Medical Patient Assessment for Respiratory Distress (PASTE)
| Parent skills | Medical Patient Assessment |
|---|---|
| Video annotations Click on a timestamp to navigate through the video. | |
| Self-assessment | |
| Use the acronym and practice asking the relevant questions and performing the focused physical exam until comfortable with the work flow | |
| Equipment and materials | |
| More video data | |
Dyspnea, the sensation of breathlessness and the patient’s reaction to it, is often described by patients as difficulty breathing or chest tightness. Anything that can impair oxygenation and/or ventilation can cause dyspnea. Origins can involve many body systems, such as pathology affecting the lungs and airway, cardiovascular/hematologic dysfunction, and infection. Narrowing the differential diagnosis in the prehospital setting is important.
Having a structured and systematic approach to these cases will help you develop and streamline the diagnostic workup and more quickly determine transport priority. Severe dyspnea is a potentially life threatening situation which can deteriorate rapidly. You should not hesitate to start high flow oxygen therapy during your primary assessment.
Signs and Symptoms[edit | edit source]
Once immediate threats to life have been addressed, focus in on the underlying causes and potential treatments for a patient in respiratory distress. Use the PASTE mnemonic during the Signs and Symptoms step of the SAMPLE history to elicit the characteristics of the patient's dyspnea to help with the differential diagnosis.
| Mnemonic component | Questions to Ask | Findings |
|---|---|---|
| Provocation and Progression | "What were you doing when it started? How long has this been going on? How has is changed over time?" | Find out whether any things such as movement or environmental factors are making the situation better or worse. This is especially important for toxic inhalation and allergic reactions. |
| Associated Chest Pain | "Is there any pain when you breathe?" Ask for a description of the nature and quality | Pain with breathing should increase your level of suspicion that the patient may be having a cardiac event or a pulmonary embolism. Add in the OPQRST mnemonic to your history taking. |
| Sputum (color and amount) /Speech | "Is anything coming up when you cough?" Ask for a description | Thick mucus that is yellow or greenish can indicate a respiratory infection, pink/frothy sputum indicates a potential cardiac origin. |
| Talking, Tiredness | Is the patient talking with you? Can they speak in complete sentences? Are they feeling tired? | Note if the patient can only speak in 1-2 word sentences. If the patient is not talking or responding to your voice, perform CPR immediately. |
| Exercise Tolerance | "Could you walk across the room?" | It is important to monitor whether the condition of the patient is worsening with time. |
Focused Physical Exam[edit | edit source]
Obtaining breath sounds is an important step in assessing a patient in respiratory distress. Auscultate the breath sounds over the bare chest with the diphragm of the sthoscop in firm contact with the skin. Check the breath sounds on the right and left sides of the chest and on the patient's back between and below the scapulae. Note assymetry between the two lungs, or any changes in sounds between the apex and the base of the lungs.
| Breath Sounds | Disease | Associated Signs and Symptoms |
|---|---|---|
| Wheezes | Asthma
COPD Congestive Heart Failure Pneumonia Bronchitis Anaphylaxis |
Dyspnea
Productive cough Dependent edema/pink frothy sputum Fever, pleuritic chst pain Clear or white sputum Hives, swelling, stridor |
| Rhonchi | COPD
Pneumonia Bronchitis |
Productive Cough
Fever, pleuritic chest pain Clear or white sputum |
| Crackles | CHF/pulmonary edema
pneumonia |
Dependent edema, pink frothy sputum
Fever, pleuritic chest pain |
| Stridor | Croup
Epiglottitis |
Fever, barking cough
Fever, sore throat, drooling |
| Decreased or absent breath sounds | Asthma
COPD Pneumonia Hemothorax Pneumothorax Atelectasis |
non productive cough, dyspnea
Productive cough Fever, pleuritic chest pain Shock, respiratory distres Dyspnea, pleuritic chest pain Fever, decreased oxygen saturation |
