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Students performing chest compressions during a CPR class with manikins

The PASTE mnemonic can serve as an important and useful reminder in an emergency. One of the most well-known mnemonic acronyms for doing a basic medical assessment during an emergency is SAMPLE.

This is often used by first responders on the scene to assess the state of casualties through a series of questions covering Signs & Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events leading up to present injury (SAMPLE).

An alternative to the famous SAMPLE that is geared more specifically toward patients undergoing respiratory distress is known as PASTE. PASTE is an alternate assessment tool for evaluating patients who are having difficulty breathing. It can be used once immediate threats to life had been addressed and will help with diagnosis.

What does P stand for in the PASTE mnemonic?

P: Provocation and Progression

Discover whether there is any external factor that is making their respiratory situation better or worse, such as their posture, whether they’re breathing through their nose or their mouth, etc. You also want to know whether the problem started suddenly or worsened over time. This is particularly vital for people who may have inhaled something toxic or are having an allergic reaction.

Example Question: “What were you doing when you began having difficulty breathing?”

What does A stand for in the PASTE mnemonic?

A: Associated Chest Pain

These questions should get the patient to reveal any pain they feel in or around their chest. Pain associated with breathing means there’s a higher chance of the patient having a cardiac event or pulmonary embolism.

Example Question: “Do you feel any pain as you breathe?”

What does S stand for in the PASTE mnemonic?

S: Sputum Production (color)

The responder should identify whether the distressed person is coughing up any sputum and, if so, take note of its color and consistency. Thick green or yellow mucus-like sputum could indicate that there is an infection, blood can point to internal bleeding, pink or frothy sputum might mean the problem is of cardiac origin. Note that a pulmonary embolus may not result in any sputum at all.

Example Question: “Is anything coming up when you cough?”

What does T stand for in the PASTE mnemonic?

T: Talking (and) Tiredness

Is the patient still verbally responsive and coherent? Is simply speaking difficult or causing undue respiratory distress? Do they seem confused or tired? If they’re not responding properly to the person providing aid, it could indicate a number of problems ranging from a relatively minor concussion to hypoxia or a more serious head injury. CPR should be performed immediately on a patient who does not talk or show any response to being spoken to.

Example Question: Any. You can also try asking the patient to repeat a sentence you give them and see how many words they are able to repeat without needing to inhale.

What does E stand for in the PASTE mnemonic?

E: Exacerbation/Exercise Tolerance

Check whether the patient’s condition is stable or worsening (exacerbating). This is also called “exercise tolerance” because whether their condition is worsening can be checked by getting the patient to do some kind of simple exercise like walking across the room. Exercise tolerance decreases as breathing problems and hypoxia increases.

Example Question: “Are you able to walk to the other side of the room and back?”

Why is PASTE Used?

medics practicing with the PASTE mnemonic

Performing these deeper PASTE assessments while taking SAMPLE histories can be life-saving on people experiencing a respiratory emergency. These kinds of mnemonics are taught in first-aid training courses so that students can go on to more effectively assess the conditions of their future patients.

Extra Tips

Congestive heart failures by themselves are not considered respiratory diseases or respiratory emergencies but rather chronic cardiac conditions. However, acute exacerbations of congestive heart failures can lead to a rapid increase in pulmonary edema, creating a V/Q mismatch and stopping the offload and load of CO2 and O2 respectively. This is the cause of hypoxia and respiratory distress found in CHF patients.