Recognising respiratory distress is a critical skill that could save lives, as this condition affects millions of Australians each year, from newborn infants to elderly adults. Whether it’s acute respiratory distress syndrome (ARDS), severe respiratory failure, or simply difficulty breathing due to an underlying cause, recognising the signs of respiratory distress can be the difference between life and death.
When someone is having trouble breathing or not getting enough oxygen, every minute counts. You don’t need to be a healthcare provider to learn the signs of respiratory distress and provide crucial first aid support while waiting for professional help. Understanding these vital signs and symptoms helps you identify when a person needs immediate medical attention, whether they’re experiencing acute respiratory failure or developing respiratory compromise.
From infants and children showing signs of increased work of breathing to adults with severe acute respiratory conditions, respiratory distress can strike anyone, anywhere. This guide will teach you how to recognise when someone is experiencing respiratory distress and the practical steps you can take to help before emergency services arrive.
Signs and Symptoms of Respiratory Distress
Learning to identify the signs of respiratory distress may save someone’s life. The symptoms of respiratory distress often develop rapidly, and it’s important to learn the signs early before a person develops severe respiratory failure or respiratory arrest.
Physical Signs to Watch For
The most obvious signs include rapid breathing, with an increased number of breaths per minute compared to normal respiratory rate. Adults typically breathe 12-20 times per minute at rest, but those experiencing respiratory distress often show a dramatically elevated breathing rate. Look for chest retraction, where the skin pulls in around the ribs or above the collarbone with each breath, indicating respiratory distress and increased respiratory effort.
Skin colour changes are critical warning signs. When someone has low oxygen levels or low blood oxygen, their lips, fingernails, or skin may appear blue or grey. The person might also appear cool or clammy, particularly around their face and hands, as their body struggles to maintain adequate oxygenation.
Breathing Sounds and Patterns
Listen for abnormal sounds heard with each breath. A wheeze might indicate narrowed airways, while gurgling sounds could suggest fluid in the lungs or airway obstruction. Stridor, a high-pitched sound during breathing, often shows signs of upper airway problems requiring immediate attention.
Behavioural Changes
People with acute respiratory distress often cannot speak in full sentences due to shortness of breath. They may appear restless, confused, or unusually drowsy as low levels of oxygen affect their brain function. Many will instinctively lean forward or refuse to lie down, positioning themselves to maximise air in the lungs.
Signs That May Indicate Severe Conditions
Some respiratory symptoms suggest serious underlying conditions like acute respiratory distress syndrome or severe acute respiratory failure. These signs include extreme difficulty breathing despite efforts to improve ventilation, persistent low oxygen despite supplemental oxygen, and signs of organ failure such as altered consciousness or decreased urine output.
Immediate Steps You Can Take
When you suspect someone is experiencing respiratory distress, your first aid response can provide crucial respiratory support while professional help is on the way.
Stay Calm and Assess the Situation
Approach the person calmly and introduce yourself. Ask simple questions like “Are you having trouble breathing?” to assess their ability to speak and their level of consciousness. This helps you gauge the severity of their respiratory compromise while keeping them calm.
Call Emergency Services Immediately
Don’t hesitate to call 000 if you observe signs that may indicate severe respiratory distress. Emergency operators can guide you through first aid steps while dispatching paramedics. Tell them you have someone experiencing respiratory distress and describe the specific symptoms you’re observing, including breathing rate, skin colour, and the person’s ability to speak.
Positioning and Comfort Measures
Help the person find a comfortable position that makes breathing easier. Most people experiencing respiratory distress prefer to sit upright or lean slightly forward, as this position helps maximise airway function and allows better air movement into the lungs. Never force someone to lie down if they’re having difficulty breathing.
Loosen any tight clothing around their neck, chest, or waist that might restrict breathing. Remove ties, tight collars, or belts that could interfere with their respiratory effort. If they’re wearing restrictive clothing, help them remove or loosen it carefully.
Clear the Airway if Safe
Only attempt to clear visible obstructions from the airway if you can see them clearly and remove them safely. Never blindly sweep someone’s mouth with your fingers, as this can push objects further down and worsen the airway obstruction.
Assist with Medications
If the person has prescribed medications for breathing problems (like asthma inhalers), help them use these if they request assistance. Don’t give medications to someone who hasn’t been prescribed them, as this could cause respiratory distress to worsen.
