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Deteriorating Patient

Respiratory Distress



  • The presence of respiratory distress indicates that the patient has significant pathology (respiratory or otherwise) that requires immediate assessment and management.
    • Signs of Respiratory Distress

    • Tachypnoea
    • Psychomotor agitation
    • Nasal flaring
    • Pursed lips
    • Speech - phrases → words → none
    • Tripod position - sitting forward with hands on thighs
    • Accessory muscle use
    • Intercostal recession
    • Subcostal recession
    • Paradoxical abdominal breathing

Cheyne-Stokes Respiration

  • Periods of hyperventilation interspersed with periods of apnoea or bradypnoea.
  • Occurs when hyperventilation (due to increased CO₂ sensitivity) lowers the arterial CO₂ below the apnoeic threshold.
    • Significance

    • A poor prognostic sign in patients with heart failure, and a symptom of CNS pathology.
    • Causes of Cheyne-Stokes Respiration

    • Congestive cardiac failure
    • CNS pathology - infarct, haemorrhage, trauma, tumour, meningitis
    • Physiologic - sleep, high altitude

Kussmaul Respiration

  • Kussmaul respiration is associated with severe metabolic acidosis, especially due to diabetic ketoacidosis.
    • Look For

    • Deep, rapid respiration.
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