Definition:

Respiratory distress is a potentially life-threatening emergency.  There are many causes of respiratory distress therefore the Ambulance Officer should attempt to differentiate through appropriate assessment and history taking. If you are unable to differentiate the cause of the respiratory distress, the proper management is to administer High Concentration Oxygen and transport in a position of comfort.

Information Needed:

History:

• Onset: fast or slow, slow or rapid deterioration.
• Activity at the time of onset.
• Relevant past medical history: chronic lung or heart problems; relevant medications; home oxygen; previous hospitalisations.
• Allergies?
• Associated symptoms: chest pain.
• Emotional distress.
  

Common Causes:

• Asthma
• Chronic Airways Limitation
• Airway obstruction
• Airway injury or illness
• Anaphylaxis
• Chest infection
• Pneumonia
• Hyperventilation
• Trauma
• Exposure: chemical, smoke, irritant
• Chest Pain
• Chest wall injury, e.g. rib fractures, flail chest.
• Pneumothorax (collapsed lung)
• Haemothorax (bleeding into chest cavity, compresses lung)
• Pulmonary embolism
• Non-Cardiogenic Pulmonary Oedema (e.g. near-drowning, toxic gases, etc.).
  

Signs and Symptoms:

• Shortness of breath, laboured breathing.
• Anxiety.
• Pale and/or cyanosis.
• Abnormal breath sounds: stridor, wheeze, wet, crackles.
• Increased respiratory effort: Use of accessory muscles.
• Speech: full sentences, phrases, words or nil.

Paediatric-specific Dyspnoea

General Principles:

• Do not make the child more upset or anxious as this will further compromise the airway.
• Administer oxygen carefully to avoid upsetting the child.
• Children achieve higher Oxygen concentrations because of lower inspiratory rate, tidal volume, and dead space. Even a therapy mask can give 60 — 70% Oxygen in a child.
• Children with croup, epiglottis or laryngeal oedema who develop respiratory arrest, usually do so due to exhaustion or spasm. You will still be able to ventilate gently with appropriate bag-valve-mask, mouth-to-mask or mouth-to-mouth.
• Sudden complete obstruction due to epiglottitis may respond to tipping the child steeply head down, and using back-blows to dislodge the swollen epiglottis.