Medical Patient Assessment for Respiratory Distress (PASTE)

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About this medical skill
Parent skills Medical Patient Assessment
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Use the acronym and practice asking the relevant questions and performing the focused physical exam until comfortable with the work flow
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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.

PASTE Mnemonic for Respiratory Distress
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


Congestive Heart Failure





Productive cough

Dependent edema/pink frothy sputum

Fever, pleuritic chst pain

Clear or white sputum

Hives, swelling, stridor

Rhonchi COPD



Productive Cough

Fever, pleuritic chest pain

Clear or white sputum

Crackles CHF/pulmonary edema


Dependent edema, pink frothy sputum

Fever, pleuritic chest pain

Stridor Croup


Fever, barking cough

Fever, sore throat, drooling

Decreased or absent breath sounds Asthma






non productive cough, dyspnea

Productive cough

Fever, pleuritic chest pain

Shock, respiratory distres

Dyspnea, pleuritic chest pain

Fever, decreased oxygen saturation