Recognize Respiratory Distress or Failure

PALS Recognize Respiratory Distress/Failure — Figure 11

In its simplest form, respiratory distress is a condition in which pulmonary activity is insufficient to bring oxygen to and to remove carbon dioxide from the blood. Challenge arises with the recognition of respiratory distress when the person appears to be breathing but is not actually breathing effectively. Proper rate and depth of breathing is important to assess when evaluating whether the person is effectively breathing. The two main actions involved in breathing are ventilation and oxygenation. Consider the signs and symptoms presented below.

VENTILATION
Is the airway clear?	Are the muscles of the chest functioning?	Is the rate of breathing sufficient?
Ex. An obstructed airway prevents gas flow	Ex. Chest muscle fatigue can occur	Ex. CNS depression can slow/stop breathing

OXYGENATION
Is oxygen available?	Is lung blood flow adequate?	Can gases cross the pulmonary vasculature?
Ex. High altitudes have low O2	Ex. Vascular shunts may not send blood to lungs	Ex. Pulmonary edema or pneumonia

Abnormal breath sounds

STRIDOR	• Upper airway obstruction (foreign body)
GRUNTING	• Upper airway obstruction (Swollen airway) • Pneumonia (grunting to recruit alveoli)
WHEEZING	• Lower airway obstruction (Asthma)
CRACKLES	• Fluid in lungs (Wet), Atelectasis (Dry)
ABSENT/DECREASED BREATH SOUNDS	• Collapsed lung (air, blood) • Lung tissue disease (pneumonia)

Table 11

In some instances, breath sounds can provide information about the source of the breathing problem.

CAUSES OF RESPIRATORY DISTRESS/FAILURE

Respiratory distress or failure generally falls into one of four broad categories (Table 12): upper airway, lower airway, lung tissue disease, and central nervous system (CNS) issues. This list is not comprehensive, and specific conditions should be addressed with specific therapy; but these represent the most common causes of respiratory distress or failure in a pediatric population.

UPPER AIRWAY	LOWER AIRWAY	LUNG TISSUE DISEASE	CNS ISSUES
Croup (swelling)	Bronchiolitis	Pneumonia	Overdose
Foreign body	Asthma	Pneumonitis	Head trauma
Retropharyngeal abscess		Pulmonary edema
Anaphylaxis

Table 12

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