Severe Respiratory Distress
●Signs
•Brief, fragmented speech (patient isunable to answer questions with anything more than a few words), which can be quickly assessed by asking the patient to count to 10 in one breath.
•Significant tachypnea (ie, greater than 25 breaths per minute). This cutoff is not absolute, and a respiratory rate of over 20 breaths per minute should prompt a timely evaluation.
•Inability to lie supine – Many patients in respiratory distress sit bolt upright or in a tripod position. An exception is hepatopulmonary syndrome, where patients may breathe more comfortably when recumbent. (See "Hepatopulmonary syndrome in adults: Prevalence, causes, clinical manifestations, and diagnosis", section on 'Dyspnea'.)
•Profound diaphoresis,which reflects extreme sympathetic stimulation associated with severe disease (eg, myocardial infarction, severe asthma flare, diastolic cardiac dysfunction).
•Audible stridor or wheezing, which can represent upper airway obstruction or severe bronchospasm.
•Dusky skin, which indicates poor perfusion or cyanosis.
•Agitation, somnolence, or other altered mental statusin the dyspneic patient suggests severe hypoxia or hypercarbia. Patients with a depressed mental status from carbon dioxide (CO2) retention may look comfortable and lackadaisical.
Optimize arterial oxygenation (Nasal Oxygen, Intubation)
Monitor with Pulse Oximetry
Identify Life threatening Conditions
++++++++++Respiratory distress is a serious condition that occurs when someone is having difficulty breathing or getting enough oxygen. The symptoms can vary depending on the underlying cause but generally include:
1. **Shortness of Breath (Dyspnea):** Difficulty breathing or feeling like you can't get enough air.
2. **Rapid Breathing (Tachypnea):** Breathing faster than normal, often with shallow breaths.
3. **Gasping or Wheezing:** Audible sounds like wheezing or gasping for air, often associated with asthma, COPD, or airway obstruction.
4. **Retractions:** The skin between the ribs or around the neck pulls in during inhalation, indicating that the person is working hard to breathe.
5. **Nasal Flaring:** Widening of the nostrils during breathing, especially noticeable in infants and children.
6. **Cyanosis:** Bluish tint to the lips, skin, or fingernails, indicating low oxygen levels in the blood.
7. **Grunting:** A grunting sound made during exhalation, common in infants with respiratory distress.
8. **Use of Accessory Muscles:** Noticeable use of neck, chest, and abdominal muscles to assist breathing.
9. **Chest Pain or Tightness:** Discomfort or pain in the chest, which may be related to the effort of breathing.
10. **Sweating:** Excessive sweating, often associated with the struggle to breathe.
11. **Confusion or Altered Mental Status:** Changes in consciousness, confusion, or agitation due to lack of oxygen to the brain.
12. **Fatigue:** Extreme tiredness or exhaustion, often due to the energy expended trying to breathe.
If someone is experiencing symptoms of respiratory distress, it's crucial to seek medical help immediately, as it can be life-threatening.