Learning objectives
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List common causes of respiratory distress.
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Describe evaluation and management of respiratory distress.
Signs of Increased Work of Breathing
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Retractions and use of accessory muscles of respiration
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Inability to talk in full sentences
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Long pauses between sentences
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Orthopnea
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Sweating in a setting where it is not expected
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Restlessness, agitation, or decreased level of consciousness
Warning Signs of Imminent Respiratory Arrest
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Decreased level of consciousness
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Paradoxical chest–abdomen movements
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Cyanosis
Management of Respiratory Distress
Check for Airway Patency
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Look at the patient
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Listen over the neck and chest for abnormal sounds ( Table. 5.1 )
Table. 5.1
Abnormal airway sounds and what they mean:
Snoring → obstruction of the airway
Inspiratory stridor → obstruction above the cords
Expiratory stridor → obstruction below the cords
Coarse lung sounds → secretions in the airway
Wheezing → flow restriction
Crackles → fluid or atelectasis at the alveolar level
Assess Work of Breathing
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For patients with increased work of breathing, assist ventilation according to Fig. 5.1 .
Fig. 5.1
Initial of a patient with increased work of breathing.
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Tips for starting continuous positive airway pressure (CPAP):
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Best with patient in a slightly sitting position
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Requires good mask seal ( Fig. 5.2 ).
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Start with a pressure around 8–10 cm H 2 O with an upper limit of around 20 cm H 2 O
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Be aware of increased risk of aspiration ( Fig. 5.2 )
Fig. 5.2
Proper application of CPAP.
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Assess the Patient for Hypoxia (SpO 2 ≤ 94%)
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Provide supplemental O 2 as needed
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FiO 2 increases 2%–3% for every L/minute flow
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Flow rates of different devices ( Fig. 5.3 ):
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Nasal cannula → 2–6 L/minute
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Simple facemasks → 6–10 L/minute
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Non-rebreather masks →10–15 L/minute
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