Respiratory assessment in the emergency department starts at the time of triage. An adequate history is essential, including factors such as previous medical history and surgical intervention, and environmental exposures. History of the current problem should include onset of respiratory distress, activities at onset, and aggravating and relieving factors. Assessment includes level of consciousness, skin color and temperature, quality of respirations, lung sounds, chest movement, pulse oximetry, heart rate, and examination of the extremities. Any or all of these aspects of the assessment may be abnormal when a respiratory problem is present. These same history and assessment parameters should be followed with any onset of respiratory distress, such as in a clinic or inpatient setting.

Diagnostic studies may include a chest x-ray, arterial blood gases, and possibly a ventilation/perfusion scan in nuclear medicine. Treatment will depend on the cause of the respiratory distress. Oxygen should be given to maintain a saturation above 93 % in most cases. In cases of asthma, respiratory treatments, accompanied by a steroid injection, Benadryl, and another medication such as Zantac, is given intravenously in most cases. If the cause of the respiratory distress is pneumonia, cultures should be obtained as soon as ordered and antibiotics started. If pulmonary embolus is suspected, a Heparin bolus followed by a continuous infusion should be started. As always, patients should be monitored periodically for response to treatment.

Radiculopathy is a term that signifies any disease condition of the roots of the spinal nerves. Most often this term is used in conjunction with cervical and lumbar strain. The spinal nerves exit the spinal cord and extend through the spaces between the vertebra. When these nerves are constricted as they leave the spinal column, either through a disc or vertebral injury, the result may be pain or numbness along the nerve to its end. The symptoms are relieved through medication and physical therapy. Skeletal muscle relaxants and anti- inflammatory medication, as well as a medication that blocks neurotransmission, such as amitriptyline, may be used. The goal of therapy is to relieve the muscle spasms, decrease swelling, and correct postural problems.

Amyitriptyline is basically a tricyclic antidepressant which also blocks neurotransmission of impulses. While it is commonly prescribed for the antidepressant qualities, it is also used to relieve neuropathic pain. It is a central nervous system depressant and its effects may be increased with the use of other depressants at the same time. Side effects include central nervous system problems, such as dizziness, blurred vision, headache, confusion, and tremors. Therefore, its use must be monitored for symptoms which can be confused with the underlying condition.