therapy
- Asthma with any of the following concerning features:
- coexistent pneumothorax
- pneumonia
- silent chest
- cardiovascular compromise
- altered consciousness
- relative bradycardia
- decreasing rate and depth of breathing
Bronchiectasis / chronic suppurative lung disease (CSLD)
- Bronchiectasis / CSLD with any of the following concerning features:
- altered consciousness
- hypoxia (<90% oxygen saturation) when this is not normal for the patient
- evidence of significant infective exacerbation (fever and/or high volume purulent sputum)
- new haemoptysis (clots or more than streaks
- new CXR changes indicative of cavitation, consolidation or pneumonia
Chronic obstructive pulmonary disease (COPD)
- Acute exacerbation not responding to outpatient therapy
- Acute respiratory failure
Cystic fibrosis
- Cystic fibrosis with any of the following concerning features:
- respiratory distress
- new haemoptysis (clots or more than streaks)
- pleural effusion
- consolidation/pneumonia/fever
- non- response to antibiotics for chest infection
Haemoptysis without known lung disease
- Significant haemoptysis defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)
- Any haemoptysis with acute dyspnoea, measured hypoxia, altered consciousness, hypotension, tachycardia or chest pain
Interstitial lung disease (ILD)
- Acute exacerbations of known ILD with any of the following concerning features:
- severely breathless/Class 4 dyspnoea (ADL’s affected by dyspnoea)
- demonstrated worsening hypoxaemia
- new arrhythmia/chest pain
- Newly diagnosed or suspected ILD with radiographic evidence with Class 4 dyspnoea (ADLs affected by dyspnoea)
Lung cancer
- Suspected or known lung cancer with any of the following concerning features:
- massive haemoptysis
- suspected large airway obstruction
- severe dyspnoea
- SVC obstruction
- hypercalcaemia/hyponatremia with confusion
- symptomatic pleural effusion
Pleural disorders
- Large symptomatic pleural effusion
- Acute pneumothorax
Pulmonary hypertension
- Acute decompensation (hypoxia or right heart failure) with pulmonary hypertension
Sarcoidosis
- Hypercalcaemia with acute kidney injury
Shortness of breath / dyspnoea without a known cause
- Dyspnoea of uncertain origin with any of the following concerning features:
- acute dyspnoea at rest
- demonstrated hypoxia (SpO2 < 90%)
- accompanied by confusion
Tuberculosis / non-tuberculosis mycobacterial infections
- Suspected tuberculosis with significant haemoptysis (defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)