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Published: 03 November 2025
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November Tip of the Month - Not "Just" the Flu: Recognizing High-Risk Respiratory Illness

As we move into colder weather and more indoor-based activities there is typically a rise in respiratory illnesses. While these illnesses often appear mild or routine, they can lead to serious complications in vulnerable populations such as children, older adults, and those with chronic respiratory disease.

Objective: By the end of this tip, paramedics will be able to identify high-risk patients with respiratory illness and anticipate complications unique to pediatric, geriatric and respiratory compromised populations.

Scenario: During your shift, you assess two patients with flu-like symptoms:
• A 21-year old male with no significant medical history.
• A 78-year old female with a history of chronic COPD.

Question: Who is at a higher risk for deterioration – and why?

Key Content:

Why are we concerned about vulnerable populations ?

 Population   Key Vulnerabilities  Potential Complications  Assessment & Management Considerations
 Pediatrics
  • Narrow airways easily obstructed by mucus or swelling
  • Higher respiratory rates increase exposure to pathogens
  • Less effective nasal filtering (mouth breathers)
  • Higher dehydration risk
  • Prone to febrile seizures
  • Airway obstruction
  • Dehydration Secondary infection
  • Airway edema
  • Hypoxia and respiratory fatigue
  • Death
  Assess for: agitation, hydration status, mental state, feeding, lethargy, adventitious sounds

Manage with: oxygen, assisted ventilations as required, nebulized bronchodilators or epinephrine (as indicated), IV access if available, continuous reassessment.

Red Flags: rapid fatigue, cyanosis, poor tone, persistent tachypnea, apnea
 

Geriatrics

  
  • Weakened immune system
  • Reduced physiological reserve
  • Declining lung function
  • Multiple chronic conditions
  • Atypical or vague symptoms
  
  • Dehydration, malnutrition
  • Electrolyte imbalance
  • Atelectasis, pneumonia
  • Sepsis
  • Arrhythmias
  • Hypoxic delirium
  • Fluid overload
  • Death
  

Assess for: altered mentation, dehydration, increased work of breathing, adventitious sounds

Manage with: oxygen, ventilatory assistance as needed, cautious IV fluids (avoid overload), medication per ALS PCS, frequent reassessment.

Red Flags: new confusion, hypotension, new-onset dysrhythmia, increasing fatigue or hypoxia despite oxygen.

Respiratory Compromised Individuals

(COPD, cystic fibrosis, immunocompromised, etc)

  
  • Altered airway structure/function
  • Reduced mucociliary clearance
  • Limited infection response
  • Increased risk of bronchospasm and decompensation
  
  • Increased airway inflammation
  • Secondary infection
  • Prolonged recovery
  • Hypercapnia
  • Cardiac complications
  • Death
  

Assess for: deviation from baseline respiratory pattern, mental status change, accessory muscle use, fatigue, dehydration

Manage with: oxygen (titrate to baseline SpO₂), CPAP or assisted ventilation if required, bronchodilators/steroids per ALS PCS, IV fluids if indicated, continuous reassessment.

Red Flags: rising CO₂ retention signs (drowsiness, confusion), poor air entry, exhaustion, silent chest.

Takeaway Message
Effective patient care requires looking beyond the surface presentation. Two patients with similar symptoms can carry very different risks. Early recognition of vulnerable populations, and awareness of their unique physiology, is key to preventing decompensation and improving outcomes.

Reflection
Think back to your last respiratory call. Did you notice early sign of fatigue, subtle changes in mentation or other early warning signs? How might your assessment, communication or management differ next time for a pediatric, geriatric, or respiratory-compromised patient next time?

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