Overview
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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