- Dyspnoea and respiratory distress is difficulty in breathing or shortness of breath. It is a sign of a variety of disorders and is primarily an indication of inadequate ventilation or of insufficient oxygen.
Read the complete article; Dyspnoea in the Medical Library > Pathophysiology.
- Shortness of breath
- Hypoxemia
- Cyanosis
- Tachypnoea
- Tachycardia
- Accessory muscle use/retractive breathing
- Anxiety, progressing to drowsiness and confusion
- Adventitious lung sounds:
- Crackles
- Stridor
- Wheezing (note: wheezing in older persons may be due to acute cardiogenic pulmonary oedema and not asthma; patients themselves may make an incorrect assumption). Consider calling Clinical Support for advice.
| Normal | Mild Distress | Moderate Distress | Severe Distress (Life Threatening) | |
|---|---|---|---|---|
| General Appearance | Calm, quiet | Likely to be calm, may be mildly anxious | May be distressed, anxious | Distressed, anxious, fighting to breathe, exhausted, altered conscious state |
| Speech | Clear and steady sentences | Speaks in sentences | Speaks in short phrases only | Only speaks in single words or unable to speak |
| Breath Sounds | Usually quiet, no wheeze | May have a cough Asthma: | May have a cough, stridor, crackles. Asthma: | May be unable to cough. Asthma: |
| Respiratory Rate (per minute) | 10 - 15 | 15 - 20 | > 20 | > 20 or < 6 - 8 |
| Respiratory Rhythm | Regular and even | Asthma: may be slightly prolonged expiratory phase | Asthma: prolonged expiratory phase | Asthma: prolonged expiratory phase |
| Breathing Effort | Little with small chest movements | May be slight increase in normal chest movement | Marked chest movement and may have some use of accessory muscles | Marked chest movement with accessory muscles, intercostal recession and/or tracheal tugging |
| Pulse Rate (per minute) | 60 - 90 | 60 - 90 | Tachycardia (100 - 120) | Tachycardia >120 or Bradycardia <60 |
| Skin | Normal | Normal | May be pale and sweaty | Pale and sweaty, and be cyanosed |
| Conscious State | Alert | Alert | May be altered | Altered or unconscious |
| MILD - Score 1 | MODERATE - Score 2 | SEVERE - Score 3 | |
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- Epiglottitis is inflammation of the tissue that covers the trachea.
- It is a life-threatening disease and medical emergency.
- Spasm may cause the airways to close abruptly.
- Patients suspected of suffering epiglottitis should be handled with care.
- Never cease oxygen administration if patient's level of consciousness or breathing deteriorates; oxygen almost never depresses breathing in the field and can usually be attributed exhaustion and fatigue (especially of the diaphragm). Exhaustion can depress breathing and/or level of consciousness, even if the patient is given oxygen.
- Children with croup, epiglottis or laryngeal oedema who develop respiratory arrest usually do so as a result of exhaustion or spasm. You will still be able to ventilate gently with appropriate bag-valve-mask, mouth-to-mask or mouth-to-mouth.
Hyperventilation
- Try to "talk down " the respiratory rate with or without the use of oxygen as a tool to help. If indicated as per the guideline, ensure that you administer oxygen using the appropriate mask to achieve optimal oxygenation.
- Whilst hyperventilation is usually associated with severe emotional stress, do not over-diagnose "hyperventilation " in the field. Your patient could have a pulmonary embolus or other serious problem.
- Primary Survey
- If respiratory distress caused by exposure to noxious substance, remove substance or patient if safe to do so. Assistance from Department of Fire & Emergency Service (DFES) or other appropriate resource may be required.
- Position patient appropriately (sitting patient upright or in a position of comfort; lateral position if unconscious)
- Reassurance (continuous)
- Conduct Vital Sign Survey, particularly respiratory rate and pulse oximetry
- Consider oxygen therapy; titrate SpO2 using the appropriate mask to a target of 94–98% for adults (88–92% for COPD patients) and at ≥ 95% for children.
- Ventilate the patient if required
- Newborn/Neonate: Manage as per Newborn Life Support in regards to ventilatory support/resuscitation
- Consider Secondary Survey
- As per Primary Care guidelines
- Manage as per CPG:
- Treat airway obstruction
- Consider cardiac monitor
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
- As per Advanced Care guidelines
- Respiratory arrest
- Cardiac arrest
| Settings | |
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| Extended Care: | |
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