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Deteriorating Patient
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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