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The Respiratory Distress Observation Scale (RDOS) is a validated non-verbal clinical tool used by nurses and healthcare providers to assess and quantify respiratory distress in patients who are UNABLE to self-report dyspnea — including unconscious, endotracheally intubated, cognitively impaired, or obtunded patients. RDOS was developed and validated by Campbell et al. through systematic observation of behavioral and physiological indicators of respiratory distress in critical care and palliative care populations. RDOS provides 0–16 points and correlates with dyspnea intensity in those who can self-report, allowing care providers to infer and respond to respiratory distress when verbal report is impossible.
Heart Rate (beats per minute)
Respiratory Rate (breaths per minute) — visually count for 60 seconds
Restlessness — non-purposeful motor activity or agitation related to breathing
Paradoxical Breathing — thoracic and abdominal movement out of phase with inspiration
Accessory Muscle Use — visible SCM (neck) or scalene contraction with breathing
Nasal Flaring — visible external nare dilation during inspiration
Facial Expression Indicating Distress — furrowed brow, grimacing, fearful expression during breathing
Expiratory Grunting — audible sound at end of expiration (glottic closure against expiratory flow)
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