Respiratory distress is defined as an impairment of respiratory function which, in the short term, may affect the body’s other vital functions (circulatory and neurological functions) and lead to the victim’s death.
Whilst respiratory arrest is a serious respiratory emergency requiring immediate first aid, there are a number of situations in which a victim may show visible signs of respiratory distress without, however, being in respiratory arrest.
The three vital functions are closely linked, and any impairment of respiratory function leads, sooner or later, to a disruption of the others.
Causes
There are several causes of respiratory distress. For example:
- severe or partial airway obstruction, for example caused by a foreign body, an allergic reaction, trauma or infection;
- lung diseases, including asthma;
- chest trauma;
- inhalation of corrosive substances or fumes.
Risks & Consequences
Impaired respiratory function quickly affects the other two systems and poses an immediate or very short-term threat to the victim’s life, as their vital organs (brain, heart) can very quickly be deprived of oxygen.
Signs
Signs of respiratory distress are identified during the emergency assessment.
Any casualty who has lost consciousness and is not breathing, or whose breathing is abnormal, must be treated as if they are in cardiac arrest.
Any casualty who has lost consciousness but is still breathing must be regarded as being at high risk of respiratory distress, as their airways are compromised.
When the victim is conscious, the first-aider identifies signs of respiratory distress based on what the victim says, if they are able to speak, as well as on what they see and hear.
What the victim says (complaints):
- I feel uncomfortable or I’m finding it hard to breathe.
- I’m suffocating.
- It hurts when I breathe.
What the first-aider sees (signs):
- The victim refuses to lie down but tries to remain seated, as this makes breathing easier.
- The victim is struggling to breathe, clutching their chest, and the muscles in the upper chest and neck are tensing.
- The victim is covered in sweat, despite not having exerted themselves or having a fever, which indicates a failure to clear carbon dioxide (CO₂) from the blood.
- The victim has a bluish tinge (cyanosis), particularly on the fingers, earlobes and lips. This bluish tinge indicates a lack of oxygen in the blood.
- The victim is confused, drowsy, anxious or agitated, which indicates a lack of oxygen to the brain and a build-up of CO₂.
- nasal flaring and retraction (indentation above the breastbone or at the pit of the stomach when breathing in) in children.
What the first-aider hears (signs):
- difficulty or inability to speak.
- a wheezing sound caused by air passing through narrowed airways (asthma).
- gurgling sounds indicating that the airways are blocked by secretions or vomit.
- rales indicating the presence of fluid in the lungs (drowning, heart failure).
What the first-aider looks for (signs):
The victim’s breathing is:
- rapid, often exceeding 30 min⁻¹;
- As it is superficial, it is difficult to see the victim’s stomach and chest rising and falling.
Hypoxia is confirmed by a fall in pulse oximetry (O² saturation) to < 94 per cent, or < 89 per cent in patients with chronic respiratory failure.
Principle of emergency response
The rescue operation must ensure that:
- to immediately address any obvious cause of respiratory distress, such as a severe airway obstruction;
- to improve oxygenation of the body and its vital organs through an appropriate recovery position and the administration of oxygen.
- to receive medical assistance quickly;
- to monitor the victim closely and adapt first-aid measures as the situation develops.