NREMT EMT 2: Primary Assessment - Breathing Adequacy, Rate, Rhythm, Quality, Breath Sounds

Breathing Adequacy: Rate, Rhythm, Quality, and Breath Sounds

Breathing adequacy refers to how well a person is breathing, including how fast, how regularly, and how well they're taking in oxygen. This matters in emergencies because if someone's breathing is inadequate, they might not get enough oxygen to their brain and other vital organs. Think of breathing like a car's engine – if it's not running smoothly, the car won't go far.

Key Steps / Core Facts

• Respiratory Rate: The number of breaths per minute (bpm). Normal rate is 12-20 bpm. (Use the AVPU mnemonic: Alert, Verbal, Pain, Unresponsive)
  • Example: A normal adult's respiratory rate is 16 bpm.
• Breathing Rhythm: The pattern of breaths. Normal rhythm is regular and even.
  • Example: A person with a normal breathing rhythm takes in and out breaths at the same pace.
• Breath Sounds: The sounds made while breathing. Normal sounds are soft and even.
  • Example: A person with normal breath sounds makes a soft "whooshing" sound while inhaling and exhaling.
• Breathing Quality: How well a person is taking in oxygen. Normal quality is smooth and effortless.
  • Example: A person with normal breathing quality can speak and move without getting winded.
• Apnea: The absence of breathing. (Use the OPQRSTI mnemonic: Onset, Pattern, Quality, Region, Severity, Time, Involvement)
  • Example: A person in cardiac arrest has no breathing (apnea).
• Agonal Breathing: Irregular, gasping breaths. ( Agonal breathing is NOT normal breathing – start CPR)
  • Example: A person in cardiac arrest might make agonal breathing sounds.
• Bradypnea: Slow breathing rate (less than 12 bpm). (Use the SAMPLE mnemonic: Size, Age, Mechanism, Allergies, Past medical history, Last oral intake)
  • Example: A person with a slow breathing rate might be in shock.
• Tachypnea: Fast breathing rate (more than 20 bpm). (Use the OPQRSTI mnemonic)
  • Example: A person with a fast breathing rate might be anxious or have a fever.
• Dyspnea: Difficulty breathing. (Use the OPQRSTI mnemonic)
  • Example: A person with difficulty breathing might be short of breath or wheezing.
• Wheezing: High-pitched sounds while breathing out. (Use the OPQRSTI mnemonic)
  • Example: A person with asthma might wheeze while breathing out.
• Stridor: High-pitched sounds while breathing in. (Use the OPQRSTI mnemonic)
  • Example: A person with a blocked airway might make stridor sounds.

What Laypeople Can Do

• If someone is having trouble breathing, try to keep them calm and comfortable.
• If someone is not breathing, start CPR (30 chest compressions, 2 breaths).
• If someone is wheezing or making stridor sounds, try to keep them upright and call for help.

Common Mistakes

• Mistake: Thinking a person is breathing normally when they're actually in distress.
  • Fix: Check the person's breathing rate, rhythm, and quality to see if they're in trouble.
• Mistake: Not recognizing the signs of respiratory distress (e.g., wheezing, stridor).
  • Fix: Pay attention to the person's breathing sounds and look for red flags (e.g., blue lips, rapid breathing).
• Mistake: Not calling for help when someone is having trouble breathing.
  • Fix: Call 911 or your local emergency number if someone is having trouble breathing.

Quick Practice Scenarios

1. A person is lying on the ground, gasping for air. What should you do first?
   • Answer: Call 911 and start CPR.
   • Reason: The person is in cardiac arrest and needs immediate help.
2. A person is wheezing and having trouble breathing. What should you do first?
   • Answer: Try to keep them upright and call for help.
   • Reason: Keeping them upright can help them breathe better, and calling for help will get them medical attention.
3. A person is breathing very slowly (8 bpm). What should you do first?
   • Answer: Check their pulse and breathing rate, and call for help if necessary.
   • Reason: A slow breathing rate can be a sign of shock or other serious medical conditions.

Last-Minute Exam Cram

• Normal respiratory rate: 12-20 bpm.
• Normal breathing rhythm: regular and even.
• Normal breath sounds: soft and even.
• Agonal breathing: irregular, gasping breaths ().
• Bradypnea: slow breathing rate (less than 12 bpm).
• Tachypnea: fast breathing rate (more than 20 bpm).
• Dyspnea: difficulty breathing.
• Wheezing: high-pitched sounds while breathing out.
• Stridor: high-pitched sounds while breathing in.
• CPR ratio: 30 chest compressions, 2 breaths.
• AVPU mnemonic: Alert, Verbal, Pain, Unresponsive.
• OPQRSTI mnemonic: Onset, Pattern, Quality, Region, Severity, Time, Involvement.
• SAMPLE mnemonic: Size, Age, Mechanism, Allergies, Past medical history, Last oral intake.