How to Distinguish Respiratory Distress from Failure

Respiratory emergencies come in many forms. It could be an asthmatic who has suffered since childhood; the COPD patient who still smokes a pack a day; or the near-drowning who was pulled from the deep end of the pool. Whatever the crisis, you, as an emergency responder, are called on to treat it.


Therefore, it would beneficial to you, and especially, your patient if you are able to distinguish respiratory distress from failure because the first condition can be easily remedied (in most situations), while the second can be a precursor to death.

Let's briefly review the signs and symptoms of each.


Respiratory Distress

Many situations can cause respiratory distress. Think about the patients we discussed earlier. For the asthmatic, it could be the early stages of an attack or simply a mild reaction. For the COPD sufferer, a recent illness could be exacerbating the usual distress. And for the near-drowning, perhaps he or she was pulled from the pool before losing consciousness. Each of these situations could cause respiratory distress, in which your patient would typically exhibit the following:


  • Mild anxiety, but LOC should be normal
  • Cyanosis should be minimal but may be present
  • Tachycardia and possible chest tightness
  • Altered breath sounds possible
  • Decreased O2 saturation

In the stable patient, you can alleviate these signs and symptoms with oxygen. Another useful tool is suction, so be sure to bring your portable suction unit on ANY call involving the respiratory system. Should your patient not improve with oxygen, suction, repositioning, or drug therapy, be alert for the onset of respiratory failure.

Respiratory Failure

Respiratory failure can happen quickly, so pay attention to those in distress. It is always easier to treat distress than failure, so quick action on your part can stop its progression. Here are the typical signs of impending failure:


  • Altered mental status
  • Retractions or use of accessory muscles
  • Tachycardia >130 bpm
  • Decreased O2 saturation, even with oxygen therapy
  • Pale skin and diaphoresis
  • Absent breath sounds
  • Cyanosis
  • Inability to speak due to dyspnea
  • Abnormal respiratory patterns


In a respiratory emergency, every second counts. And the quicker you can distinguish between distress and failure, the faster you can apply treatment, stabilize your patient, and correct the underlying problem. Early recognition is key! So give each respiratory emergency the care and attention it deserves.


2011, Pollak, A., Ed.

Critical Care Transport, American College of Emergency Physicians, Jones and Bartlett.