Emergency admission is most commonly required when a new acute problem (such as a respiratory tract infection, pulmonary embolism, or sudden-onset arrhythmia) exacerbates breathlessness caused by a chronic condition (such as chronic obstructive pulmonary disease or chronic heart failure).

• Determine the need for emergency admission by assessing the person's blood pressure, pulse, temperature, level of consciousness, peak expiratory flow rate (PEFR), oxygen saturation, and (if possible) electrocardiogram (ECG).
• Arrange emergency admission for people with:
• Respiratory rate of more than 30 breaths per minute.
• Tachycardia greater than 130 beats per minute.
• Systolic blood pressure less than 90 mmHg, or diastolic blood pressure less than 60 mmHg (unless this is normal for them).
• Oxygen saturation less than 92%, or central cyanosis (if the person has no history of chronic hypoxia).
• Peak expiratory flow rate (PEFR) less than 33% of predicted.
• Altered level of consciousness.
• A large respiratory effort (particularly if the person is becoming exhausted).
• Stridor.
• Clinical features of a pulmonary embolus or pneumothorax.
• ECG suggesting a cardiac arrhythmia or myocardial infarction.
• Consider arranging emergency admission, depending on the severity and number of risk factors present, if the person has breathlessness associated with any of the following:
• Elevated respiratory rate (but if it is more than 30 breaths per minute, arrange emergency admission).
• Tachycardia (but if it is more than 130 beats per minute, arrange emergency admission).
• Hypotension (but if blood pressure is less than 90 mmHg systolic or 60 mmHg diastolic, arrange emergency admission).
• A high temperature (particularly if it is higher than 38.5°C).
• PEFR less than 50% of predicted (but if it is less than 33%, arrange emergency admission).
• Older than 65 years of age.