Respiratory distress shouldn't be downplayed or ignored in the hospital

Our son is learning to play the saxophone. In his first lesson, his instructor emphasized the importance of moving air to play the saxophone using the diaphragm.

The diaphragm is a large dome-shaped muscle that separates the abdomen from the chest. It’s the major muscle not only for playing the saxophone, but also for respiration. The diaphragm works by contracting and flattening to allow the lungs and chest cavity to expand.

The diaphragm plays such a significant role in respiration that physicians, physician assistants (PAs) nurse practitioners (NPs), and registered nurses should observe and take note when a patient is relying on other muscles to breathe. Those other muscles are called accessory muscles and include muscles of the chest, neck, and shoulders. Accessory muscles are called into action when a patient is having labored breathing or respiratory distress.

Respiratory distress

Although there are more formal definitions, respiratory distress is the situation where a patient is having trouble breathing. Some of the signs and symptoms that doctors and healthcare providers look for to identify respiratory distress include:

• Use of accessory muscles for breathing, rather than relying only on the diaphragm.

• A rapid respiratory rate. A normal respiratory rate for an adult is 12–20 breaths per minute. When a patient is breathing at a faster rate than that, it’s a sign of overcompensation because of breathing difficulty.

• Nasal flaring, which is an involuntary response to open that is required to get more air.

• Cyanosis, or a bluish color, to the skin, lips, or fingernails.

• Retractions. This is when a patient is gasping, causing the area between the neck and ribs to sink in.

• Fatigue or weakness.

• Low blood pressure.


Doctors and healthcare teams must address the immediate need of providing any necessary support through supplemental oxygen, often delivered by a facemask or nasal cannula. Next, physician attention should divert to what’s causing respiratory distress.

The differential diagnosis for respiratory distress is extensive. Infection and sepsis (a systemic inflammatory response) could be at play. Pleural effusions (excess fluid around the lungs) can mechanical restricting the ability of the lungs to fully inflate. The list goes on and on.

What’s clear, though, is the standard of care requires doctors and the medical team to perform a thorough physical exam and order appropriate laboratory, diagnostic imaging, and other studies, as needed, to work through the potential causes of respiratory distress on the differential diagnosis.

While the medical work is underway, the standard of care requires the nursing staff to keep patients with respiratory distress under close observation.

Here at Painter Law Firm, we’ve handled numerous cases where patients did the right thing by seeking medical treatment at a hospital after having difficulty breathing. Even after being diagnosed with respiratory distress, these people weren’t appropriately worked up by the physician team or adequately monitored by the nursing staff.

In these tragic cases, some patients have sustained permanent brain injuries. Others have died. In both situations it was because their respiratory distress was allowed to progress into respiratory arrest.

If you’ve been seriously injured because of poor hospital, medical, or nursing care in Texas, then contact a top-rated, experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.