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.
- 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.
- Associated symptoms: chest pain.
- Emotional distress.
Signs and Symptoms:
- Shortness of breath, laboured breathing.
- 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.
|Age||6 months - 4 years of age||Over 3 years, can effect adults|
|Time of Day||Often worse at night||None specific|
|Onset||Gradual - often associated with a cold or other viral infection||Rapid (hours)|
|Appearance / Position||Variable||Pale complexion, may be postured with neck extended into the sniffing position, with lower jaw protrusion|
|Fever||Moderate <38°oC||High >38.5°C|
|Breath Sounds||Inspiration stridor||Soft expiratory stridor or soft snore|
|Cough||Barking "seal" cough||Minimal or absent|
|Speech||Hoarse voice (sore throat)||Minimal or unable to speak|
|Swallowing||Able to swallow||Pain upon swallowing, evolving to inability to swallow|
|Severe Signs & Symptoms|
- Agitated, distressed or lethargic, decreased level of consciousness.
- Increased stridor.
- Cyanosis and marked pallor are late signs of life-threatening airway obstruction.
- Drooling - a very serious sign
- High temperature
- 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.