Quick Chart
  • 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.

 Clinical Presentation
  • 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.
 Exclusion Criteria
Exclusion Criteria
 Risk Assessment

NormalMild DistressModerate DistressSevere Distress
(Life Threatening)
General Appearance Calm, quietLikely to be calm, may be mildly anxiousMay be distressed, anxiousDistressed, anxious, fighting to breathe, exhausted, altered conscious state
Speech Clear and steady sentencesSpeaks in sentencesSpeaks in short phrases onlyOnly speaks in single words or unable to speak
Breath Sounds Usually quiet, no wheeze

May have a cough

Mild expiratory wheeze

May have a cough, stridor, crackles.

Expiratory wheeze, may also have a mild inspiratory wheeze

May be unable to cough.

Expiratory wheeze, may also have inspiratory wheeze. If severe may be no breath sounds

Respiratory Rate (per minute) 10 - 1515 - 20> 20> 20 or < 6 - 8
Respiratory Rhythm Regular and evenAsthma: may be slightly prolonged  expiratory phaseAsthma: prolonged  expiratory phaseAsthma: prolonged  expiratory phase
Breathing Effort Little with small chest movementsMay be slight increase in normal chest movementMarked chest movement and may have some use of accessory musclesMarked chest movement with accessory muscles, intercostal recession and/or tracheal tugging
Pulse Rate (per minute) 60 - 9060 - 90Tachycardia (100 - 120)Tachycardia >120 or Bradycardia <60
Skin NormalNormalMay be pale and sweatyPale and sweaty, and be cyanosed
Conscious State AlertAlertMay be alteredAltered or unconscious

 MILD - Score 1MODERATE - Score 2SEVERE - Score 3
  • Stridor on exertion/crying
  • Some inspiratory stridor at rest
  • Partial airway obstruction
  • Biphasic stridor at rest
  • Imminent airway obstruction
Behaviour and feeding
  • Normal
  • Age appropriate vocalisation
  • Some/intermittent irritability
  • Difficulty vocalising
  • Difficulty feeding
  • Increased irritability or lethargy
  • Looks exhausted
  • Unable to vocalise or feed
  • Changes in conscious state such as agitated, confused or drowsy
Respiratory rate/pattern
  • Mildly increased
  • Respiratory rate increased
  • Abnormal pauses
  • Respiratory rate significantly increased / absent breath sounds / silent chest
Work of breathing
  • Mild intercostal and suprasternal recession
  • Moderate intercostal and suprasternal recession
  • Nasal flaring or tracheal tug
  • Marked intercostal, suprasternal and sternal recession
  • May have brief apnoeas (5-10 secs)
  • Gasping, grunting
  • Extreme pallor, cyanosis
  • Increasingly frequent or prolonged apnoeas (≥20 secs)
* Scores refer to the Respiratory Distress Assessment component of the PARROT Early Warning Score
  • 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.


  • 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 Care
  • 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
Intermediate Care
  • As per Primary Care guidelines
Advanced Care
Critical & Extended Care
  • As per Advanced Care guidelines
 Additional Information
  • Respiratory arrest
  • Cardiac arrest
Key Terms & Links
Extended Care:
Colour assist:


Document Control

Clinical Services

Responsible Manager
Head of Clinical Services


Published Date

Review Date

Clinical Resources Website

St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.

Other users – Terms of Use

The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.

St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.

St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website. 

No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au

Where links are provided to resources on external websites, St John WA:

  • Gives no assurances about the quality, accuracy or relevance of material on any linked site;
  • Accepts no legal responsibility regarding the accuracy and reliability of external material; and
  • Does not endorse any material, associated organisation, product or service on other sites.

Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.

To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).


Please read this cookie policy carefully before using Clinical Resources from St John WA.

The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.

Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.

If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.

St John Ambulance Western Australia Ltd © Copyright 2020, All Rights Reserved

Terms of Use | Privacy Policy | Copyright Statement & Disclaimer