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Breathing
The purpose of the breathing assessment is to ensure not only that the casualty is breathing, but that they are breathing effectively. Even with a maintained airway, ineffective breathing will quickly lead to hypoxia and may lead to cardiac arrest.
Check for Breathing
Check for breathing by placing your ear near to the casualty’s nose and mouth and placing your hand on the stomach of the casualty. Listen, Watch, and Feel for breathing. Check for 10 seconds to establish if the casualty is breathing.
If the casualty is not breathing, start CPR. Do not stop CPR until Emergency Services arrive or you become exhausted. If you have an assistant, tell them to get an AED if there is one available in your area. If you have an assistant available, prepare to take turns giving CPR. Beware of the potential for agonal gasps and seizure-like movements with cardiac arrests.
Assess Breathing
If the casualty is breathing, expose the chest and check for 30 seconds to determine their respiratory rate. A normal rate is 12-20 breaths per minute. Listen for abnormal breathing sounds such as gurgling, wheezing, and stridor. Look at the casualty for obvious respiratory distress, the use of accessory muscles, or cyanosis.
If the respiratory rate is below 10 or above 30, consider supporting breathing with a bag-valve-mask (BVM).
Perform a thorough assessment of the chest for life-threatening injury. Start at the larynx and check down to the bottom of the rig cage for abnormalities. Look for equal rise and fall of the chest on both sides. Look at the chest wall (front, back, sides, and armpits) for uneven shape, bruising, lacerations, holes, or flail segment. Feel the chest for tenderness, crepitus, or deformity.
Check the casualties SpO2. In the event of major trauma or an SpO2 below 94% consider applying high flow-rate oxygen.
Consider all possible causes at the scene for difficulty breathing, such as traumatic injuries, medical conditions, or issues such as smoke inhalation.
Traumatic Injuries: If indicated by the mechanism of injury consider life-threatening chest injuries such as pneumothorax, haemothorax, open chest wounds, or flail chest. Read more about traumatic chest injuries.
Medical Conditions: Consider potential medical causes of respiratory distress, such as asthma, COPD exacerbation, or anaphylaxis.
If an injury of condition is encountered, treat appropriately and restart the primary survey.
Monitor Vital Signs
Record the casualty’s respiratory rate and their SpO2. This will act as a baseline and allow for improvement or deterioration to be determined later. Reassess these vital signs frequently.
Once respiration and all life threatening chest-injuries have been managed, move on to assess circulation.