Respiratory Distress: Causes, Symptoms, and Pre-Hospital Treatment

OBJECTIVES

Upon completion of this lesson, you will be able to:

1. Define respiratory distress.
2. List seven signs and symptoms of respiratory distress.
3. List five steps for pre-hospital treatment of respiratory distress.
4. List four causes of respiratory distress.
5. Define hyperventilation.
6. List eight signs and symptoms of toxic product inhalation.
7. List five steps for pre-hospital treatment of toxic product inhalation.

1. Respiratory Distress

Definition:
Shortness of breath or a feeling of air hunger with labored breathing.

Respiratory distress affects one’s ability to exchange oxygen and carbon dioxide.
Respiratory medical emergencies have common signs and symptoms inherent to all types of breathing difficulties. Respiratory distress is characterized by quick, labored breathing, shortness of breath, and the sensation of unavailable air. It can produce a blue coloration (cyanosis) of the skin and mucous membranes.

Signs and symptoms of a respiratory emergency:

• Inability to speak in full sentences without pausing to breathe
• Noisy breathing
• Use of accessory muscles to breathe
• Tripod positioning, leaning forward, sitting upright
• Abnormal breathing rate or pattern
• Increased pulse rate
• Poor skin color (cyanotic, pale, or ashen)

Pre-hospital treatment for respiratory distress

Use universal precautions and secure the scene.

1. Move the patient away from the contaminated area (if the cause is toxic product inhalation).
2. Assess patient’s breathing to determine if adequate. Provide artificial ventilation if needed.
   Maintain open airway.
3. Position the responsive patient in a comfortable position, usually sitting upright.
4. Administer oxygen per local protocol.
5. Comfort and reassure the patient by providing emotional support.

Transport the patient as soon as possible.

2. Causes of Respiratory Distress

The following conditions are among the more common respiratory problems you will encounter in the field. It is not necessary to diagnose a patient’s condition; in fact, the care for all respiratory conditions is essentially the same for the medical first responder.

• Bronchial asthma is an inflammatory illness characterized by the narrowing of the large air passages called the bronchi. The patient experiences difficulty exhaling from the lungs. This is usually due to a spasm of thin muscle that lines the bronchial walls. Asthma is generally triggered by allergens, strong scents, irritating gases, smoke, and weather changes

Chronic Obstructive Pulmonary Disease (COPD)

Emphysema and chronic bronchitis are the most common forms of COPD. Emphysema causes the alveoli to lose their elasticity and become distended. This traps air and prevents the alveoli from working correctly. As more and more alveoli become affected, breathing becomes increasingly difficult for the patient. Chronic bronchitis is characterized by excessive mucus becoming trapped in the large air passages of the bronchial tree. Patients diagnosed with this condition will suffer from a persistent cough.

Patients who have COPD usually have a history of smoking; however, it is also common among people who live in areas of high air pollution.

Anaphylaxis

Anaphylaxis is an acute, severe allergic reaction that puts the patient’s life in immediate danger. The reaction may be triggered by many different routes of exposure, including direct skin contact, ingestion, and inhalation. Exposure to the allergen will cause blood vessels to dilate rapidly and cause a drop in blood pressure (hypotension).

Many tissues may swell, including those lining the respiratory system. This swelling can block the airway, leading to respiratory failure. Signs and symptoms frequently observed are urticaria, edema in the face, lips, and neck. In extreme cases, edema can appear in the larynx and glottis, making it difficult for the patient to breathe.

Anaphylactic Shock

Definition:
A life-threatening reaction of the body caused by something to which the patient is extremely allergic.

This condition represents a true emergency where immediate transportation to a medical center is imperative.

Causes of Anaphylactic Shock

• Food Allergies (e.g., peanuts, shellfish, eggs, milk, tree nuts, etc.)
• Insect Stings (e.g., bees, wasps, ants)
• Medications (e.g., antibiotics like penicillin, NSAIDs, anesthetics)
• Latex (e.g., gloves, medical equipment)
• Other Allergens (e.g., pollen, certain vaccines, or contrast dyes used in imaging procedures)

Signs of Anaphylactic Shock

• Skin: Hives, redness, or swelling, often with itching.
  Breathing: Wheezing, shortness of breath, or noisy breathing.
  Pulse: Weak, rapid, or irregular heartbeat.
  State of consciousness: Dizziness, confusion, or loss of consciousness.

Pre-hospital Treatment for Anaphylactic Shock

When you interview the patient, ask if he or she is allergic to anything and if they were in contact with that substance.

As with any type of shock, treat the patient with total care (see pre-hospital treatment of shock).

The patient needs medication to combat the allergic reaction. Transport the patient immediately.

Hyperventilation

Hyperventilation is a condition characterized by breathing too fast. It is normal for most people, such as when they are frightened, as long as the rate of breathing quickly returns to normal.

Hyperventilation syndrome is an abnormal state in which rapid breathing persists. It is commonly associated with anxiety or panic attacks. Symptoms include rapid and deep breathing, chest pain, dizziness, faintness, and numbness around the mouth, hands, and feet. Not every patient who is breathing rapidly or deeply is hyperventilating. Several serious conditions may be the cause, including fever, infections, trauma, diabetes, or overdose.

Hyperventilation is a relatively common respiratory emergency that can often be corrected by calming the patient and encouraging slow, controlled breathing.

If the patient does not respond immediately, administer oxygen per local protocol; this will not make hyperventilation worse.

Avoid using the traditional method of treating anxiety-induced hyperventilation by having the patient breathe into a paper bag. Caution should be exercised when using this technique. Remember to allow the patient to receive enough oxygen.

If breathing does not improve with the explained measures, assume that the problem is more serious.

3. Toxic Product Inhalation

Many fire-related deaths are due to problems associated with the inhalation of toxic products of combustion rather than from burns.
Fire-related injury can affect the patient two different ways:

• Pulmonary thermal injury (burning of the airways)
• Toxic product inhalation

Fluid in the lungs (edema) may develop from pulmonary thermal injury when surrounding temperatures exceed 50°C (120°F). Carbon monoxide and ammonia are common examples of inhaled toxic products.

Signs and symptoms of toxic product inhalation:

• Irritation and inflammation of air passages, eyes, and nose
• Altered frequency and depth of breathing
• Possible cardio-respiratory arrest
• Singed nasal hairs
• Dusty grey spittle
• Wheezing and noisy breathing
• Coughing
• Hoarseness

Pre-hospital treatment for toxic product inhalation

Use universal precautions and secure the scene.

1. Remove the patient from the contaminated area.
2. Conduct initial assessment and apply basic life support as necessary.
3. If the patient is breathing and does not have any signs of neck or spinal trauma, place the patient in a comfortable seated position.
4. Administer oxygen per local protocol.
5. Treat for shock.

Transport the patient as soon as possible.

Conclusion:

In conclusion, understanding respiratory emergencies and their various causes is essential for providing effective pre-hospital care. By recognizing key signs and symptoms of respiratory distress, toxic inhalation, and anaphylaxis, and following structured treatment protocols, first responders can stabilize patients and prevent complications. Mastery of these concepts, along with calm and efficient action, ensures better patient outcomes in critical situations. This lesson equips you with the knowledge to respond confidently, saving lives and enhancing overall emergency care practices.