In this micro-lecture, we’re going to talk about how to assess a patient’s respiratory system using a breathing assessment
In today’s micro-lecture, we’re going to talk about how to assess the respiratory system.
Now, when you’re a paramedic, you have to be able to conduct a primary survey, and you have to be able to do it really efficiently, too. Because that will not only determine how quickly you need to treat the patient, but it will also determine the type of treatments you need to give, and how quickly you need to deliver those, as well as to helping you to monitor that patient’s condition. So, the primary survey consists of danger response, airway breathing and circulation, disability and exposure.
When you first greet the patient, you’re looking at the patient using the patient assessment triangle, you’ll determine is the airway is clear. The next thing you’ll do is have a look at their breathing status to determine if their breathing is okay or not. So, when we’re looking at the respiratory system for the primary survey, we’re looking to see what the general rate of breathing is.
When you look at your colleague or your friend or your family or your partner, and you look at their chest movements, you’ll notice that normal, quiet breathing is very difficult to establish because it’s normal, it’s not over excessively inflated, they’re generally not panting, they’re not taking deep sighs. This is what we expect to find in a patient who is not unwell.
Of course, in an adult, the respiratory rate is between 12 and 20 breaths per minute. So, when you are doing your primary survey assessment, you’re looking for any abnormal breathing problems that need addressing and dealing with right away, straightaway.
Now, however, let’s say you’ve moved on to a secondary survey and now, you’re doing a more thorough respiratory system assessment, you’re looking in more detail at the depth of breathing, in other words, the rise and fall of the chest. Is it sufficient to maintain life, or is it too shallow, or is it too deep? You’re looking at the rate. Does it fall below 12, or above 20?
Now, these things in isolation don’t generally mean a lot, but when you put them together, they’re a very powerful tool to determine how sick your patient is. For example, if you have a patient whose respiratory rate is 12 breaths per minute, then you can determine that it’s on the lower side.
But, if they’re ventilating okay, if they’ve got good rise and fall of the chest, and they’ve got good color on their face, then it’s okay. You don’t need to take a massive amount of interventions, but rather, you need to just monitor it. So, that’s the rate, that’s the depth.
It’s also the regularity. Do both sides go up and down at the same time, or does one side go up, and the other doesn’t? Now, that might be indicative of trauma, or a tension pneumothorax, or a whole range of other types of things.
So, when you’re assessing the breathing, you’re looking at it in the primary survey, you’re looking in the secondary survey. You are also connecting all the things we’ve just talked about, rate, depth, adequacy, and you’re looking at your patient to see if your patient is pale and sweaty and clammy. Because if your patient is, then there’s a problem with the breathing rate.
You can also add on a sat probe as well, oxygen saturation probe. Because if the rate and depth and other characteristics of breathing are not okay, and the sats are low as well, that gives you a bigger picture of how seriously ill the patient is.
Then, finally, you’re just considering the added sounds, the added breath sounds. In other words, anything that you can hear that’s not air. I hope you’ve enjoyed this micro-lecture. My name is Sam Willis (from Australian Paramedical College), and I look forward to talking to you again soon.
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