Downes Score | Pediatrics

Summary

The transcript provides a detailed analysis of a scoring system used to assess a patient's respiratory distress. The system evaluates several factors including respiratory rate, signs of cyanosis, air entry, retractions, and audible grunting sounds. Based on these factors, the patient is assigned scores that reflect the severity of their respiratory condition. The assessment indicates that the patient is experiencing severe respiratory stress, with a high total score indicating urgent medical attention is required.

Takeaways

• 😀 Respiratory rate (RR) scoring is critical for assessing a patient's condition. Normal RR ranges from 40 to 60 breaths per minute.
• 😀 A score of '0' is given if the patient's respiratory rate is between 40 to 60, indicating normal respiration.
• 😀 Scores increase with higher respiratory rates; for rates between 60 to 80, a score of '1' is assigned, indicating mild distress.
• 😀 Severe respiratory distress is marked by a score of '2' if the rate exceeds 80 breaths per minute.
• 😀 Central cyanosis (bluish discoloration of skin) leads to a score of '2' even if the patient is on more than 40% oxygen.
• 😀 Absence of central cyanosis results in a score of '0', indicating no oxygen deficit.
• 😀 The degree of retraction is also scored: mild retraction gets a '1', while marked retraction gets a '2'.
• 😀 Audibility of grunting sounds plays a role in scoring; audible grunting results in a higher score, typically a '2'.
• 😀 A patient with paradoxical breathing or visible retraction receives a higher score, indicating severe respiratory stress.
• 😀 The final score is calculated by combining these factors, providing a comprehensive assessment of the patient's respiratory distress severity.

Q & A

What is the scoring range for respiratory rate (RR) based on the patient's score?

The scoring for respiratory rate (RR) is as follows: 0 points for a rate between 40-60 breaths per minute, 1 point for a rate between 60-80, and 2 points for a rate above 80 breaths per minute.

How is central cyanosis scored for a patient?

If a patient does not have cyanosis, the score is 0. For a patient with central cyanosis, even when on room air, the score is 2. If oxygen above 40% has been given but central cyanosis persists, the score remains 2.

What does the scoring for airway entry indicate?

The scoring for airway entry is as follows: a score of 0 indicates normal entry, a score of 1 indicates mild decrease in airway entry, and a score of 2 indicates marked decrease.

What does the term 'retraction' refer to in the scoring system?

Retraction refers to the inward movement of the chest wall during breathing. If no retraction is observed, the score is 0. Mild retraction is scored 1, while marked retraction is scored 2.

How is respiratory distress related to the audible grunting sound?

The audible grunting sound indicates severe respiratory distress. If the grunting sound is heard, it suggests a high level of respiratory stress and affects the overall scoring of the patient.

How is the total score calculated for a patient in this system?

The total score is calculated by summing the individual scores for respiratory rate, central cyanosis, airway entry, retraction, and other relevant signs. A higher score indicates more severe respiratory distress.

What does paradoxical breathing indicate in terms of scoring?

Paradoxical breathing, where the chest moves inward during inhalation and outward during exhalation, is indicative of severe respiratory distress and contributes to a higher score.

What is the significance of a respiratory rate between 60-80 breaths per minute?

A respiratory rate between 60-80 breaths per minute is considered elevated, and it results in a score of 1. This rate indicates moderate respiratory distress.

How does the presence of marked retraction affect the overall score?

Marked retraction, where the chest wall visibly sinks in with each breath, is a sign of severe respiratory distress and is assigned a score of 2, contributing to a higher total score.

What does a score of 6 indicate regarding the patient's respiratory status?

A score of 6 indicates severe respiratory stress, with multiple signs of respiratory distress including significant retraction, grunting sounds, paradoxical breathing, and elevated respiratory rate.