Provide Reassurance
Keep talking to the person in a calm, reassuring voice. Panic can worsen respiratory symptoms, so your calm presence can help reduce their anxiety and potentially improve their breathing. Let them know that help is coming and that you’re staying with them.
Special Considerations for Children
Respiratory distress in children requires special attention, as infants and children can develop severe respiratory failure more rapidly than adults. Children’s airways are smaller and more easily obstructed, making early recognition of respiratory compromise crucial for their survival.
Unique Signs in Children
Children experiencing respiratory distress often show signs that differ from adults. Look for nasal flaring, where the nostrils widen with each breath, indicating increased respiratory effort. Grunting sounds with breathing often show signs of severe respiratory distress in young children and newborn infants.
Head bobbing is common in infants having trouble breathing, where the head moves forward with each breath as they struggle to get enough oxygen. Children may also show more pronounced chest retraction than adults, with significant pulling in of the skin between ribs, above the collarbone, or below the ribcage.
Behavioural Changes in Children
Children with respiratory symptoms may become unusually irritable, restless, or conversely, abnormally quiet and lethargic. They might refuse to eat, drink, or play, focusing all their energy on breathing. Older children might complain of feeling scared or say they can’t catch their breath.
When Children Need Immediate Help
Call 000 immediately if a child shows any signs of severe respiratory distress, including blue lips or skin, extreme difficulty breathing, or inability to cry or speak. Children can develop acute respiratory failure quickly, and conditions like transient tachypnoea of the newborn or other acute respiratory conditions require immediate medical intervention.
Keeping Everyone Calm
When a child is experiencing respiratory distress, parents and caregivers often panic, which can make the situation worse. Speak calmly to both the child and their parents, explaining what you’re observing and what help is coming. A calm environment helps reduce the child’s anxiety, which may improve their breathing patterns and overall condition.
When to Call for Emergency Help
Knowing when to call 000 can mean the difference between life and death for someone experiencing respiratory distress. Understanding the severity of symptoms helps ensure the person gets appropriate treatment of the underlying cause as quickly as possible.
Call 000 Immediately For:
Call emergency services without delay if someone shows signs of severe acute respiratory distress, including inability to speak in sentences, blue or grey skin colour, extreme rapid breathing, or signs of respiratory arrest. Anyone experiencing symptoms of severe respiratory failure needs immediate transport to an intensive care unit for possible mechanical ventilation and respiratory support.
Other emergency signs include chest pain with difficulty breathing, sudden onset of severe shortness of breath, confusion or altered consciousness due to low oxygen levels, or any signs suggesting acute onset of respiratory compromise.
Signs That Always Require Emergency Response:
- Complete inability to breathe or speak
- Blue lips, face, or fingernails
- Unconsciousness or extreme drowsiness
- Chest pain with breathing difficulties
- Choking with inability to cough or make sounds
- Severe allergic reactions affecting breathing
When in Doubt, Call for Help
If you’re unsure whether someone’s breathing problems are serious enough for emergency services, call anyway. Paramedics can perform chest x-rays, monitor blood oxygen levels, and provide treatments that might prevent someone from developing ARDS or requiring mechanical ventilation. It’s always better to have professionals assess the situation than to risk someone’s life by waiting.
Emergency responders would rather be called for a false alarm than arrive too late to help someone in acute respiratory distress syndrome or severe respiratory failure.
FAQs
How Can I Prevent Respiratory Distress?
While not all causes of respiratory distress can be prevented, you can reduce risk by managing conditions like asthma with proper medication, avoiding known triggers (allergens, pollutants), staying current with vaccinations, and seeking prompt treatment for respiratory infections. Keep small objects away from children to prevent choking.
What's the Difference Between Normal Shortness of Breath and Respiratory Distress?
Normal shortness of breath occurs after activity and resolves with rest, while respiratory distress involves difficulty breathing at rest, blue skin colour, chest retractions, or inability to speak in full sentences. If someone can’t complete a sentence without gasping or shows blue lips/fingernails, call 000 immediately.
Should I Move Someone Who's Having Breathing Problems?
Only move someone experiencing respiratory distress if they’re in immediate danger. Let them choose their preferred position (usually sitting upright or leaning forward). If you must move them, support them gently and maintain their breathing position. Unnecessary movement can worsen their condition.
