Atrius India Core FHIR Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Er Acute Breathlessness Pathway

ED acute breathlessness clinical pathway

Clinical decision support pathway for a person presenting to the emergency department with acute breathlessness / dyspnea. This is a clinical-protocol PlanDefinition: danger-sign gate → airway rescue → parallel stabilization → classify etiology → branch-specific management.

See also: CDS clinical reasoning, ER chest pain pathway.

Clinical overview

The pathway follows standard ED breathlessness logic:

1. Confirm context — active emergency encounter with dyspnea as chief complaint.
2. Review danger signs — select any that apply (altered consciousness, exhausting breathing, silent chest, refractory hypoxemia, hemodynamic instability, unprotected airway), or None of the above.
3. Airway rescue (when any danger sign is selected — not when None of the above) — senior/ICU help, NIV preparation, intubation readiness.
4. Parallel stabilization — Tasks: IV access, start oxygen. Orders: CXR, ECG, BMP, lactate, troponin, BNP.
5. Classify etiology — SNOMED CT working diagnosis (typeahead + curated quick-picks). CQL maps concepts to mutually exclusive branches:
   • Cardiogenic pulmonary edema / acute HF
   • COPD / asthma exacerbation
   • Pulmonary embolism
   • Pneumonia / infection
   • Pneumothorax
   • Upper airway obstruction
   • Other / unclear (explicit Unknown, or any non-curated concept)
6. Branch management (exactly one order set after classification):
   • Cardiogenic / acute HF — NIV prep, IV furosemide, BNP, echo, daily weight, cardiology
   • COPD / asthma — salbutamol neb, prednisolone, peak flow, pulmonology
   • PE — D-dimer, CT chest, therapeutic enoxaparin, general medicine
   • Pneumonia — CBC, blood cultures, ceftriaxone + azithromycin, general medicine
   • Pneumothorax — CXR, chest-drain prep, senior/ICU
   • Upper airway — senior/ICU, ENT, RSI prep
   • Other / unclear — clinical reassessment, CBC, general medicine

ED encounter + dyspnea
        │
        ▼
 Danger signs checklist (QuestionnaireResponse)
        │
        ├── any danger sign ──► Airway rescue (senior, NIV, RSI prep)
        │
        ▼
 Parallel stabilization (access, O2, monitor, CXR, ECG, labs)
        │
        ▼
 Record classification (QuestionnaireResponse — SNOMED typeahead)
        │
        ▼
 Apply pathway branch ──exactly-one──► ...

Artifacts

CDS Hooks service id: er-acute-breathlessness-pathway (hook: encounter-start, expression: In Scope).

CQL expressions

Frontend (v0)

ER syndrome picker entry: Acute breathlessness → /pathway/er-acute-breathlessness-pathway. Complete danger-signs and classification questionnaires on the pathway page (same pattern as chest pain).